Adverse Childhood Experiences and Cognitive-Functional Aging Trajectories: A Nationally Representative Study in China

Abstract

BACKGROUNDS: Adverse childhood experiences (ACEs) are associated with long-term health risks, yet how childhood adversity shapes joint trajectories of cognitive and functional aging remains unclear. OBJECTIVES: This study examined associations between ACEs and joint cognitive-functional trajectories and tested whether social participation moderates these relationships. PARTICIPANTS AND SETTINGS: Data were drawn from 8,590 adults aged 45+ across five waves (2011-2020) of the China Health and Retirement Longitudinal Study. METHODS: Group-based trajectory modeling identified joint cognitive-functional patterns. Multinomial logistic regression assessed associations between ACEs and trajectory membership, with social participation moderation tested. RESULTS: Five distinct trajectories emerged. Each additional ACE was associated with 24% higher risk of the most disadvantaged trajectory. Both threat- and deprivation-related ACEs predicted adverse trajectories, with bullying and household mental illness showing strongest associations. Social participation was independently associated with more favorable trajectories, but did not significantly moderate the association between ACEs (cumulative, threat-related, or deprivation-related) and trajectory membership. CONCLUSIONS: ACEs were associated with heterogeneous cognitive-functional aging pathways in a dose-response manner. While social participation was independently linked to more favorable trajectories, it did not buffer the adverse associations between ACEs and trajectory membership.

The authors' abstract, as published at the source. Clinical Gerontologist, 2026 · DOI ↗