ADVERSE CHILDHOOD EXPERIENCES AND RISK OF HYPERTENSION AMONG MIDDLE-AGED AND OLDER ADULTS IN CHINA: A POPULATION-BASED STUDY

Abstract

Objective: Although the association of ACEs with hypertension has been reported in different contexts, the conclusions remain inconsistent, and few studies have investigated the independent role of threat-related and deprivation-related ACEs on later-life hypertension in the general population. We aimed to examine the association between threat-related and deprivation-related ACEs and incident hypertension and to assess whether demographic characteristics (age, sex) and socioeconomic status (education, occupation, and income) could modify these associations. Design and method: This prospective cohort study used data from the baseline survey (year 2011-2012) and follow-up survey (year 2015) of the China Health and Retirement Longitudinal Study (CHARLS). The study population consisted of middle-aged and older adults with complete data on ACEs and two physical assessments and without hypertension at baseline. The associations of 5 threat-related ACEs (ie, physical abuse, household substance abuse, domestic violence, unsafe neighborhood, and bullying) and 5 deprivation-related ACEs (ie, emotional neglect, household mental illness, incarcerated household member, parental separation or divorce, and parental death) with hypertension were evaluated using Cox proportional hazards regression models. The cumulative scores of the 2 ACE dimensions were calculated and grouped into 3 categories as 0, 1, and 2 or more in main analyses. Results: Of the 7,912 individuals included, the mean (SD) age was 58.65 (8.65) years and 4018 (50.8%) were men. Compared with no exposures, experience of 2 or more threat-related ACEs was associated with higher risk of hypertension (HR = 1.26 [95% CI, 1.03-1.53)]). In addition, compared with those who experienced no deprivation-related exposures, both experience of 1 and 2 or more deprivation-related exposures were associated with hypertension (HR for 1 exposure: 1.32 [1.09-1.55]; HR for 2 or more exposures: 1.65 [1.15-2.31]). These associations were not significantly modified by demographic and socioeconomic characteristics. Conclusions: Both threat-related and deprivation-related ACEs were associated with higher risk of later-life hypertension, independent of demographic and socioeconomic factors. These findings highlight importance of in preventing later-life hypertension among individuals who have experienced ACEs.