The Effects Of Adverse Childhood Experiences On Health Of Middle-Aged And Older Chinese: A Life Course Perspective

Background Population aging is a crucial trend of social development,and presents an unprecedented set of challenges worldwide.Population aging brings severe challenges to families,society and ecnomy development,highlighting the importance and urgency to conduct population aging research.The health outlook for older Chinese is not optimistic,which is the root of the negative effects of aging.From the perspective of life course,adverse childhood experiences(ACEs)is a key "upstream factor" of health status among middle-aged and older people,and the government emphasizes the life-cycle health management in implementing the National Strategy of Actively Responding to Population Aging and the Healthy China Strategy.Objectives From a life course perspective,this study aimed to explore the impacts of ACEs on multiple health indicators,to discern the significant fileds of National Strategy of Actively Responding to Population Aging,and to improve health and life quality among middle-aged and older Chinese.Firstly,we elucidated how lifecourse trajectories of health indicators among middle-aged and older Chinese varied across ACEs and population subgroups by gender and urban-rural in the framework of age-period-cohort(APC).Next,this research identified the underlying pathways in the associations between ACEs and health indicators among middle-aged and older Chinese.Methods Three types of ACEs,including childhood neglect,childhood abuse,childhood socioeconomic status(SES)disadvantage,were obtained from China Health and Retirement Longitudinal Study(CHARLS)2014.Data from CHARLS 2011,2013,2015 and 2018 were used to measure activities of daily living(ADL),depression,cognition and self-rated health among middle-aged and older Chinese.Hierarchical age-period-cohort-growth curve models(HAPC-GCMs)were used to examine net of age and cohort effects,and to explore the life-course trajectories of health indicators across ACEs,gender and urban-rural among middle-aged and older Chinese.A series of latent growth curve models were utilized to identify the longitudinal mediators of social participation in the relationships between ACEs and health indicators among middle-aged and older Chinese.Results(1)The prevalence of ADL among middle-aged and older Chinese was17.1%,and increased with age linearly(p<0.001).Cognition among middle-aged and older Chinese had a mean of 14.675,and decreased 0.103 units(p<0.001)per age at a rate of 0.006(p<0.001),thereby exhibiting an accelerating decrease.Self-rated health among middle-aged and older Chinese had a mean of 3.430 and decreased 0.004 units(p=0.025)per age at a rate of 0.001(p=0.019),thereby exhibiting an accelerating decrease.(2)More recent cohorts showed lower ADL(p<0.001),higher mean levels of cognition(β=0.428,p<0.001)and self-rated health(β=0.047,p<0.001),while nonsignificant cohort effect was observed in depression(β=-0.019,p=0.526).(3)There were dose-response gradients between ACEs and health indicators among middle-aged and older Chinese.However,childhood neglect(β=-0.021,p=0.626)could not significantly predict ADL,and childhood abuse(β=0.108,p=0.112)could not significantly predict cognition.(4)The effect of childhood neglect on depression(β=0.131,p=0.030)and the impact of childhood SES disadvantage on self-rated health increased across successive cohorts(β=-0.028,p=0.020),while the urban-rural disparities in cognition(β=0.091,p=0.025)and depression(β=-0.133,p=0.022)decreased across successive cohorts among middle-aged and older Chinese.Also,the gender gaps in cognition trajectories showed a converge trend and then a diverge trend(β=-0.173,p<0.001),whereas the gender gaps in self-rated health trajectories diverged for recent cohorts(β=0.022,p=0.012).(5)Increasing urban-rural(β=-0.060,p<0.001)and cohort(β=0.068,p<0.001)disparities with age were observed in cognition,and gender disparities in depression were also widened with age(β=-0.053,p=0.006).(6)Baseline social participation was associated with ADL(β=-0.202,p<0.001),depressive symptoms(β=-0.250,p<0.001),cognition(β=0.374,p<0.001),and selfrated health(β=0.175,p<0.001)at baseline,and the slope of social participation significantly affected the slope of ADL(β=-0.138,p=0.014),depressive symptoms(β=-0.195,p=0.009),cognition(β=0.585,p<0.001)and self-rated health(β=0.167,p=0.002)among middle-aged and older Chinese.(7)The longitudinal mediation analysis indicated that baseline social participation mediated respectively 9.8% and 12.1% of the total effect of childhood SES disadvantage on the baseline ADL and depression.Baseline social participation partially mediated the effect of childhood SES disadvantage on cognition(β=-0.026,p<0.001),accounting for 16.1% of the total effect.Also,baseline social participation mediated respectively 11.1% of the total effect of childhood SES disadvantage on the baseline self-rated health,while the slope of social participation fully mediated the effect of childhood SES disadvantage on the slope of self-rated health(β=-0.014,p=0.041).Conclusions: Aging,social status decline,and transitions of social role may explain the decling trends of all health indicators with age.All health indicators are improved in more recent cohorts except for depression,due to economic development,technological progress,improvement of social environment.ACEs is an "upstream" risk factor for health among middle-aged and older Chinese.As childhood neglect exerts stronger adverse effects on depression and the impact of childhood SES disadvantage on self-rated health increased across successive cohorts,it is vital to explore the long-term and dynamic effects of ACEs on health trajectories throughout the life course.Social participation can mitigate the long-term negative effects of childhood SES disadvantage on health indicators.Relevant departments should give priority to the life-cycle health management,developing human capital and social capital of middle-aged and older adults,and further reducing health disparities.