Life course adversity, premature mortality, and life expectancy: role of Life's Essential 8

Abstract Aims Life course adversity has been linked to various health outcomes, but the interrelationship between adversity, Life's Essential 8 (LE8), and premature mortality remains unclear. We aimed to examine the associations of childhood and adulthood adversity with premature mortality and life expectancy and whether LE8 modifies these associations. Methods and results This study included 148 137 participants from the UK Biobank, with LE8 data available for 94 289 individuals. Adversity exposures, including abuse (sexual, physical, emotional) and neglect (physical, emotional), were used to calculate cumulative adversity scores for childhood and adulthood. Associations of adversity with premature mortality (death before age 75) and life expectancy were evaluated using Cox proportional hazards regression and flexible parametric survival models, with and without stratification by LE8 status. Over a median follow-up of 13.4 years, 3070 premature deaths were recorded. Compared with participants reporting no adversity, those with ≥2 adversities in childhood and adulthood had a higher risk of premature mortality, with hazard ratios of 1.237 [95% confidence interval (CI): 1.132–1.351] and 1.229 (95% CI: 1.121–1.348), respectively. Corresponding years of life lost at age 45 were 1.026 (95% CI: 0.584–1.468) for childhood and 1.322 (95% CI: 0.862–1.783) for adulthood. Stratified analyses showed that the associations of adversity with premature mortality and life expectancy were attenuated and eventually eliminated as LE8 levels increased (P for multiplicative and additive interaction < 0.05). Conclusion Life course adversities are associated with increased risks of premature mortality and reduced life expectancy. Maintaining favourable LE8 levels may mitigate the excess premature mortality risk associated with adversity.