The study used data from the China Health and Retirement Longitudinal Study and included adults aged 45 years and above. Investigators assessed childhood adversity across seven domains: adverse family environment, family abuse, adverse personal experiences, inadequate healthcare, adverse community conditions, exposure to violence and peer-related problems. Responses across these domains were combined into a cumulative score intended to capture participants’ overall exposure to adverse childhood experiences.

To distinguish among possible forms of support, the researchers divided social support into informal and formal categories. Informal support included financial help, emotional care and daily assistance from family members, as well as participants’ subjective sense of being supported. Formal support was measured through participation in community activities and access to benefits provided through health insurance. The analysis was designed to determine whether these support measures were associated with gastrointestinal conditions and whether they statistically mediated the relationship with childhood adversity.

Logistic regression was used to assess relationships among adverse childhood experiences, social support and gastrointestinal disease. Restricted cubic spline models were also applied to investigate potential nonlinear associations between adversity and disease risk. Interaction and mediation analyses examined the roles of the two support domains, with adjustments for age, sex, educational attainment and lifestyle factors. The investigators also conducted sensitivity analyses to assess the robustness of the exploratory mediation results.

The principal finding was that higher levels of adverse childhood experiences were associated with an elevated risk of gastrointestinal diseases, with the clearest pattern appearing across increasing adversity exposure levels. Female participants had a higher risk of gastrointestinal disease than male participants in the analysis. The study also found that childhood adversity was inversely related to both informal and formal social support, indicating that participants reporting more adverse experiences tended to report less support in both categories.

Informal support showed a significant indirect association in the relationship between adverse childhood experiences and gastrointestinal disease. This statistical result suggests that lower levels of family assistance, emotional care, practical help and perceived support may form part of the pathway connecting childhood adversity with gastrointestinal health in later life. The finding concerns associations observed in the model rather than a demonstrated biological or causal mechanism. The supplied research summary does not report numerical effect sizes, confidence intervals, gastrointestinal disease definitions or the magnitude of the indirect association through informal support.

The cross-sectional design is the study’s central limitation. Childhood adversity, social support and gastrointestinal disease were analyzed in relation to one another rather than tracked prospectively from childhood through later adulthood. As a result, the analysis cannot determine the temporal sequence among adversity, support and illness, and it cannot establish that reduced informal support transmitted the effect of childhood adversity. Statistical adjustment and sensitivity analyses can address some measured confounding, but unmeasured influences and reverse causation remain possible explanations that the design cannot exclude.

Within those limits, the findings connect cumulative childhood adversity with gastrointestinal health and social support in a large population of Chinese adults aged 45 and older. The results support examining childhood experiences and social relationships together when studying health in later life, while the exploratory mediation analysis identifies informal support as a possible statistical pathway that merits further investigation. Longitudinal research would be needed to evaluate the sequence and mechanisms underlying the observed relationships.

Subject of Research: Exploratory analysis of childhood adversity, social support and gastrointestinal disease among Chinese adults aged 45 and older

Article Title: Associations of adverse childhood experiences and social support with gastrointestinal disease among middle-aged and older Chinese adults: an exploratory mediation analysis

Article References: Wei, M., Wei, L., Li, X., Wang, J., Qiu, W., Liu, M., Deng, J., She, Z., & Yang, L. (2026). Associations of adverse childhood experiences and social support with gastrointestinal disease among middle-aged and older Chinese adults: an exploratory mediation analysis. BMC Public Health. https://doi.org/10.1186/s12889-026-29617-x

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29617-x

Keywords: adverse childhood experiences, gastrointestinal disease, social support, informal support, health ageing, dose-response association, mediation analysis, cross-sectional study, China Health and Retirement Longitudinal Study, Associations, adverse, childhood