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Original article Associations between adverse childhood experiences and diabetes among middle-aged and older Chinese: a social-ecological perspective
Siyu Zhu1orcid , Leying Hou1orcid , Jiaying Ma1orcid , Shuting Li1orcid , Weidi Sun1orcid , Wen Liu1orcid , Jiajun Hao1orcid , Wenhan Xiao1orcid , Siqing Cheng1,2orcid , Dexing Zhang3orcid , Dong Zhao4orcid , Peige Song1orcid
Epidemiol Health 2023;e2023071
DOI: https://doi.org/10.4178/epih.e2023071 [Accepted]
Published online: August 2, 2023
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1School of Public Health and Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
2The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
3JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
4Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
Corresponding author:  Dong Zhao,
Email: peigesong@zju.edu.cn
Peige Song,
Email: peigesong@zju.edu.cn
Received: 12 April 2023   • Revised: 27 June 2023   • Accepted: 2 July 2023

This study examined the associations between adverse childhood experiences (ACEs) and diabetes within a social-ecological framework, incorporating personal and environmental unfavorable conditions during childhood from family, school, and community contexts.
Data were obtained from the China Health and Retirement Longitudinal Study (2014 life history survey and 2015 survey), including 9179 participants aged ≥45 years. ACEs were collected through self-report questionnaires, and participants were categorized based on the number of distinct ACEs experienced (0, 1, 2, 3, or ≥4 ACEs). Diabetes was defined by biomarkers, self-reported diagnosis, and treatment status. Logistic regression was conducted to explore the associations between ACEs and diabetes. Subgroup analyses were conducted by gender, age, and obesity status.
Compared with participants without ACEs, those exposed to any ACE (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.01-1.40), 3 ACEs (OR, 1.32; 95% CI, 1.07-1.62) and ≥4 ACEs (OR, 1.29; 95% CI, 1.07-1.56) had an increased risk of diabetes. For each additional ACE, the risk of diabetes increased by about 5%. Regarding the source of ACEs, those originating from the family (OR, 1.23; 95% CI, 1.08-1.41) were associated with diabetes. In terms of specific ACE types, family members with substance abuse (OR, 1.23; 95% CI, 1.01-1.52), emotional abuse (OR, 1.28; 95% CI, 1.12-1.46), and poor parental relationship (OR, 1.25; 95% CI, 1.09-1.43) were associated with diabetes.
ACEs, particularly those originating from the family, were associated with diabetes. Interventions aimed at preventing and mitigating ACEs are essential for the early prevention of diabetes.

Epidemiol Health : Epidemiology and Health