Cumulative social determinants of health and long-term health outcomes among survivors of childhood sexual abuse: A retrospective chart review.

BACKGROUND

Childhood sexual abuse (CSA) is associated with long-term adverse physical, mental, and reproductive health outcomes. However, less is known about how cumulative social determinants of health (SDOH) further stratify risk within this population.

OBJECTIVE

To evaluate associations between cumulative SDOH exposure and long-term health outcomes among adult survivors of CSA.

PARTICIPANTS AND

SETTING

A retrospective chart review of 70 adult CSA survivors receiving care at a large urban academic medical center in the Midwestern United States between 2015 and 2024.

METHODS

Cumulative indices of SDOH exposure (housing instability, food insecurity, intimate partner violence, and transportation barriers) and chronic disease burden were constructed. Multivariable linear and logistic regression models assessed associations with physical, mental, and reproductive health outcomes and examined potential modification by psychosocial factors.

RESULTS

Higher cumulative SDOH exposure was associated with increased chronic physical disease burden and greater odds of reproductive complications among female patients, demonstrating a dose-response relationship. The association with chronic physical disease burden remained significant after adjustment for psychosocial factors, with similar effect estimates observed in sensitivity analyses accounting for demographic and socioeconomic variables. No significant associations were observed for chronic mental health conditions.

CONCLUSIONS

Social and structural disadvantage further stratifies long-term health risk among CSA survivors. Findings support integration of SDOH screening within trauma-informed care models to improve long-term outcomes in this population.