Adverse childhood experiences, social participation and multimorbidity risk in Europe

BACKGROUND: Adverse childhood experiences (ACEs) are linked to multimorbidity, but evidence from longitudinal research on potential macro and micro-level protective factors is lacking. We investigated the associations between ACEs, social participation, national health expenditure, and their interactions, with the risk of developing multimorbidity in later life. METHODS: Data from 25,885 adults aged 50+ from 15 countries in the Survey of Health, Ageing and Retirement in Europe (SHARE) were analyzed. ACEs (separation from parents, household dysfunction, hunger, property loss) and social participation (community, political, religious, or charity participation) were measured in Waves 3 (2009) and 4 (2011), respectively. Multimorbidity was defined as the simultaneous presence of two or more conditions (diabetes, cancer, heart disease, stroke, depression) in Waves 5-8 (2013-2019). Country-level health expenditure per capita (2011) was included. Multilevel logistic regression models nested within countries tested associations and interactions in unadjusted and adjusted (n = 14,478) analyses. RESULTS: 16.3% developed multimorbidity, 19.3% reported ACEs, and 47.7% were socially active in their communities. ACEs, social participation, and health care expenditure were each uniquely associated with the odds of incident multimorbidity, and results held when adjusting for sociodemographic and lifestyle factors (OR = 1.32, 95% CI = 1.18,1.47; OR = 0.86, 95% CI = 0.78, 0.94; OR = 0.9998, 95% CI = 0.9997,0.9999, respectively). Multiple imputation for missing covariates demonstrated similar results. No significant interactions were found. CONCLUSIONS: ACEs were associated with increased multimorbidity risk, and although social participation and health expenditure were associated with lower risk, they did not mitigate the impact of ACEs. Policies aimed at preventing ACEs and promoting social participation among older adults may be beneficial in reducing the risk of multimorbidity in later life. KEY MESSAGES: • ACEs are associated with an increased risk of multimorbidity in later life. • While social participation and greater national health expenditure are associated with lower multimorbidity risk, these factors do not mitigate the impact of ACEs.