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Adverse Childhood Experiences and Trajectories of ADL Disability among Middle-Aged and Older Adults in China: Findings from the CHARLS Cohort Study

  • Original Research
  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

There is little evidence on the association between adverse childhood experiences (ACEs) and disability trajectories among middle-aged and older adults. This study aimed to investigate the association between ACEs and activities of daily living (ADL) trajectories over eight years of follow-up and the mediation role of different chronic diseases on this relationship.

Design

Prospective cohort study, eight-year follow-up.

Setting

China Health and Retirement Longitudinal Study(CHARLS).

Participants

A total of 10651 participants age 45 and over from CHARLS 2011 to 2018 were included in this study.

Measurements

Five ACEs exposure groups were formed based on the cumulative ACE scores. A 6-item ADL score was used, including bathing, dressing, eating, getting in/out of bed, using the toilet, and controlling urination, to measure the ADL disability, and the group-based trajectory model (GBTM) was used to identify the ADL disability trajectories. Multinomial logistic regression was performed to investigate the association between ACEs and ADL disability trajectory memberships, and KHB-method was used to estimate the contribution of different chronic diseases on this relationship.

Results

Of the 10651 participants, 9.64% showed a mild-increasing trajectory in terms of change in ADL score during follow-up, followed by the low-mild trajectory (32.00%) and low-low trajectory (58.36%). Compared with those without ACEs exposure, participants who had ≥4 ACEs were associated with an increased risk of being on low-mild trajectory (OR 1.32, 95%CI:1.11–1.57) and mild-increasing trajectory (OR 1.41, 95%CI: 1.06–1.89), respectively. Besides, mediation analysis revealed chronic diseases had a mediation effect in this association, with the largest effect from arthritis or rheumatism (over 60%), followed by digestive system disease (around 14%), respiratory disease (around 12%), and cardio-metabolic disease (around 5%).

Conclusion

This study suggested that exposure to ACEs was associated with a higher risk of being worse ADL disability trajectories. Moreover, chronic disease accounts for a meaningful proportion of this association. Further studies are needed to clarify how chronic diseases mediate the association between ACEs and ADL disability trajectories.

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Acknowledgment

The authors gratefully acknowledge the National School of Development of Peking University for providing the data of China Health and Retirement Longitudinal Study (CHARLS).

Funding

Funding sources: This work was supported by National Natural Science Foundation of China (grant numbers: 41871360), National Key Research and Development Program of China (No. 2018YFC1004303), and National Health Commission Key Laboratory of Birth Defects Prevention, Henan Province (grant numbers: ZD202002).

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Authors and Affiliations

  1. Institute of Population Research/China Center on Population Health and development, Peking University, No.5 Yiheyuan Road, Haidian District, Beijing, 100871, China

    J. Li, S. Lin, X. Yan & Lijun Pei

  2. Division of Prevention and Community Health, National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China

    Z. Wang

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  1. J. Li
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  2. S. Lin
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Contributions

Author contributions: Jiajia Li & Shiqi Lin: literature search, writing (original draft); Jiajia Li & Xiaojin Yan statistical analysis and visualization, Lijun Pei & Zengwu wang: conceptualization, funding acquisition, and writing (review and revised the article critically for important intellectual content).

Corresponding author

Correspondence to Lijun Pei.

Ethics declarations

Conflict of interest: None declared.

Ethic approval: The study was approved by the Institutional Review Board at Peking University. The IRB approval number for the main household survey, including anthropometrics, is IRB00001052-11015. Written consent was obtained from all participants or their legal representatives.

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Li, J., Lin, S., Yan, X. et al. Adverse Childhood Experiences and Trajectories of ADL Disability among Middle-Aged and Older Adults in China: Findings from the CHARLS Cohort Study. J Nutr Health Aging 26, 1034–1041 (2022). https://doi.org/10.1007/s12603-022-1863-z

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  • DOI: https://doi.org/10.1007/s12603-022-1863-z

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