{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T21:01:51Z","timestamp":1790715711205,"version":"4.1.0"},"reference-count":40,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsmedizin Greifswald","id":[{"id":"https:\/\/ror.org\/025vngs54","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Childhood maltreatment (CM) is associated with adult cardiovascular disease (CVD) risk. Systolic (SBP) and diastolic (DBP) blood pressure (BP), key markers of CVD risk, exhibit age- and sex-dependent variability, which was insufficiently accounted for in previous studies on the CM-BP relationship. This study therefore aimed to assess age- and sex-specific associations between CM and adult BP-based outcomes and hypertension using cross-sectional data from the population based German National Cohort (NAKO).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Complete data were available for 150,983 participants (49.3% female), who took part in the baseline assessment between 2014 and 2019. CM was assessed via the Childhood Trauma Screener (CTS). Resting BP was assessed using a standardized procedure. Hypertension was defined as either SBP\u2009\u2265\u2009140 mmHg or DBP\u2009\u2265\u200990 mmHg or intake of antihypertensive medication. Age- and sex-stratified multivariable regression models estimated age- and sex-specific associations between CM and BP-based markers and sex-stratified logistic regression models were calculated for hypertension as the outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A pattern of inverse associations between CTS sum score (CTS\n                      <jats:sub>SUM<\/jats:sub>\n                      ) and BP markers emerged. Compared to their non-exposed counterparts, females (OR\u2009=\u20090.87, 95%-CI: 0.80; 0.94) but not males (OR\u2009=\u20091.01, 95%-CI: 0.91; 1.13) with high cumulative CM exposure (i.e., \u2265\u20093 CM categories) had lower odds of hypertension. Age-dependent inverse associations between CTS\n                      <jats:sub>SUM<\/jats:sub>\n                      and BP markers revealed sex-specific patterns. The age- and sex-dependent inverse associations of CM with BP markers were more consistent for the abuse vs. neglect subscales.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The association between CM and BP revealed age- and sex-dependent patterns, highlighting the complexity of physical consequences in adulthood associated with CM.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12889-026-29019-z","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:13:07Z","timestamp":1788930787000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Childhood maltreatment and adult blood pressure-based outcomes: age- and sex-specific associations in the German National Cohort (NAKO)"],"prefix":"10.1186","volume":"26","author":[{"given":"Tara Alissa","family":"Thielcke","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Klinger-K\u00f6nig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvia","family":"Stracke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Berger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie","family":"Castell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin Halina","family":"Greiser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volker","family":"Harth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margit","family":"Heier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9","family":"Karch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Keil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilian","family":"Krist","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Leitzmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seraina","family":"Lerch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcello Ricardo Paulista","family":"Markus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Meinke-Franze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Mikolajczyk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilais Moreno","family":"Vel\u00e1squez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Obi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Pischon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten Oliver","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabine","family":"Schipf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrike","family":"Siewert-Markus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"V\u00f6lzke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margarethe","family":"Woeckel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans J.","family":"Grabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Till","family":"Ittermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0041-6538","authenticated-orcid":false,"given":"Philipp","family":"T\u00f6pfer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"issue":"10","key":"29019_CR1","doi-asserted-by":"publisher","first-page":"e517","DOI":"10.1016\/S2468-2667(19)30145-8","volume":"4","author":"MA Bellis","year":"2019","unstructured":"Bellis MA, Hughes K, Ford K, Rodriguez GR, Sethi D, Passmore J. Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: a systematic review and meta-analysis. Lancet Public Health. 2019;4(10):e517\u201328.","journal-title":"Lancet Public Health"},{"issue":"9657","key":"29019_CR2","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1016\/S0140-6736(08)61706-7","volume":"373","author":"R Gilbert","year":"2009","unstructured":"Gilbert R, Widom CS, Browne K, Fergusson D, Webb E, Janson S. Burden and consequences of child maltreatment in high-income countries. lancet. 2009;373(9657):68\u201381.","journal-title":"lancet"},{"issue":"8","key":"29019_CR3","doi-asserted-by":"publisher","first-page":"e356","DOI":"10.1016\/S2468-2667(17)30118-4","volume":"2","author":"K Hughes","year":"2017","unstructured":"Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, Mikton C, et al. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health. 2017;2(8):e356\u201366.","journal-title":"Lancet Public Health"},{"issue":"12","key":"29019_CR4","doi-asserted-by":"publisher","first-page":"1269","DOI":"10.1001\/jamapediatrics.2021.2320","volume":"175","author":"LR Grummitt","year":"2021","unstructured":"Grummitt LR, Kreski NT, Kim SG, Platt J, Keyes KM, McLaughlin KA. Association of Childhood Adversity With Morbidity and Mortality in US Adults: A Systematic Review. JAMA Pediatr. 2021;175(12):1269\u201378.","journal-title":"JAMA Pediatr"},{"issue":"13","key":"29019_CR5","doi-asserted-by":"publisher","first-page":"1761","DOI":"10.1161\/01.CIR.0000143074.54995.7F","volume":"110","author":"M Dong","year":"2004","unstructured":"Dong M, Giles WH, Felitti VJ, Dube SR, Williams JE, Chapman DP, et al. Insights Into Causal Pathways for Ischemic Heart Disease. Circulation. 2004;110(13):1761\u20136.","journal-title":"Circulation"},{"issue":"4","key":"29019_CR6","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1136\/hrt.2009.188250","volume":"96","author":"J Korkeila","year":"2010","unstructured":"Korkeila J, Vahtera J, Korkeila K, Kivim\u00e4ki M, Sumanen M, Koskenvuo K, et al. Childhood adversities as predictors of incident coronary heart disease and cerebrovascular disease. Heart. 2010;96(4):298\u2013303.","journal-title":"Heart"},{"key":"29019_CR7","doi-asserted-by":"crossref","unstructured":"de Rooij SR, Ginty AT, Ehrlich KB, John-Henderson NA. Biobehavioral and social pathways linking childhood adversity and health across the lifespan. Front Psychol. 2022;13:992562.","DOI":"10.3389\/fpsyg.2022.992562"},{"issue":"5","key":"29019_CR8","doi-asserted-by":"publisher","first-page":"642","DOI":"10.1038\/mp.2015.67","volume":"21","author":"D Baumeister","year":"2016","unstructured":"Baumeister D, Akhtar R, Ciufolini S, Pariante CM, Mondelli V. Childhood trauma and adulthood inflammation: a meta-analysis of peripheral C-reactive protein, interleukin-6 and tumour necrosis factor-\u03b1. Mol Psychiatry. 2016;21(5):642\u20139.","journal-title":"Mol Psychiatry"},{"issue":"4","key":"29019_CR9","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1016\/S0749-3797(98)00017-8","volume":"14","author":"VJ Felitti","year":"1998","unstructured":"Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998;14(4):245\u201358.","journal-title":"Am J Prev Med"},{"issue":"1","key":"29019_CR10","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1111\/jmwh.13213","volume":"66","author":"J Scott","year":"2021","unstructured":"Scott J, McMillian-Bohler J, Johnson R, Simmons LA. Adverse Childhood Experiences and Blood Pressure in Women in the United States: A Systematic Review. J Midwifery Womens Health. 2021;66(1):78\u201387.","journal-title":"J Midwifery Womens Health"},{"key":"29019_CR11","doi-asserted-by":"publisher","first-page":"107840","DOI":"10.1016\/j.chiabu.2025.107840","volume":"172","author":"L Niu","year":"2026","unstructured":"Niu L, Liu S, Chen R, Wang Y, Zhang J, Lin S, et al. Association of childhood maltreatment with hypertension outcomes in adulthood: A systematic review and meta-analysis. Child Abuse Negl. 2026;172:107840.","journal-title":"Child Abuse Negl"},{"issue":"3","key":"29019_CR12","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/j.annepidem.2013.12.004","volume":"24","author":"JL Ford","year":"2014","unstructured":"Ford JL, Browning CR. Effects of exposure to violence with a weapon during adolescence on adult hypertension. Ann Epidemiol. 2014;24(3):193\u20138.","journal-title":"Ann Epidemiol"},{"issue":"19","key":"29019_CR13","doi-asserted-by":"publisher","first-page":"1674","DOI":"10.1161\/CIRCULATIONAHA.114.013104","volume":"131","author":"S Su","year":"2015","unstructured":"Su S, Wang X, Pollock JS, Treiber FA, Xu X, Snieder H, et al. Adverse Childhood Experiences and Blood Pressure Trajectories From Childhood to Young Adulthood. Circulation. 2015;131(19):1674\u201381.","journal-title":"Circulation"},{"issue":"7","key":"29019_CR14","doi-asserted-by":"publisher","first-page":"1373","DOI":"10.1017\/S0033291723003264","volume":"54","author":"C Souama","year":"2024","unstructured":"Souama C, Milaneschi Y, Lamers F, Vinkers CH, Giltay EJ, Liemburg EJ, et al. Metabolic syndrome after childhood trauma: a 9-year longitudinal analysis. Psychol Med. 2024;54(7):1373\u201381.","journal-title":"Psychol Med"},{"issue":"12","key":"29019_CR15","doi-asserted-by":"publisher","first-page":"e0225544","DOI":"10.1371\/journal.pone.0225544","volume":"14","author":"HMC Schreier","year":"2019","unstructured":"Schreier HMC, Jones EJ, Nayman S, Smyth JM. Associations between adverse childhood family environments and blood pressure differ between men and women. PLoS ONE. 2019;14(12):e0225544.","journal-title":"PLoS ONE"},{"issue":"8","key":"29019_CR16","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1080\/15622975.2021.2018724","volume":"23","author":"J Terock","year":"2022","unstructured":"Terock J, Hannemann A, Klinger-K\u00f6nig J, Janowitz D, Grabe HJ, Murck H. The neurobiology of childhood trauma-aldosterone and blood pressure changes in a community sample. World J Biol Psychiatry. 2022;23(8):622\u201330.","journal-title":"World J Biol Psychiatry"},{"issue":"2","key":"29019_CR17","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1080\/10615806.2016.1238076","volume":"30","author":"K Winzeler","year":"2017","unstructured":"Winzeler K, Voellmin A, Hug E, Kirmse U, Helmig S, Princip M, Anxiety, et al. Stress Coping. 2017;30(2):145\u201354.","journal-title":"Stress Coping"},{"issue":"3","key":"29019_CR18","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1001\/jamacardio.2019.5306","volume":"5","author":"H Ji","year":"2020","unstructured":"Ji H, Kim A, Ebinger JE, Niiranen TJ, Claggett BL, Bairey Merz CN, et al. Sex Differences in Blood Pressure Trajectories Over the Life Course. JAMA Cardiol. 2020;5(3):19\u201326.","journal-title":"JAMA Cardiol"},{"issue":"10","key":"29019_CR19","doi-asserted-by":"publisher","first-page":"1107","DOI":"10.1007\/s10654-022-00890-5","volume":"37","author":"A Peters","year":"2022","unstructured":"Peters A, Peters A, Greiser KH, G\u00f6ttlicher S, Ahrens W, Albrecht M, et al. Framework and baseline examination of the German National Cohort (NAKO). Eur J Epidemiol. 2022;37(10):1107\u201324.","journal-title":"Eur J Epidemiol"},{"issue":"3","key":"29019_CR20","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1055\/s-0031-1298984","volume":"39","author":"HJ Grabe","year":"2012","unstructured":"Grabe HJ, Schulz A, Schmidt CO, Appel K, Driessen M, Wingenfeld K, et al. [A brief instrument for the assessment of childhood abuse and neglect: the childhood trauma screener (CTS)]. Psychiatr Prax. 2012;39(3):109\u201315.","journal-title":"Psychiatr Prax"},{"issue":"4","key":"29019_CR21","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1055\/s-0033-1343116","volume":"40","author":"H Glaesmer","year":"2013","unstructured":"Glaesmer H, Schulz A, H\u00e4user W, Freyberger HJ, Br\u00e4hler E, Grabe HJ. [The childhood trauma screener (CTS) - development and validation of cut-off-scores for classificatory diagnostics]. Psychiatr Prax. 2013;40(4):220\u20136.","journal-title":"Psychiatr Prax"},{"issue":"4","key":"29019_CR22","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1007\/s00103-020-03109-8","volume":"63","author":"T Schikowski","year":"2020","unstructured":"Schikowski T, Wigmann C, Fuks KB, Schipf S, Heier M, Neuhauser H, et al. Blutdruckmessung in der NAKO \u2013 methodische Unterschiede, Blutdruckverteilung und Bekanntheit der Hypertonie im Vergleich zu anderen bev\u00f6lkerungsbezogenen Studien in Deutschland. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 2020;63(4):452\u201364.","journal-title":"Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz"},{"issue":"38","key":"29019_CR23","doi-asserted-by":"publisher","first-page":"3912","DOI":"10.1093\/eurheartj\/ehae178","volume":"45","author":"JW McEvoy","year":"2024","unstructured":"McEvoy JW, McCarthy CP, Bruno RM, Brouwers S, Canavan MD, Ceconi C, et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension: Developed by the task force on the management of elevated blood pressure and hypertension of the European Society of Cardiology (ESC) and endorsed by the European Society of Endocrinology (ESE) and the European Stroke Organisation (ESO). Eur Heart J. 2024;45(38):3912\u20134018.","journal-title":"Eur Heart J"},{"issue":"1","key":"29019_CR24","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1111\/j.1365-2702.2005.01494.x","volume":"16","author":"I E\u015fer","year":"2007","unstructured":"E\u015fer I, Khorshid L, G\u00fcne\u015f UY, Demir Y. The effect of different body positions on blood pressure. J Clin Nurs. 2007;16(1):137\u201340.","journal-title":"J Clin Nurs"},{"issue":"3","key":"29019_CR25","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1001\/jamacardio.2024.5213","volume":"10","author":"DM Giao","year":"2025","unstructured":"Giao DM, Col H, Larbi Kwapong F, Turkson-Ocran RA, Ngo LH, Cluett JL, et al. Supine Blood Pressure and Risk of Cardiovascular Disease and Mortality. JAMA Cardiol. 2025;10(3):265\u201375.","journal-title":"JAMA Cardiol"},{"key":"29019_CR26","doi-asserted-by":"publisher","first-page":"104530","DOI":"10.1016\/j.neubiorev.2022.104530","volume":"134","author":"RC Brindle","year":"2022","unstructured":"Brindle RC, Pearson A, Ginty AT. Adverse childhood experiences (ACEs) relate to blunted cardiovascular and cortisol reactivity to acute laboratory stress: A systematic review and meta-analysis. Neurosci Biobehavioral Reviews. 2022;134:104530.","journal-title":"Neurosci Biobehavioral Reviews"},{"issue":"2","key":"29019_CR27","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1001\/jamacardio.2020.6050","volume":"6","author":"LC Godoy","year":"2021","unstructured":"Godoy LC, Frankfurter C, Cooper M, Lay C, Maunder R, Farkouh ME. Association of adverse childhood experiences with cardiovascular disease later in life: a review. JAMA Cardiol. 2021;6(2):228\u201335.","journal-title":"JAMA Cardiol"},{"issue":"1","key":"29019_CR28","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.physbeh.2011.08.019","volume":"106","author":"A Danese","year":"2012","unstructured":"Danese A, McEwen BS. Adverse childhood experiences, allostasis, allostatic load, and age-related disease. Physiol Behav. 2012;106(1):29\u201339.","journal-title":"Physiol Behav"},{"issue":"3","key":"29019_CR29","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1056\/NEJM199801153380307","volume":"338","author":"BS McEwen","year":"1998","unstructured":"McEwen BS. Protective and damaging effects of stress mediators. N Engl J Med. 1998;338(3):171\u20139.","journal-title":"N Engl J Med"},{"key":"29019_CR30","doi-asserted-by":"publisher","first-page":"105832","DOI":"10.1016\/j.neubiorev.2024.105832","volume":"164","author":"M Sheppard","year":"2024","unstructured":"Sheppard M, Rasgado-Toledo J, Duncan N, Elliott R, Garza-Villarreal EA, Muhlert N. Noradrenergic alterations associated with early life stress. Neurosci Biobehavioral Reviews. 2024;164:105832.","journal-title":"Neurosci Biobehavioral Reviews"},{"issue":"1","key":"29019_CR31","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1111\/j.1749-6632.1995.tb44679.x","volume":"771","author":"G Aguilera","year":"1995","unstructured":"Aguilera G, Kiss A, Luo X, Akbasak B. The Renin Anggiotensin System and the Stress Response. Ann N Y Acad Sci. 1995;771(1):173\u201386.","journal-title":"Ann N Y Acad Sci"},{"key":"29019_CR32","doi-asserted-by":"publisher","first-page":"100987","DOI":"10.1016\/j.yfrne.2022.100987","volume":"66","author":"S Sch\u00e4r","year":"2022","unstructured":"Sch\u00e4r S, M\u00fcrner-Lavanchy I, Schmidt SJ, Koenig J, Kaess M. Child maltreatment and hypothalamic-pituitary-adrenal axis functioning: A systematic review and meta-analysis. Front Neuroendocr. 2022;66:100987.","journal-title":"Front Neuroendocr"},{"key":"29019_CR33","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1016\/j.bbi.2020.12.018","volume":"93","author":"KS Dempster","year":"2021","unstructured":"Dempster KS, O\u2019Leary DD, MacNeil AJ, Hodges GJ, Wade TJ. Linking the hemodynamic consequences of adverse childhood experiences to an altered HPA axis and acute stress response. Brain Behav Immun. 2021;93:254\u201363.","journal-title":"Brain Behav Immun"},{"issue":"3","key":"29019_CR34","doi-asserted-by":"publisher","first-page":"E281","DOI":"10.1152\/ajpendo.00058.2022","volume":"323","author":"C Dearing","year":"2022","unstructured":"Dearing C, Handa RJ, Myers B. Sex differences in autonomic responses to stress: implications for cardiometabolic physiology. Am J Physiology-Endocrinology Metabolism. 2022;323(3):E281\u20139.","journal-title":"Am J Physiology-Endocrinology Metabolism"},{"issue":"1","key":"29019_CR35","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1186\/s12905-020-00932-8","volume":"20","author":"S Chan","year":"2020","unstructured":"Chan S, Gomes A, Singh RS. Is menopause still evolving? Evidence from a longitudinal study of multiethnic populations and its relevance to women\u2019s health. BMC Womens Health. 2020;20(1):74.","journal-title":"BMC Womens Health"},{"issue":"10250","key":"29019_CR36","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1016\/S0140-6736(20)31561-0","volume":"396","author":"F Mauvais-Jarvis","year":"2020","unstructured":"Mauvais-Jarvis F, Merz NB, Barnes PJ, Brinton RD, Carrero J-J, DeMeo DL, et al. Sex and gender: modifiers of health, disease, and medicine. Lancet. 2020;396(10250):565\u201382.","journal-title":"Lancet"},{"issue":"10","key":"29019_CR37","doi-asserted-by":"publisher","first-page":"1103","DOI":"10.1111\/jcpp.12621","volume":"57","author":"A Reuben","year":"2016","unstructured":"Reuben A, Moffitt TE, Caspi A, Belsky DW, Harrington H, Schroeder F, et al. Lest we forget: comparing retrospective and prospective assessments of adverse childhood experiences in the prediction of adult health. J Child Psychol Psychiatry. 2016;57(10):1103\u201312.","journal-title":"J Child Psychol Psychiatry"},{"issue":"8058","key":"29019_CR38","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1038\/s41586-025-08774-w","volume":"640","author":"MW Nielsen","year":"2025","unstructured":"Nielsen MW, Gissi E, Heidari S, Horton R, Nadeau KC, Ngila D, et al. Intersectional analysis for science and technology. Nature. 2025;640(8058):329\u201337.","journal-title":"Nature"},{"issue":"9859","key":"29019_CR39","doi-asserted-by":"publisher","first-page":"2224","DOI":"10.1016\/S0140-6736(12)61766-8","volume":"380","author":"SS Lim","year":"2012","unstructured":"Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990\u20132010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224\u201360.","journal-title":"Lancet"},{"issue":"7","key":"29019_CR40","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1161\/CIRCULATIONAHA.120.049360","volume":"143","author":"H Ji","year":"2021","unstructured":"Ji H, Niiranen TJ, Rader F, Henglin M, Kim A, Ebinger JE, et al. Sex Differences in Blood Pressure Associations With Cardiovascular Outcomes. Circulation. 2021;143(7):761\u20133.","journal-title":"Circulation"}],"container-title":["BMC Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12889-026-29019-z","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-026-29019-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-026-29019-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T20:03:08Z","timestamp":1790712188000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12889-026-29019-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,9]]},"references-count":40,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["29019"],"URL":"https:\/\/doi.org\/10.1186\/s12889-026-29019-z","relation":{},"ISSN":["1471-2458"],"issn-type":[{"value":"1471-2458","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,9]]},"assertion":[{"value":"26 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Written declarations of informed consent were obtained from all participants, data were collected in accordance with the Declaration of Helsinki, and the data collection process was approved by the ethics committees of all 18 participating examination sites (in alphabetical order): Augsburg, Berlin (3 sites: Berlin Center, Berlin North, Berlin South), Bremen, D\u00fcsseldorf, Essen, Freiburg, Halle, Hamburg, Hannover, Kiel, Leipzig, Mannheim, M\u00fcnster, Neubrandenburg, Neustrelitz, Regensburg, Saarbr\u00fccken.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"2698"}}