Adverse childhood experiences contribute to increased risk of health in middle and late life: The longitudinal mediating effect of activities of daily living and chronic diseases

Adverse Childhood Experiences (ACEs) have long-term effects on health, but the mechanisms remain unclear. To investigate the association between ACEs and health status, exploring the potential mediating roles of activities of daily living (ADL) and chronic diseases. 9575 middle-aged and older adults from the China Health and Retirement Longitudinal Study (CHARLS). Longitudinal analysis of 4 waves (2013-2018) data. ACEs were derived from 2014 self-report life history survey. Latent growth curve modeling assessed the mediating effect of ADL and chronic diseases on the relationship between ACEs and self-rated health (SRH). Among the 9575 individuals (mean [standard deviation, SD] age, 58.12 [8.73] years; 5174 [54.04 %] were females), the average ACEs score was 2.27 (SD = 1.75). Individuals with higher ACEs reported lower baseline SRH (β = -0.156, P < .001) and greater decline over time (β = -0.075, P < .001). Mediation analysis indicated that both baseline and longitudinal changes in ADL and chronic diseases (intercept and slope) partially mediated the association between ACE and the intercept of SRH, while ADL (intercept and slope) and chronic diseases (slope) fully mediated the association between ACE and the slope of SRH. ACEs were associated with poorer health status and accelerated decline, partially mediated by impaired ADL and increased chronic diseases. Interventions targeting ACE reduction, enhancing ADL, and managing chronic diseases could effectively improve the health of middle-aged and older adults.