Exposure to Adverse Childhood Experiences and Incident Functional Disability in Middle‐Aged and Older Chinese Adults: A Longitudinal Cohort Study

ABSTRACT

This study aims to investigate the potential relationship between adverse childhood experiences (ACEs) and the first onset of difficulty in any activity of daily living (ADL) task in middle and late adulthood. We used data from the China Health and Retirement Longitudinal Study (CHARLS) collected between 2011 and 2018. Information on ACEs was obtained from the 2014 CHARLS life history survey. Cox proportional hazards regression models were used to examine the association between ACEs and incident functional disability, defined as the first onset of difficulty in any ADL task. Population attributable risk (PAR) was calculated to quantify the potential contribution of ACEs to functional disability. Among 14,563 respondents aged 45 years and older (52% male, 48% female; mean age 56.0 [SD 7.7]), 25% experienced the first onset of difficulty in at least one ADL task during the 7‐year follow‐up period, and 65% experienced at least one ACE. In fully adjusted models, we found an increased risk of functional disability associated with any ACEs (HR, 1.26; 95% CI, 1.09–1.47). In a multi‐ACE model, the associations were similar to those observed in single‐ACE models for witnessing domestic violence (HR, 1.32; 95% CI, 1.00–1.73) and mental illness in a household member (HR, 1.24; 95% CI, 1.07–1.44). Estimates of PAR showed that all ACEs together accounted for 14.84% (95% CI, 6.1%–22.8%) of the functional disability burden. Among the types of ACEs, mental illness in a household member had the greatest impact (PAR, 9.71%; 95% CI, 4.72%–14.45%). Moreover, the association for neglect differed by gender, whereas that for emotional abuse differed between urban and rural participants. ACE exposure was associated with a higher hazard of first observed functional disability. These findings support further investigation of the life‐course pathways linking childhood adversity to functional health in middle and later life.