Wang Qing
Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250014, Shandong, China; National Institute of Health Data Science of China, Shandong University, Jinan 250014, Shandong, China.
Maturitas. 2023 Apr;170:1-8. doi: 10.1016/j.maturitas.2023.01.011. Epub 2023 Jan 28.
The determinants of gender differences in frailty remain unknown but may include social factors. International attention is increasingly focusing on the adverse childhood experiences of women. This study therefore examined the gender-specific association of adverse childhood experiences with frailty index level and trajectory.
This population-based study used data from the China Health and Retirement Longitudinal Study, with a nationally representative sample of people aged 45 years or more. The frailty index was based on 41 health measurements, and 18 types of adverse childhood experiences were examined. Weighted ordered logistic models were used with additive interaction.
Compared with those exposed to one or no adverse events, exposure to two or three childhood adverse experiences was associated with a 44 % (95%CI: 1.16-1.80) increase in the likelihood of frail status for women, but not significantly associated with the likelihood of frail status for men. Additionally, for men and women, experiencing four or more adversities was associated with a 69 % (95%CI: 1.36-2.09) and a 138 % (95%CI: 1.93-2.94) increase in the likelihood of frail status, respectively. A similar association was found between accumulative scores for adverse childhood experiences and trajectory of the frailty index (men vs. women: OR of exposure to two or three adversities: 1.17 (95%CI: 0.84-1.64) vs. 1.26 (95%CI: 1.02-1.56); OR of exposure to four or more adversities: 1.70 (95%CI: 1.24-2.34) vs. 2.12 (95%CI: 1.70-2.63)). The greatest increase in risk of frailty was observed among men and women experiencing a high level of adversity, followed by socioeconomic deprivation and intrafamilial aggression. There was a significant additive interaction between women and childhood socioeconomic deprivation or a high level of adversity. The risk of being frail or having a rapidly increasing frailty index trajectory for women with a high level of adversity was approximately 4.34 (95%CI: 3.36-5.59) and 4·07 (95%CI: 3·34-4.96) times higher than that for men with a low level of adversity. However, gender differences were not found in the effects of childhood intrafamilial aggression.
Men and women routinely experienced adult frailty as a result of adverse childhood events. The biological interaction between women and adverse childhood experiences was evident, with women's frailty being more sensitive to childhood socioeconomic deprivation and a high level of adversity. The findings have important implications for reducing the risk of frailty by mitigating early life stress, especially among women.
虚弱状态下性别差异的决定因素尚不清楚，但可能包括社会因素。国际社会越来越关注女性童年时期的不良经历。因此，本研究探讨了童年不良经历与虚弱指数水平及轨迹之间的性别特异性关联。
这项基于人群的研究使用了中国健康与养老追踪调查的数据，该调查样本具有全国代表性，涵盖45岁及以上人群。虚弱指数基于41项健康指标，研究了18种童年不良经历。采用加权有序逻辑模型及相加交互作用进行分析。
与经历过一次或未经历不良事件的人相比，经历过两次或三次童年不良经历的女性出现虚弱状态的可能性增加了44%（95%置信区间：1.16 - 1.80），但与男性出现虚弱状态的可能性无显著关联。此外，对于男性和女性，经历四次或更多不良事件分别使出现虚弱状态的可能性增加了69%（95%置信区间：1.36 - 2.09）和138%（95%置信区间：1.93 - 2.94）。童年不良经历累积得分与虚弱指数轨迹之间也存在类似关联（男性与女性相比：经历两次或三次不良事件的比值比：1.17（95%置信区间：0.84 - 1.64）对1.26（95%置信区间：1.02 - 1.56）；经历四次或更多不良事件的比值比：1.70（95%置信区间：1.24 - 2.34）对2.12（95%置信区间：1.70 - 2.63））。在经历高水平逆境的男性和女性中，虚弱风险增加最为显著，其次是社会经济剥夺和家庭内部攻击。女性与童年社会经济剥夺或高水平逆境之间存在显著的相加交互作用。高水平逆境的女性出现虚弱或虚弱指数轨迹快速上升的风险分别比低水平逆境的男性高约4.34倍（95%置信区间：3.36 - 5.59）和4.07倍（95%置信区间：3.34 - 4.96）。然而，童年家庭内部攻击的影响在性别上未发现差异。
男性和女性都因童年不良事件而经常经历成年后的虚弱状态。女性与童年不良经历之间的生物学交互作用明显，女性的虚弱对童年社会经济剥夺和高水平逆境更为敏感。这些发现对于通过减轻早期生活压力来降低虚弱风险具有重要意义，尤其是对女性而言。
