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Nurses who experienced severe physical abuse or forced sexual activity in childhood and adolescence had a higher crude premature mortality rate than nurses without such abuse in childhood or adolescence (3.15\n                      <jats:italic>v<\/jats:italic>\n                      1.83 and 4.00\n                      <jats:italic>v<\/jats:italic>\n                      1.90 per 1000 person years, respectively). The corresponding age adjusted hazard ratios for premature deaths were 1.65 (95% confidence interval 1.45 to 1.87) and 2.04 (1.71 to 2.44), respectively, which were materially unchanged after further adjusting for personal characteristics and early life socioeconomic status (1.53, 1.35 to 1.74, and 1.80, 1.50 to 2.15, respectively). Cause specific analyses indicated that severe physical abuse was associated with a greater risk of mortality due to external causes of injury and poisoning (multivariable adjusted hazard ratio 2.81, 95% confidence interval 1.62 to 4.89), suicide (3.05, 1.41 to 6.60), and diseases of the digestive system (2.40, 1.01 to 5.68). Forced sexual activity as a child and adolescent was associated with greater risk of mortality due to cardiovascular disease (2.48, 1.37 to 4.46), external injury or poisoning (3.25, 1.53 to 6.91), suicide (4.30, 1.74 to 10.61), respiratory disease (3.74, 1.40 to 9.99), and diseases of the digestive system (4.83, 1.77 to 13.21). The association of sexual abuse with premature mortality was stronger among women who smoked or had higher levels of anxiety during adulthood. Smoking, low physical activity, anxiety, and depression each explained 3.9-22.4% of the association between early life abuse and premature mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Early life physical and sexual abuse could be associated with a greater risk of adult premature mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj-2022-073613","type":"journal-article","created":{"date-parts":[[2023,5,3]],"date-time":"2023-05-03T20:05:13Z","timestamp":1683144313000},"page":"e073613","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":33,"title":["Association of early life physical and sexual abuse with premature mortality among female nurses: prospective cohort study"],"prefix":"10.1136","volume":"381","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4324-2408","authenticated-orcid":false,"given":"Yi-Xin","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA"},{"name":"Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey A","family":"Missmer","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA"},{"name":"Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn M","family":"Rexrode","sequence":"additional","affiliation":[{"name":"Division of Women\u2019s Health, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea L","family":"Roberts","sequence":"additional","affiliation":[{"name":"Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge E","family":"Chavarro","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA"},{"name":"Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA"},{"name":"Channing Division of Network Medicine, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet W","family":"Rich-Edwards","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA"},{"name":"Division of Women\u2019s Health, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,5,3]]},"reference":[{"key":"2025110102141466000_381.may03_11.e073613.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30187-3"},{"key":"2025110102141466000_381.may03_11.e073613.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61591-9"},{"key":"2025110102141466000_381.may03_11.e073613.3","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1518393112"},{"key":"2025110102141466000_381.may03_11.e073613.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)61706-7"},{"key":"2025110102141466000_381.may03_11.e073613.5","unstructured":"Organization WH . 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