Heavy drinking amplifies the risk of cardiometabolic multimorbidity attributed to adverse childhood experiences in middle-aged and older Chinese adults

Abstract

To examine longitudinal associations between adverse childhood experiences (ACEs) and cardiometabolic multimorbidity (CMM) and to assess whether unhealthy lifestyles modify these associations. This study utilized data from 5 waves of the China Health and Retirement Longitudinal Study (CHARLS). The study population comprised 11 200 participants aged 45 years or older, with available data on CMM and all 12 ACE indicators. The longitudinal associations between ACEs and CMM were assessed by generalized estimating equation (GEE) regression models. A mediation analysis examined the potential causal chain in which unhealthy lifestyle scores mediate the relationship between ACEs and CMM. A total of 11 200 participants were eligible for our analysis (mean (SD) age, 58.1 (8.8) years; 5839 (52.1%) were females), and 949 (8.47%) reported four or more ACEs. Compared with those without ACE exposure, participants who experienced four or more ACEs had an increased risk of CMM (odds ratio (OR), 1.40; 95% confidence interval (CI), 1.08–1.83). Drinking status significantly modified the associations between ACE groups and CMM (P for interaction = 0.034). Mediation analyses showed that unhealthy lifestyles partially explained 8.59% (95% CI, 0.56%–16.62%) of the relationship between ACEs and CMM. Childhood adverse events contribute to the development of CMM, and this effect is more significant in people who drink alcohol. Unhealthy lifestyles can aggravate the health inequity of ACEs on CMM.

Keywords

adverse childhood experiences / cardiometabolic multimorbidity / unhealthy lifestyle / health inequity / China Health and Retirement Longitudinal Study

References

[1] Fabbri LM , Celli BR , Agustí A , Criner GJ , Dransfield MT , Divo M , Krishnan JK , Lahousse L , Montes de Oca M , Salvi SS , Stolz D , Vanfleteren LEGW , Vogelmeier CF . COPD and multimorbidity: recognising and addressing a syndemic occurrence. Lancet Respir Med 2023; 11(11): 1020–1034

[2] Busija L , Lim K , Szoeke C , Sanders KM , McCabe MP . Do replicable profiles of multimorbidity exist? Systematic review and synthesis. Eur J Epidemiol 2019; 34(11): 1025–1053

[3] Xie H , Li J , Zhu X , Li J , Yin J , Ma T , Luo Y , He L , Bai Y , Zhang G , Cheng X , Li C . Association between healthy lifestyle and the occurrence of cardiometabolic multimorbidity in hypertensive patients: a prospective cohort study of UK Biobank. Cardiovasc Diabetol 2022; 21(1): 199

[4] Bellis MA , Hughes K , Ford K , Ramos Rodriguez G , Sethi D , Passmore J . Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: a systematic review and meta-analysis. Lancet Public Health 2019; 4(10): e517–e528

[5] Antoniou G , Lambourg E , Steele JD , Colvin LA . The effect of adverse childhood experiences on chronic pain and major depression in adulthood: a systematic review and meta-analysis. Br J Anaesth 2023; 130(6): 729–746

[6] Godoy LC , Frankfurter C , Cooper M , Lay C , Maunder R , Farkouh ME . Association of adverse childhood experiences with cardiovascular disease later in life: a review. JAMA Cardiol 2021; 6(2): 228–235

[7] Lin L , Wang HH , Lu C , Chen W , Guo VY . Adverse childhood experiences and subsequent chronic diseases among middle-aged or older adults in China and associations with demographic and socioeconomic characteristics. JAMA Netw Open 2021; 4(10): e2130143

[8] Flores-Torres MH , Comerford E , Signorello L , Grodstein F , Lopez-Ridaura R , de Castro F , Familiar I , Ortiz-Panozo E , Lajous M . Impact of adverse childhood experiences on cardiovascular disease risk factors in adulthood among Mexican women. Child Abuse Negl 2020; 99: 104175

[9] Basu A , McLaughlin KA , Misra S , Koenen KC . Childhood maltreatment and health impact: the examples of cardiovascular disease and type 2 diabetes mellitus in adults. Clin Psychol (New York) 2017; 24(2): 125–139

[10] Merrick MT , Ford DC , Ports KA , Guinn AS . Prevalence of adverse childhood experiences from the 2011–2014 behavioral risk factor surveillance system in 23 states. JAMA Pediatr 2018; 172(11): 1038–1044

[11] Shao J , Wang X , Zou P , Song P , Chen D , Zhang H , Tang L , Huang Q , Ye Z . Associating modifiable lifestyle factors with multimorbidity in community dwelling individuals from mainland China. Eur J Cardiovasc Nurs 2021; 20(6): 556–564

[12] Han Y , Hu Y , Yu C , Guo Y , Pei P , Yang L , Chen Y , Du H , Sun D , Pang Y , Chen N , Clarke R , Chen J , Chen Z , Li L , Lv J; China Kadoorie Biobank Collaborative Group . Lifestyle, cardiometabolic disease, and multimorbidity in a prospective Chinese study. Eur Heart J 2021; 42(34): 3374–3384

[13] Jin Y , Liang J , Hong C , Liang R , Luo Y . Cardiometabolic multimorbidity, lifestyle behaviours, and cognitive function: a multicohort study. Lancet Healthy Longev 2023; 4(6): e265–e273

[14] Zhao Y , Hu Y , Smith JP , Strauss J , Yang G . Cohort profile: the China Health and Retirement Longitudinal Study (CHARLS). Int J Epidemiol 2014; 43(1): 61–68

[15] Gong J , Wang G , Wang Y , Chen X , Chen Y , Meng Q , Yang P , Yao Y , Zhao Y . Nowcasting and forecasting the care needs of the older population in China: analysis of data from the China Health and Retirement Longitudinal Study (CHARLS). Lancet Public Health 2022; 7(12): e1005–e1013

[16] Lin L , Cao B , Chen W , Li J , Zhang Y , Guo VY . Association of adverse childhood experiences and social isolation with later-life cognitive function among adults in China. JAMA Netw Open 2022; 5(11): e2241714

[17] Björkenstam C , Kosidou K , Björkenstam E . Childhood adversity and risk of suicide: cohort study of 548 721 adolescents and young adults in Sweden. BMJ 2017; 357: j1334

[18] Chen W , Wang X , Chen J , You C , Ma L , Zhang W , Li D . Household air pollution, adherence to a healthy lifestyle, and risk of cardiometabolic multimorbidity: results from the China health and retirement longitudinal study. Sci Total Environ 2023; 855: 158896

[19] Guo C , Liu Z , Fan H , Wang H , Zhang X , Fan C , Li Y , Han X , Zhang T . Associations of healthy lifestyle and three latent socioeconomic status patterns with physical multimorbidity among middle-aged and older adults in China. Prev Med 2023; 175: 107693

[20] Robins JM , Greenland S . Identifiability and exchangeability for direct and indirect effects. Epidemiology 1992; 3(2): 143–155

[21] Hou X , Wang D , Zuo J , Li J , Wang T , Guo C , Peng F , Su D , Zhao L , Ye Z , Zhang H , Zheng C , Mao G . Development and validation of a prognostic nomogram for HIV/AIDS patients who underwent antiretroviral therapy: data from a China population-based cohort. EBioMedicine 2019; 48: 414–424

[22] Yang BY , Hu LW , Jalaludin B , Knibbs LD , Markevych I , Heinrich J , Bloom MS , Morawska L , Lin S , Jalava P , Roponen M , Gao M , Chen DH , Zhou Y , Yu HY , Liu RQ , Zeng XW , Zeeshan M , Guo Y , Yu Y , Dong GH . Association between residential greenness, cardiometabolic disorders, and cardiovascular disease among adults in China. JAMA Netw Open 2020; 3(9): e2017507

[23] Luo H , Zhang Q , Yu K , Meng X , Kan H , Chen R . Long-term exposure to ambient air pollution is a risk factor for trajectory of cardiometabolic multimorbidity: a prospective study in the UK biobank. EBioMedicine 2022; 84: 104282

[24] Zhang YB , Chen C , Pan XF , Guo J , Li Y , Franco OH , Liu G , Pan A . Associations of healthy lifestyle and socioeconomic status with mortality and incident cardiovascular disease: two prospective cohort studies. BMJ 2021; 373(604): n604

[25] Shonkoff JP , Slopen N , Williams DR . Early childhood adversity, toxic stress, and the impacts of racism on the foundations of health. Annu Rev Public Health 2021; 42(1): 115–134

[26] Hughes K , Bellis MA , Hardcastle KA , Sethi D , Butchart A , Mikton C , Jones L , Dunne MP . The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health 2017; 2(8): e356–e366

[27] Friedman EM , Montez JK , Sheehan CM , Guenewald TL , Seeman TE . Childhood adversities and adult cardiometabolic health: does the quantity, timing, and type of adversity matter. J Aging Health 2015; 27(8): 1311–1338

RIGHTS & PERMISSIONS

Higher Education Press