Adverse childhood experiences and multimorbidity in adulthood: Findings from the Survey of Health, Ageing and Retirement in Europe (SHARE)

This study investigated the associations between adverse childhood experiences (ACEs), social participation, national health expenditure per capita (NHEPC), and their interactions, with the risk of developing multimorbidity in later life.

Data were from 25,884 adults aged 50+ from 15 countries in the Survey of Health, Ageing and Retirement in Europe (SHARE). ACEs and social participation were measured in 2009 and 2011, respectively. NHEPC (2011) for each country was based on World Bank data, categorized into quartiles. Multimorbidity, defined as two or more conditions (diabetes, cancer, heart disease, stroke, depression), was assessed from 2013 to 2019. Risk ratios (RR) and 95% confidence intervals (CI), nested within countries, were calculated in unadjusted and adjusted (n = 19,030) analyses.

Among those surveyed, 16.3% developed multimorbidity. ACEs, social participation, and NHEPC were each associated with the risk of multimorbidity (adjusted RR = 1.25, p < .001; adjusted RR = 0.90, p = .003; adjusted RR = 1.62 [quartile 1 vs quartile 4], p = .006, respectively). A significant interaction was found, where countries with high NHEPC had a more pronounced association between ACEs and multimorbidity.

ACEs, lower social participation, and lower NHEPC were associated with increased multimorbidity risk. However, higher NHEPC did not protect those with ACEs from developing multimorbidity.