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

Adverse childhood experiences have been widely documented as being linked to a broad spectrum of chronic diseases in adulthood; however, their long-term implications for gastrointestinal health in later life remain underexplored. Meanwhile, social support may act as an important mediator linking childhood adversity to health outcomes in adulthood, yet the precise mechanisms underlying this relationship are not fully elucidated. Building on existing evidence, this study examined the association between adverse childhood experiences and gastrointestinal diseases while exploring the potential mediating roles of both formal and informal social support. Using data from the China Health and Retirement Longitudinal Study, this study included 6,158 middle-aged and older adults aged 45 years and above. Adverse childhood experiences were operationalized across seven domains, including adverse family environment, family abuse, adverse personal experiences, inadequate healthcare, adverse community conditions, exposure to violence, and peer-related problems, with a cumulative score subsequently constructed to reflect overall exposure. Given the heterogeneity in the sources and forms of social support, this study classified social support into two domains: informal and formal support. Informal social support mainly consisted of financial help, emotional care, daily assistance from family members, and subjectively perceived support. In contrast, formal social support was reflected in participation in community activities and the benefits provided through health insurance. To examine these relationships, the study applied logistic regression to explore how adverse childhood experiences and social support relate to gastrointestinal conditions. In addition, restricted cubic spline models were employed to investigate potential nonlinear effects of adverse childhood experiences exposure on disease risk. Subsequently, interaction and mediation analyses were performed to further examine the role of social support in this association, with adjustment for potential confounders including age, sex, educational attainment, and lifestyle factors. Further sensitivity analyses were conducted to assess the robustness of the exploratory mediation analysis results. Higher Adverse childhood experiences exposure levels were linked to an elevated risk of gastrointestinal diseases, with a clear dose–response association observed. Female participants exhibited a higher risk of gastrointestinal diseases compared to males. Adverse childhood experiences were inversely related to both formal and informal social support. Further analyses suggested that informal social support showed a significant indirect association in the relationship between Adverse childhood experiences and gastrointestinal diseases, indicating a potential mediating role. However, due to the cross-sectional nature of the study, a causal explanation cannot be drawn. Adverse childhood experiences were associated with an increased risk of gastrointestinal diseases and lower levels of informal social support middle-aged and older adults. Informal social support may represent one potential pathway linking Adverse childhood experiences to gastrointestinal health. These findings highlight the importance of adopting a life-course perspective when addressing gastrointestinal health and promoting healthy ageing.