The association between adverse childhood experiences and frailty among middle-aged and older adults in Rural South Africa

• We examined the association between adverse childhood experience and frailty. • Adverse childhood experience was related to a higher frailty burden in later life. • More attention should be paid to improving early life conditions. Adverse childhood experiences (ACEs) negatively impact later physical and mental health. However, evidence is lacking in low- and middle-income countries. We examined the association between ACEs and frailty among middle-aged and older adults in rural South Africa. We included 3,825 respondents aged ≥40 years who participated in the survey, Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in rural South Africa (HAALSI). We included four ACEs: (1) parental unemployment for more than 6 months, (2) parents who argued or fought often, (3) parents who drank, did drugs, or had mental health problems, and (4) parental physical abuse. Frailty was measured by the Fried’s frailty phenotype approach using five criteria: slowness, weakness, exhaustion, inactivity, and shrinking. We assessed the independent association between each ACE and frailty using multinomial logistic regression. Having experienced parents arguing or fighting often was significantly associated with frailty (prevalence ratio [PR]=1.62, 95%CI: 1.06-2.48). After adjusting for age and sex, we found a positive association between parents unemployed for 6 or more months and frailty (PR=1.48, 95%CI: 1.00-2.19). People having two or more ACEs were positively associated with frailty in the unadjusted (PR=1.63, 95%CI: 1.07-2.47) and adjusted models (PR=1.60, 95%CI: 1.05-2.45) relative to those having only one ACE. ACEs were associated with a higher burden of frailty among middle-aged and older adults in rural South Africa. Future studies utilizing individual-centered statistical techniques such as cluster analysis and latent class analysis might be considered to offer a more in-depth understanding of the relationships between ACEs and frailty.