Association of adverse childhood experiences with total and disability-free life expectancy in later life: a nationwide multi-state life table analysis

Background Adverse childhood experiences (ACEs) can trigger long-term health deficits, whereas their overall impact on disability-free longevity remains underexplored. This study aimed to examine the association of ACEs with functional disability and mortality, thus quantifying their effects on total life expectancy (TLE) and disability-free LE (DFLE). Methods The China Health and Retirement Longitudinal Study (CHARLS) was a nationwide cohort established in 2011 and followed up until 2020. we included 11,033 individuals aged ≥ 45 years with data on ACEs and Activities of Daily Living (ADL) at baseline and during follow-ups. ACEs were assessed retrospectively via 20 items as 6 subtypes. Cumulative ACE burden was defined as counts of ACE subtypes (0–6) and further classified as low (0–4) and high ACE burden group (≥ 5). Functional disability was defined as difficulty in ≥ 1 ADL item. Multi-state life table (MLST) was adopted to estimate TLE and DFLE related to ACE burden. Modification by sociodemographic characteristics was assessed via stratified analyses. Results Of individuals included, the median age was 57.0 years, 49.7% were men, and 82.9% were identified as disability-free. Higher ACE burden was associated with elevated risks of disability and premature death. TLE was 46.0 years for low ACE burden versus 38.2 years for high ACE burden, of which 31.7 years (69.0%) and 23.4 years (61.3%) were spent disability-free, respectively. Childhood violence exhibited the strongest impact among all subtypes, with odds ratio (OR) and 95% confidence interval (CI) of 1.39 (1.29–1.51) for transition to disability and 1.37 (1.08–1.75) for transition to death from a disability-free state. Significant interactions by sex ( P _interaction =0.03) and marital status ( P _interaction =0.01) were observed, heightening the vulnerability of women and married/partnered participants. Conclusions For middle-aged and older Chinese, high ACE burden was associated with reduced longevity and enlarged healthspan-lifespan gap, emphasizing the importance of preventing ACEs to promote healthy aging.