Association of Childhood Adversity With Frailty and the Mediating Role of Unhealthy Lifestyle: A Lifespan Analysis

Gan Yang, Xingqi Cao, Jie Yu, Xueqin Li, Liming Zhang, Jingyun Zhang, Chao Ma, Ning Zhang, Qingyun Lu, Chenkai Wu, Xi Chen, Emiel O. Hoogendijk, Thomas M. Gill, Zuyun Liu

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Objectives: Childhood adversity and lifestyle have been associated with frailty in later life, but not much is known about factors that may explain these associations. Therefore, this study aims to investigate the association of childhood adversity with frailty, and the mediating role of unhealthy lifestyle in the association. Methods: This lifespan analysis included 152,914 adults aged 40–69 years old from the UK Biobank. We measured childhood adversity with five items: physical neglect, emotional neglect, sexual abuse, physical abuse, and emotional abuse through online mental health survey. Frailty was measured by the frailty index; an unhealthy lifestyle score (range: 0–5) was calculated based on unhealthy body mass index, smoking, alcohol consumption, physical inactivity, and unhealthy diet at the baseline survey. Multiple logistic regression and mediation analysis were performed. Results: A total of 10,078 participants (6.6%) were defined as having frailty. Participants with any childhood adversity had higher odds of frailty. For example, in the fully adjusted model, with a one-point increase in cumulative score of childhood adversity, the odds of frailty increased by 38% (odds ratio: 1.38; 95% Confidence Interval: 1.36, 1.40). Unhealthy lifestyle partially mediated the associations of childhood adversity with frailty (mediation proportion: 4.4%–7.0%). The mediation proportions were largest for physical (8.2%) and sexual (8.1%) abuse. Conclusions: Childhood adversity was positively associated with frailty, and unhealthy lifestyle partially mediated the association. This newly identified pathway highlights the potential of lifestyle intervention strategies among those who experienced childhood adversity (in particular, physical, and sexual abuse) to promote healthy aging.
Original languageEnglish
Pages (from-to)71-82
Number of pages12
JournalAmerican Journal of Geriatric Psychiatry
Issue number1
Early online date2023
Publication statusPublished - Jan 2024


  • Aging
  • childhood adversity
  • frailty
  • lifestyle
  • mediation analysis

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