Adverse childhood experiences and multimorbidity among middle-aged and older adults: Evidence from China

Background
Associations between adverse childhood experiences (ACEs) and multimorbidity among middle-aged and older Chinese individuals have not been well documented.

Objective
We aimed to examine the associations of ACEs and different multimorbidity measures among Chinese middle-aged and older adults.

Participants and setting
The study population included 6428 participants aged 45 years or older who were obtained from the China Health and Retirement Longitudinal Study (CHARLS).

Methods
Multimorbidity was assessed by the number of self-reported physician diagnoses of 14 chronic diseases, the Chinese multimorbidity-weighted index (CMWI), multimorbidity trajectories and multimorbidity patterns. ACEs were measured retrospectively by whether the individuals having physical abuse, emotional neglect, household substance abuse, household mental illness, domestic violence, incarcerated household member, parental separation or divorce, unsafe neighborhood, bullying, parental death, sibling death, and parental disability or not, which were characterized by the binarized presence or absence of any ACE. We estimated the associations between ACEs and multimorbidity using a mixed-effects model. Latent growth curve modelling was used to investigate the trajectory of multimorbidity by ACEs. Both models Adjusted for sociodemographic and other health risk factors. Patterns of multimorbidity by ACEs were explored using hierarchical cluster analysis.

Results
Of the 6428 individuals included (mean [SD] age, 56.67 [8.00] years; 6181 [45.29 %] were females), 81.16 % had experienced ACEs at baseline. ACEs were associated with an increased number of chronic diseases (β = 0.30; 95 % CI, 0.21 to 0.40) and the lower CMWI (β = −0.49; 95 % CI, −0.64 to −0.33). ACEs were associated with an increased number of chronic diseases at the baseline (intercept: 0.28, 95%CI: 0.20 to 0.36) and a more rapid increase in the number of chronic diseases over 7 years (intercept: 0.03, 95%CI: 0.01 to 0.05). The results of continuous variables (the number of ACEs) were consistent with those of binary variables (ACEs). ACEs were associated with lower scores at the baseline (intercept: -0.46, 95%CI: −0.60 to −0.33) but weren't related to a faster decrease (intercept: -0.04, 95%CI: −0.07 to 0.00). The number of ACEs was associated with the lower scores of CMWI at baseline and the faster the decrease in CMWI scores (intercept: -0.17, 95%CI: −0.21 to −0.14; slope: -0.03, 95%CI: −0.04 to −0.02). The above results varied among different types of ACEs. The binary multimorbidity pattern (arthritis and stomach/digestive disease) had the highest prevalence (15.50 %) in the participants with ACEs. There were differences in multimorbidity patterns between individuals exposed to ACE or not. The liver-kidney cluster more likely clustered with the arthritis-stomach cluster in individuals without ACE, but with the cancer-psych cluster in counterparts with ACEs.

Conclusions
There was an association between ACEs and multimorbidity with its trajectories and patterns after age 45. This study encourages a comprehensive life-course perspective to better understand and potentially prevent multimorbidity.