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

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Higher Education Press 2026

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