Associations of Adverse Childhood Experiences and Childhood Socioeconomic Status with Cognitive Impairment in Middle-Aged and Older Adults: The Mediating Role of Lifestyle

Tian Jianing; Yu Hongyan; Zhu Tingfei

doi:10.16719/j.cnki.1671-6981.20260515

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Journal of Psychological Science ›› 2026, Vol. 49 ›› Issue (5) : 1192-1203. DOI: 10.16719/j.cnki.1671-6981.20260515

Social，Personality & Organizational Psychology

Associations of Adverse Childhood Experiences and Childhood Socioeconomic Status with Cognitive Impairment in Middle-Aged and Older Adults: The Mediating Role of Lifestyle

Tian Jianing ¹ ,
Yu Hongyan ¹^,^** ,
Zhu Tingfei ²

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Abstract

Cognitive impairment has become an increasingly pressing public health concern in aging populations, particularly in low- and middle-income countries. Emerging evidence indicates that adverse childhood experiences (ACEs) and childhood socioeconomic status (SES) may leave enduring biological and psychosocial imprints, shaping cognitive trajectories throughout the life course. However, the independent and combined contributions of ACEs and childhood SES to cognitive impairment in later life remain inadequately characterized, and the underlying mechanisms linking early-life adversity to subsequent cognitive decline are poorly understood. Addressing these gaps is critical for identifying modifiable pathways and informing interventions aimed at preserving cognitive health across the lifespan.

This longitudinal study used data from the China Health and Retirement Longitudinal Study (CHARLS). A total of 4964 adults aged ≥45 years without baseline cognitive impairment were included and followed for a median of 8.9 years. ACEs were retrospectively assessed using ten indicators from the 2014 life history survey, and childhood SES was measured based on parental education and childhood family economic conditions. Cognitive impairment was identified using a validated composite measure covering episodic memory, orientation, numerical ability, and visuospatial function. Lifestyle factors, including smoking, alcohol consumption, sleep duration, and social participation, were combined into a composite lifestyle score. Cox proportional hazards models were applied to estimate the independent and joint associations of ACEs and childhood SES with incident cognitive impairment. Both additive and multiplicative interactions were tested. Additionally, subgroup analyses were conducted according to sex, age, residence, marital status, educational level, and activities of daily living to explore potential effect modification. Causal mediation analysis under a counterfactual framework was further performed to assess the mediating role of lifestyle behaviors.

During follow-up, 889 participants (17.9%) developed cognitive impairment. Compared with individuals without ACEs, exposure to 1-2 ACEs was associated with an 18% higher risk of cognitive impairment (HR = 1.18, 95% CI: 1.01-1.37, p <.05), whereas exposure to three or more ACEs was associated with a 36% higher risk (HR = 1.36, 95% CI: 1.10-1.68, p <.01). Relative to high childhood SES, middle childhood SES was associated with a 22% increased risk of cognitive impairment (HR = 1.22, 95% CI: 1.04-1.42, p <.05), and low childhood SES conferred an even greater increase in risk of 38% (HR = 1.38, 95% CI: 1.15-1.66, p =.001). Joint exposure to ≥3 ACEs and low childhood SES was associated with the highest risk of cognitive impairment (HR = 2.00, 95% CI: 1.38-2.90, p = <.001), although no significant additive or multiplicative interactions were observed. Mediation analyses indicated that lifestyle partially mediated the associations of both ACEs and childhood SES with cognitive impairment, with sleep duration emerging as a significant individual mediator in the ACEs pathway. Subgroup analyses revealed that the association between ACEs and cognitive impairment did not differ significantly across any subgroup (all p for interaction >.05). In contrast, a significant interaction was observed for childhood SES in the sex subgroup (p for interaction =.036), indicating that low childhood SES was more strongly associated with cognitive impairment in females. Both ACEs and low childhood SES independently increase the risk of cognitive impairment among middle-aged and older Chinese adults. Lifestyle behaviors were found to partially mediate these associations, indicating that adopting healthier behaviors in adulthood—such as maintaining adequate sleep, engaging in social activities, and avoiding harmful habits—may attenuate, though not fully eliminate, the long-term cognitive consequences of early-life adversity.

These results underscore the dual importance of addressing early-life risk factors and promoting life-course-oriented lifestyle interventions. Integrating early preventive strategies with sustained behavioral modifications throughout adulthood may provide a comprehensive approach to mitigating cognitive decline and supporting healthy aging in populations at risk.

Key words

childhood adversity / socioeconomic status / cognitive function / lifestyle / mediation effect

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Tian Jianing , Yu Hongyan , Zhu Tingfei. Associations of Adverse Childhood Experiences and Childhood Socioeconomic Status with Cognitive Impairment in Middle-Aged and Older Adults: The Mediating Role of Lifestyle[J]. Journal of Psychological Science. 2026, 49(5): 1192-1203 https://doi.org/10.16719/j.cnki.1671-6981.20260515

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