Epidemiology and psychiatric sciences · 2026
Association of adverse childhood experiences and gastrointestinal and liver diseases among middle-aged and elderly adults in China.
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Zhang Yuanfeng, Li Chenglong, Wu Zilun, Cao Yang, Shi Zumin
Аннотация
AIMS: Research on the link between threat-related and deprivation-related adverse childhood experiences (ACEs) and the risk of gastrointestinal (GI) and liver diseases in later life remains limited. This study aims to evaluate the independent associations of threat-related and deprivation-related ACEs with the development of GI and liver disorders in middle-aged and older Chinese adults.
METHODS: This prospective cohort study used data from the China Health and Retirement Longitudinal Study, which included participants aged 45 and older who had complete ACE data, two health assessments, and no pre-existing GI or liver conditions at baseline. Participants reported on five threat-related and deprivation-related ACEs before age 17. GI and liver diseases were classified based on self-reported physician diagnoses.
RESULTS: The outcomes of GI and liver diseases are based on self-reported physician diagnosis and broad categories. Compared with no exposures, participants with two or more threat-related ACEs exhibited a higher risk of both chronic liver disease (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.04-1.52; P = 0.016) and GI disease (HR, 1.36; 95% CI, 1.20-1.55; P < 0.001); two or more deprivation-related ACEs showed stronger associations with GI disease (HR, 1.48; 95% CI, 1.28-1.70; P < 0.001); and no significant associations with liver disease risk across all exposure levels. Additionally, depressive symptoms accounted for 10.7% (P = 0.003) of the association between threat-related ACEs and liver disease risk and accounted for 12.7% (P < 0.001) of the association between threat-related ACEs and GI disease risk. Midlife loneliness accounted for 5.3% (P = 0.001) of the association between threat-related ACEs and incident GI diseases and for 3.7% (P = 0.004) of the association between deprivation-related ACEs and incident GI diseases.
CONCLUSIONS: Threat-related ACEs are directly associated with an increased risk of liver and GI diseases. A modest proportion of this observed relationship is partially mediated through depressive symptoms and loneliness in middle age.
METHODS: This prospective cohort study used data from the China Health and Retirement Longitudinal Study, which included participants aged 45 and older who had complete ACE data, two health assessments, and no pre-existing GI or liver conditions at baseline. Participants reported on five threat-related and deprivation-related ACEs before age 17. GI and liver diseases were classified based on self-reported physician diagnoses.
RESULTS: The outcomes of GI and liver diseases are based on self-reported physician diagnosis and broad categories. Compared with no exposures, participants with two or more threat-related ACEs exhibited a higher risk of both chronic liver disease (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.04-1.52; P = 0.016) and GI disease (HR, 1.36; 95% CI, 1.20-1.55; P < 0.001); two or more deprivation-related ACEs showed stronger associations with GI disease (HR, 1.48; 95% CI, 1.28-1.70; P < 0.001); and no significant associations with liver disease risk across all exposure levels. Additionally, depressive symptoms accounted for 10.7% (P = 0.003) of the association between threat-related ACEs and liver disease risk and accounted for 12.7% (P < 0.001) of the association between threat-related ACEs and GI disease risk. Midlife loneliness accounted for 5.3% (P = 0.001) of the association between threat-related ACEs and incident GI diseases and for 3.7% (P = 0.004) of the association between deprivation-related ACEs and incident GI diseases.
CONCLUSIONS: Threat-related ACEs are directly associated with an increased risk of liver and GI diseases. A modest proportion of this observed relationship is partially mediated through depressive symptoms and loneliness in middle age.