Impact of early-life deprivation and threat on physical, psychological, and cognitive multimorbidity: Evidence from multinational prospective cohorts.

BACKGROUND: The impact of early-life stressful events on physical-psychological-cognitive multimorbidity needs to be better understood. This study aimed to examine both the prevalence patterns of physical-psychological-cognitive multimorbidity and the associations between specific adverse childhood experiences (ACEs) and multimorbidity among middle-aged and older adults in China, Europe, the US, and the UK.

METHODS: Data came from the China Health and Retirement Longitudinal Study (CHARLS) and its partner studies: the US Health and Retirement Study (HRS), the Survey of Health, Ageing and Retirement in Europe (SHARE), and the English Longitudinal Study on Ageing (ELSA). ACEs were assessed dimensionally and cumulatively. Physical, psychological, and cognitive conditions and their multimorbidity were measured. Multivariable logistic regressions were used to examine the associations between early-life stressful events on physical-psychological-cognitive multimorbidity.

RESULTS: Deprivation was associated with physical-psychological disorders (China: RR: 1.25; 95 % CI: 1.20, 1.30; the US: RR: 1.13; 95 % CI: 1.05, 1.21; Europe: RR: 1.26; 95 % CI: 1.19, 1.33; and the UK: RR: 1.35; 95 % CI: 1.18, 1.52) and physical-psychological-cognitive disorders (China: RR: 1.25; 95 % CI: 1.20, 1.30; US: RR: 1.34; 95 % CI: 1.03, 1.65; Europe: RR: 1.14; 95 % CI: 1.05, 1.23; and the UK: RR: 1.89; 95 % CI: 1.48, 2.30). Threat was linked to physical-psychological disorders (China: RR: 1.19; 95 % CI: 1.10, 1.28; Europe: RR: 1.26; 95 % CI: 1.14, 1.38) and physical-psychological-cognitive disorders (China: RR: 1.14; 95 % CI: 1.05, 1.23; Europe: RR: 1.23; 95 % CI: 1.05, 1.41).

CONCLUSION: This study identified cross-national differences in the associations between threat, deprivation, and cumulative ACEs with later-life physical, psychological, and cognitive multimorbidity, highlighting the need for context-specific intervention strategies across countries.