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Childhood adversity and trajectories of multimorbidity in mid-late life: China health and longitudinal retirement study
  1. Lei Yang1,
  2. Yaoyue Hu2,
  3. Karri Silventoinen3,
  4. Pekka Martikainen3,4
  1. 1School of Ethnology and Sociology, Minzu University of China, Beijing, China
  2. 2School of Public Health and Management, Chongqing Medical University, Chongqing, China
  3. 3Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
  4. 4Laboratory of Population Health, Max-Planck-Institute for Demographic Research, Rostock, Germany
  1. Correspondence to Yaoyue Hu, School of Public Health and Management, Chongqing Medical University, Chongqing, China;{at}


Background The association between childhood adversity and an individual’s health in later life has been extensively studied in Western societies; however, little is known about this association for the development of multimorbidity in China.

Methods Three waves (2011–2012, 2013 and 2015) of the China Health and Retirement Longitudinal Study were used for adults aged 45–101 years. Multimorbidity was assessed by the summed scores of self-reported physician diagnoses of 14 chronic diseases. Childhood adversity was measured by the incidence of childhood abuse and neglect, negative caregiver’s characteristics and low socioeconomic status. Latent growth curve modelling was used to investigate the trajectory of multimorbidity by childhood adversity.

Results Parental physical abuse was associated with increased number of chronic diseases (intercept: 0.119; 95% CI: 0.033 to 0.205 for men and 0.268: 95% CI: 0.188 to 0.348 for women) and a higher rate of increase (slope: 0.013: 95% CI: 0.000 to 0.027 for men and 0.022: 95% CI: 0.008 to 0.036 for women) in multimorbidity. Adequacy of food was associated with a lower number chronic diseases at baseline (men: −0.171: 95% CI: −0.245 to -0.097; women: −0.223: 95% CI: −0.294 to -0.152) and a slower rate of change in multimorbidity (men: −0.015 per year: 95% CI: −0.027 to -0.003; women: −0.012 per year: 95% CI: −0.024 to -0.001).

Conclusions The results demonstrate that childhood adversity exerts long-lasting effects on multimorbidity among older adults in China. Prevention of childhood maltreatment may delay or even avert the emergence of multimorbidity in later life.

  • lifecourse / childhood circumstances
  • life course epidemiology
  • morbidity
  • social and life-course epidemiology
  • gerontology

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  • Contributors All authors contributed fully to the paper. LY and YH designed the study. LY conducted the analysis,drafted the manuscript and revised the paper. YH, KS and PM made substantial contributions to revising the manuscript. All authors agreed on the final version to be submitted.

  • Funding This study was supported by the Ministry of Education of China for Youth Projects of Humanities and Social Sciences Research to LY (Grant Number 19YJC840053).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval CHARLS was approved by the Ethical Review Committee of Peking University (IRB00001052-11015).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. Data are available at China Health and Retirement Longitudinal Study (CHARLS)

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.