Adverse childhood experiences and trajectories of multimorbidity in individuals aged over 50: Evidence from the English Longitudinal Study of Ageing

Background: Adverse childhood experiences (ACE) are important for chronic diseases yet their association with multimorbidity remains understudied. Few studies consider the complexity of multimorbidity or observe multimorbidity development over time. Objective: We investigated whether ACE were associated with multimorbidity at baseline and over a 12 -year follow-up period. Participants and setting: 5326 participants aged over 50 were obtained from the English Longitudinal Study of Ageing (ELSA). Methods: An ACE summary score was derived using eight ACE items measuring abuse, social care, and household dysfunction. From repeated measurements of 29 chronic conditions over a 12 -year period (2008-2019) we derived two multimorbidity measures: number of chronic diseases and number of chronic disease categories. We used multinomial logistic regression to assess associations between ACE and both measures. Mixed effects models were estimated to examine trajectories of multimorbidity by ACE over time. Results: Graded associations between ACE and multimorbidity were observed. Compared to those without ACE, participants with >= 3 ACE had three times the risk of having >= 3 chronic diseases (RRR 3.06, 95 % CI 1.85-5.05) and falling into >= 3 chronic disease categories (RRR 2.93 95 % CI 1.74-4.95). Graded associations persisted during 12 -year follow-up, though differences in multimorbidity between those with >= 3 ACE and those without ACE remained constant (B 0.02, 95 % CI 0.01-0.03, and B -0.01, 95 % CI - 0.02-0.00, number of chronic conditions and chronic condition categories respectively). Conclusion: ACE are associated with multimorbidity risk and complexity, associations arising before the age of 50. Early intervention amongst those with ACE could attenuate this association.