Association of adverse childhood experiences with subsequent kidney disease among middle-aged and older adults in China: A national analysis

Abstract

ObjectiveFew studies have been performed to address the impacts of adverse childhood experiences (ACEs) on kidney function in later life. We aimed to investigate the association between ACEs with subsequent kidney disease among middle-aged and older adults.MethodsThis national population-based study used data from the China Health and Retirement Longitudinal Study (CHARLS) 2015 and the life history survey in 2014. A total of 10102 participants aged ≥ 45 years from China were included. A wide range of 11 ACE indicators including childhood hunger, child’s poor health, physical abuse, emotional neglect, loneliness, peer bullying, domestic violence, household mental illness, household substance abuse, parental death, and incarcerated household member were measured by validated questionnaires. The cumulative number of ACEs was summed and and classified into four subgroups: ≤ 1, 2, 3 and ≥ 4. Glomerular filtration rate (eGFR) was estimated by serum cystatin C concentration and chronic kidney disease (CKD) was defined as eGFR < 60 ml/min/1.73m2. Multiple regression models were used to explore the relationship between accumulated ACEs and individual ACE indicator with subsequent kidney function.FindingsOf the 10102 participants, 46.8% were males, and 16.0% reported exposure to four or more ACEs. Compared those with ≤ 1 ACE, participants who experienced four or more ACEs have a higher risk of decreased eGFR (β= -1.169, 95%CI: -2.113 to -0.225) and CKD (adjusted odds ratio, aOR=1.35, 1.04-1.75), after controlling for confounders. Exposure to specific ACE indicators of childhood poor health, physical abuse and household mental illness presented significant associations with reduced eGFR. The effects were more evident in men aged ≥ 60 years, with lower education or worse financial status.ConclusionsOur study suggests that higher ACEs exposure increased the risk of subsequent kidney disease. The findings provide implications for mitigating the adverse effects of early-life stress and promoting kidney health by reducing ACEs.