Supplementary Material for: Associations of Adverse Childhood Experiences with Frailty in Older Adults: A Cross-Sectional Analysis of Data from the Canadian Longitudinal Study on Aging

Introduction: Frailty in older adults, characterized by a decline in multiple physiological systems and increasing vulnerability to loss of independence, disability, and death, is a public health priority in developed countries. Etiology of frailty extends across the lifespan and may begin in early life, but empirical evidence for this association is scarce. In this study, we examined whether adverse childhood experiences (ACEs) are associated with frailty in later life. Methods: We conducted a cross-sectional analysis of data for a population-based sample of 27,748 adults aged 45–85 years from the Canadian Longitudinal Study on Aging. The frailty index (FI) was computed with 76 health-related characteristics of physical and cognitive performance, self-rated health, chronic conditions, visual and hearing ability, activities of daily living, and well-being. Self-reported exposure to ACEs included physical, emotional, and sexual abuse, neglect, and witnessing intimate partner violence prior age of 16 and parental death, divorce, and living with a family member with mental illness prior age of 18. Generalized linear regression models with gamma error distribution and identity link function, adjusted for age and sex, were used to examine associations of each ACE type and the number of ACE types (0, 1, 2, or 3+) reported by an individual with FI. All models were adjusted for income, education, smoking, and alcohol consumption in sensitivity analysis. Results: Individuals exposed to ACEs had elevated levels of FI (mean = 0.13, SD = 0.09) than those unexposed, with the largest difference observed for neglect (B [95% CI]: 0.05 [0.04, 0.06]) and the smallest for parental death and divorce (0.015 [0.01,0.02]). The ACE count was associated with frailty in a graded manner, with the FI difference reaching 0.04 [0.037, 0.044] for participants exposed to 3+ ACE types. The association between ACEs and frailty tended to be stronger for women than men and for men aged 45–64 years than older men. Conclusions: Our study supports previous studies showing that exposure to ACEs is associated with frailty in adults. Our findings suggest that screening for ACEs involving childhood maltreatment may be useful for identifying individuals at risk of frailty and prevention of ACEs may have long-term benefits for healthy aging.引言：老年衰弱综合征（Frailty）是以多生理系统衰退、对丧失独立能力、残疾与死亡的易感性逐步升高为特征的病症，在发达国家已成为公共卫生重点关注议题。衰弱的病因贯穿整个生命周期，甚至可始于生命早期阶段，但此类关联的实证证据仍较为匮乏。本研究旨在探讨儿童期不良经历（Adverse Childhood Experiences, ACEs）与晚年衰弱是否存在关联。方法：本研究针对加拿大老龄化纵向研究（Canadian Longitudinal Study on Aging）中27748名年龄介于45至85岁的人群代表性样本数据开展横断面分析。通过纳入76项与健康相关的特征——包括躯体与认知功能、自评健康状况、慢性疾病、视听能力、日常生活活动能力以及幸福感——计算得到衰弱指数（Frailty Index, FI）。本研究定义的自我报告式儿童期不良经历包括：16岁前遭受躯体虐待、情感虐待、性虐待、忽视，以及目睹亲密伴侣暴力；18岁前经历父母离世、父母离异，或与患有精神疾病的家庭成员共同生活。本研究采用服从伽马误差分布且连接函数为恒等函数的广义线性回归模型，在校正年龄与性别因素后，分别检验各类儿童期不良经历、以及个体报告的不良经历数量（0、1、2或3种及以上）与衰弱指数的关联。在敏感性分析中，所有模型进一步校正了收入、受教育水平、吸烟与饮酒情况。结果：暴露于儿童期不良经历的个体，其衰弱指数水平（均值=0.13，标准差=0.09）显著高于未暴露人群；其中差异最为显著的为忽视经历（回归系数B[95%置信区间]：0.05[0.04, 0.06]），差异最小的为父母离世与离异经历（0.015[0.01, 0.02]）。儿童期不良经历的数量与衰弱程度呈剂量-反应梯度关联：暴露于3种及以上不良经历的参与者，其衰弱指数差值可达0.04[0.037, 0.044]。儿童期不良经历与衰弱的关联在女性群体中强于男性，在45至64岁男性群体中强于老年男性。结论：本研究验证了既往研究中关于儿童期不良经历暴露与成年期衰弱存在关联的结论。本研究结果提示，针对儿童期虐待相关不良经历的筛查，或可用于识别衰弱高风险人群；而预防儿童期不良经历，或将对健康老龄化产生长期益处。