Gender-specific association of adverse childhood experiences with frailty index level and trajectory in China

The determinants of gender differences in frailty remain unknown but may include social factors. International attention is increasingly focusing on the adverse childhood experiences of women. This study therefore examined the gender-specific association of adverse childhood experiences with frailty index level and trajectory.This population-based study used data from the China Health and Retirement Longitudinal Study, with a nationally representative sample of people aged 45 years or more. The frailty index was based on 41 health measurements, and 18 types of adverse childhood experiences were examined. Weighted ordered logistic models were used with additive interaction.Compared with those exposed to one or no adverse events, exposure to two or three childhood adverse experiences was associated with a 44 % (95%CI: 1.16-1.80) increase in the likelihood of frail status for women, but not significantly associated with the likelihood of frail status for men. Additionally, for men and women, experiencing four or more adversities was associated with a 69 % (95%CI: 1.36-2.09) and a 138 % (95%CI: 1.93-2.94) increase in the likelihood of frail status, respectively. A similar association was found between accumulative scores for adverse childhood experiences and trajectory of the frailty index (men vs. women: OR of exposure to two or three adversities: 1.17 (95%CI: 0.84-1.64) vs. 1.26 (95%CI: 1.02-1.56); OR of exposure to four or more adversities: 1.70 (95%CI: 1.24-2.34) vs. 2.12 (95%CI: 1.70-2.63)). The greatest increase in risk of frailty was observed among men and women experiencing a high level of adversity, followed by socioeconomic deprivation and intrafamilial aggression. There was a significant additive interaction between women and childhood socioeconomic deprivation or a high level of adversity. The risk of being frail or having a rapidly increasing frailty index trajectory for women with a high level of adversity was approximately 4.34 (95%CI: 3.36-5.59) and 4·07 (95%CI: 3·34-4.96) times higher than that for men with a low level of adversity. However, gender differences were not found in the effects of childhood intrafamilial aggression.Men and women routinely experienced adult frailty as a result of adverse childhood events. The biological interaction between women and adverse childhood experiences was evident, with women's frailty being more sensitive to childhood socioeconomic deprivation and a high level of adversity. The findings have important implications for reducing the risk of frailty by mitigating early life stress, especially among women.