Lifelong Stress Tied to Higher Risk of Nine Chronic Diseases in Chinese Adults

Middle-aged and older adults in China who experienced stressful life events both as children and as adults carried a higher risk of developing several chronic diseases, according to a prospective cohort study drawing on the China Health and Retirement Longitudinal Study (CHARLS). The research, published in Archives of Public Health, examined how the timing and accumulation of stressful life events across the life course relate to the onset of 14 incident chronic diseases, including diabetes, stroke, chronic lung disease, kidney disease and psychiatric illness.

The analysis included 13,806 middle-aged and older adults. Researchers classified participants into four exposure trajectories based on whether they reported stressful life events in childhood, in adulthood, in both periods, or in neither. Using Cox proportional hazards models, the team estimated trajectory-specific hazard ratios for each of the 14 chronic diseases, with people reporting no exposure serving as the reference group. The study then quantified dose-response associations between the cumulative number of stressful events in childhood and in adulthood and incident disease, and separately examined associations for specific types of stressful life events.

Persistent exposure, meaning stressful events reported in both childhood and adulthood, was associated with the broadest pattern of elevated disease risk. Compared with the no-exposure group, this trajectory showed increased risks of diabetes (HR = 1.17, 95% CI: 1.01–1.39), chronic lung disease (HR = 1.45, 95% CI: 1.27–1.67), liver disease (HR = 1.39, 95% CI: 1.14–1.68), stroke (HR = 1.45, 95% CI: 1.22–1.74), kidney disease (HR = 1.53, 95% CI: 1.30–1.79), digestive disease (HR = 1.20, 95% CI: 1.05–1.36), psychiatric disease (HR = 1.41, 95% CI: 1.10–1.82), memory-related disease (HR = 1.31, 95% CI: 1.08–1.60), and arthritis or rheumatism (HR = 1.41, 95% CI: 1.25–1.58). A hazard ratio above 1 indicates a higher rate of new disease diagnoses over follow-up relative to the unexposed group, while the confidence intervals describe the range of values compatible with the data.

The kidney disease association produced the largest point estimate among the nine diseases linked to persistent exposure, with a hazard ratio of 1.53. Stroke and chronic lung disease each showed hazard ratios of 1.45, followed by psychiatric disease and arthritis or rheumatism at 1.41 and liver disease at 1.39. Diabetes carried the smallest elevation, at 1.17, though its confidence interval sat just above the threshold of no association. Because the estimates come from an observational cohort, they describe associations between reported stress exposure and later diagnoses rather than proven causal effects.

Childhood-only and adulthood-only exposure were also associated with increased disease risk, though to varying degrees and across different disease outcomes. This pattern suggests that stress occurring in a single life period may still matter for health, but that the combination of early-life and adult stressors was linked to the widest range of incident conditions in this population. The authors note that the four-trajectory design allowed them to distinguish people whose exposure was confined to one life stage from those reporting repeated or continuing stress across decades.

In the cumulative exposure analyses, each additional stressful life event reported in childhood or in adulthood was associated with increased risks of nine chronic diseases. This dose-response pattern indicates that the relationship between stress burden and disease risk was not limited to a simple exposed-versus-unexposed comparison; instead, the number of events accumulated over the life course tracked with progressively higher observed risk. The study did not report a threshold beyond which additional events conferred no further elevation, and the findings apply to the middle-aged and older Chinese adults included in CHARLS rather than to younger populations or other countries.

The 14 chronic diseases covered in the analysis were self-reported incident diagnoses captured through the CHARLS surveys, which follow community-dwelling adults across successive waves. The cohort design means participants were free of the counted conditions at baseline and were followed forward in time, strengthening the temporal ordering between reported stressful life events and new diagnoses compared with cross-sectional studies. Nevertheless, retrospective recall of childhood events introduces the possibility of reporting error, and unmeasured factors such as health behaviors, socioeconomic conditions or genetic susceptibility may contribute to the observed associations.

The authors conclude that among middle-aged and older Chinese adults, different exposure trajectories and the cumulative burden of stressful life events in childhood and adulthood were associated with increased risk of multiple diseases. They suggest that life-course stress exposure may be a relevant target for chronic disease prevention, framing the results as evidence that determinants beyond conventional risk factors deserve attention as the global burden of chronic disease continues to rise. The study was published as open access on 15 October 2026 under the journal’s early-release provision, which shares peer-reviewed, accepted research ahead of final version-of-record edits.

Subject of Research: Associations of life-course trajectories and cumulative burden of stressful life events with the risk of 14 incident chronic diseases in middle-aged and older Chinese adults

Article Title: Trajectories and cumulative burden of stressful life events in life-course with the risk of 14 incident chronic diseases: a prospective cohort study

Article References: Pan, Y., Jing, X., Che, F., Qi, S., & Zhang, N. (2026). Trajectories and cumulative burden of stressful life events in life-course with the risk of 14 incident chronic diseases: a prospective cohort study. Archives of Public Health. https://doi.org/10.1186/s13690-026-02097-6

Image Credits: AI Generated

DOI: 10.1186/s13690-026-02097-6

Keywords: stressful life events, chronic disease, life-course epidemiology, CHARLS, cohort study, hazard ratio, childhood adversity, adult stress, diabetes, stroke, kidney disease, dose-response