Social determinants statistically mediate link between childhood adversity and later cardiovascular disease in Chinese cohort

A prospective cohort analysis of middle-aged and older Chinese adults found that greater exposure to adverse childhood experiences was associated with a higher risk of incident cardiovascular disease during follow-up. The association showed a linear dose–response pattern and remained statistically significant after full adjustment, according to the study abstract.

The analysis used data from the China Health and Retirement Longitudinal Study, a nationally representative cohort of adults aged 45 years or older. Researchers assessed cumulative adverse childhood experiences across multiple domains, determined incident cardiovascular disease during follow-up and used Cox proportional hazards regression to estimate associations between childhood adversity and cardiovascular risk. The abstract does not report the cohort size, follow-up duration, effect estimates or uncertainty intervals.

Statistical mediation analyses examined whether an integrated construct of adult social determinants of health accounted for part of the observed association. The social determinants construct mediated a statistically significant proportion of the relationship between cumulative adverse childhood experiences and incident cardiovascular disease. A residual direct association between childhood adversity and cardiovascular disease remained after the mediator was accounted for in the model.

These findings come from an observational study, so the mediation results should not be interpreted as establishing a causal pathway. The abstract also does not provide the individual social determinants included in the construct, details of the adjustment variables, confidence intervals or sensitivity analyses. Its results therefore support an association and a model-based mediation pattern rather than proof that later social conditions transmit the effect of childhood adversity. The findings are reported for middle-aged and older adults in the CHARLS population and may not extend to other age groups, countries or socioeconomic settings.

Subject of Research: Longitudinal analysis of childhood adversity, adult social determinants and incident cardiovascular disease in Chinese adults

Article Title: The mediating role of social determinants of health in the association between adverse childhood experiences and later-life cardiovascular disease

Article References: Shi, Y., & Shen, Y. (2026). The mediating role of social determinants of health in the association between adverse childhood experiences and later-life cardiovascular disease. BMC Public Health. https://doi.org/10.1186/s12889-026-29935-0

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29935-0

Keywords: adverse childhood experiences, cardiovascular disease, social determinants of health, CHARLS, Chinese adults, cohort study, statistical mediation, longitudinal association, mediating, role, social, determinants