Adverse Childhood Experiences and Social Frailty Trajectory Among Middle-Aged and Older Adults: A Network Analysis From a Population-Based Sample.

OBJECTIVES

Life course theory posits that adverse childhood experiences (ACEs) exert lasting influences on health. However, their associations with the social frailty trajectory remain understudied in middle and later life.

METHODS

This study utilized data from the China Health and Retirement Longitudinal Study (2011-2020). The social frailty trajectory was identified using group-based trajectory modeling (GBTM), while latent class analysis (LCA) classified distinct ACE patterns. Logistic regression models examined the associations between ACEs and social frailty trajectory. Additionally, network analysis was conducted to identify central nodes.

RESULTS

This study comprised 10 730 participants. Four patterns of social frailty trajectory were identified, namely persistently low then rising, persistently moderate then rising, initially moderate-high then rapidly declining, and persistently high then rising. Greater exposure to total ACEs (RRR = 1.11 [95% CI: 1.04, 1.17]; RRR = 1.16 [95% CI: 1.07, 1.26]; RRR = 1.25 [95% CI: 1.17, 1.34]), threat-related ACEs (RRR = 1.08 [95% CI: 1.001, 1.16]; RRR = 1.13 [95% CI: 1.02, 1.26]; RRR = 1.23 [95% CI: 1.12, 1.34]), deprivation-related ACEs (RRR = 1.22 [95% CI: 1.09, 1.35]; RRR = 1.30 [95% CI: 1.11, 1.51]; RRR = 1.42 [95% CI: 1.25, 1.61]), and the LCA-derived "household mental illness" cluster (RRR = 1.58 [95% CI: 1.18, 2.11]; RRR = 1.85 [95% CI: 1.26, 2.71]; RRR = 2.20 [95% CI: 1.59, 3.05]) was significantly associated with three disadvantaged patterns of social frailty trajectories compared to the persistently low then rising pattern. Network analysis revealed "household violence," "physical abuse," "household mental illness," and "bullying" as the most central nodes.

CONCLUSIONS

These findings implicate public health policies that promote early-life adversity screening, mental health interventions, and social resilience programs to maintain social functioning among middle-aged and older adults.