The mediating role of social determinants of health in the association between adverse childhood experiences and later-life cardiovascular disease

Abstract

To investigate the longitudinal association between adverse childhood experiences (ACEs) and incident cardiovascular disease (CVD) in later life, and to examine whether the integrated construct of adult social determinants of health (SDH) mediates this association among middle-aged and older Chinese adults. Data were derived from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative cohort of adults aged ≥ 45 years. Cumulative ACEs were assessed across multiple domains. Incident CVD was ascertained during follow-up. Cox proportional hazards regression models were applied to estimate the association between ACEs and incident CVD. Mediation analyses were performed to quantify the indirect effects through the SDH construct. Greater cumulative ACEs exposure was associated with a higher risk of incident CVD, demonstrating a clear linear dose–response pattern. This association remained statistically significant after full adjustment. The integrated SDH construct accounted for a significant proportion of the ACEs–CVD association. A residual direct effect of ACEs on CVD persisted after accounting for this mediator. Childhood adversity is prospectively associated with increased cardiovascular risk in later life, with social determinants of health serving as an important intermediary pathway.These findings support the relevance of incorporating early-life adversity and social determinant perspectives in long-term cardiovascular risk assessment and prevention.