Childhood adversity associated with heightened risk of early death

Experiences of abuse, neglect, or family dysfunction during childhood may have lasting effects on how long people live, especially if they also have chronic health conditions. A new study published in JAMA Pediatrics found that adults with diabetes or hypertension who had experienced adverse childhood experiences faced a significantly higher risk of dying from any cause compared to those without such early-life adversity.

The study provides evidence that childhood adversity may contribute to mortality not only through mental health but also through chronic physical conditions. The findings support the idea that early-life experiences shape biological systems in ways that can increase vulnerability to serious illnesses later on.

“We were motivated by growing evidence that early-life adversity—such as abuse, neglect, or family dysfunction—can leave deep biological and psychological imprints,” said study author Ping-I (Daniel) Lin, an associate professor at Saint Louis University School of Medicine and adjunct associate professor at the University of New South Wales.

“Yet, its long-term impact on overall mortality risk had not been well quantified in large, representative samples. Our team wanted to bridge that gap by investigating how childhood adversity shapes lifelong health trajectories, not only through mental health but also through physical conditions that drive premature death.”

The team aimed to clarify whether adverse childhood experiences, or ACEs, continue to affect health outcomes even after accounting for chronic illnesses. By focusing on adults with diabetes, hypertension, or recent non-severe emergency visits, the researchers hoped to understand how early adversity might contribute to mortality across a range of common medical settings.

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The researchers conducted a retrospective cohort study using data from the TriNetX Analytics Network, a research platform that compiles deidentified health records from over 120 healthcare organizations across the United States. The study included adults aged 30 to 85 who were divided into three groups based on their health records: one group with diabetes, one with hypertension, and one with recent mild-to-moderate emergency department visits.

To isolate the effects of childhood adversity, the researchers excluded individuals with known psychiatric diagnoses such as depression, anxiety, psychosis, or neurodevelopmental disorders. This step was intended to reduce potential overlap between mental health conditions and ACE-related mortality risk.

Participants were further excluded if they had incomplete data, lacked documentation of ACE exposure, or showed extreme values in health biomarkers that might indicate an acute medical crisis. ACE exposure was identified through diagnostic codes reflecting childhood sexual abuse, forced labor, maltreatment, or psychological and physical abuse.

The researchers then tracked all-cause mortality in each group over time. They used statistical models to estimate the risk of death among people with and without documented ACEs, adjusting for age, sex, race, and other health indicators. In the diabetes group, they also accounted for body mass index and hemoglobin A1c levels, which are key markers of metabolic health.

Across all three groups, people with a history of childhood adversity were more likely to die from any cause than those without such a history. The association was strongest among adults with diabetes. In this group, individuals with ACE exposure had a mortality risk more than five times higher than those without ACEs. The hazard ratio was 5.59, meaning they were over five times as likely to die during the study period. This result was statistically significant, with a confidence interval ranging from 3.32 to 9.41.

In the hypertension group, the increase in mortality risk was smaller but still significant. Individuals with ACE exposure had a 74 percent higher risk of death, with a hazard ratio of 1.74. The confidence interval for this group ranged from 1.22 to 2.47.

Among those who had visited an emergency department for mild or moderate medical issues, a group chosen to represent more general or lower-acuity medical encounters, ACE exposure was linked to a 90 percent higher risk of death. The hazard ratio here was 1.90, with a confidence interval of 1.46 to 2.49.

“We were surprised by the magnitude of the mortality risk associated with diabetes among individuals exposed to childhood adversity—it was even higher than for many other major health conditions,” Lin told PsyPost. “This finding suggests that chronic stress in early life may interact with metabolic and inflammatory pathways, amplifying vulnerability to diseases like diabetes that have lifelong consequences. It highlights the complex interplay between psychological trauma and physical health.”

These results suggest that ACEs may contribute to physiological dysfunction and accelerate disease progression, especially in conditions like diabetes that are already affected by inflammation and stress. The patterns were consistent across groups, indicating that ACEs may act as an independent risk factor for early death even when medical conditions are taken into account.

“Childhood adversity is not just an emotional or psychological issue—it is a major determinant of life expectancy,” Lin said. “We found that individuals exposed to adversity in childhood face a significantly elevated risk of premature death, on par with traditional health risk factors like smoking or obesity. This means that preventing and addressing early adversity should be viewed as a public health priority, not just a mental health one.”

But as with all research, there are limitations to consider. One major issue is that ACE exposure was identified through diagnostic codes in health records. Many instances of childhood abuse or neglect go undiagnosed or undocumented, which means the study may have underestimated the true level of ACE exposure. This underreporting could lead to conservative estimates of the effects.

Another limitation is that mortality data came from electronic health records, which may not capture deaths that occurred outside the participating healthcare systems. This could affect the accuracy of the overall mortality rates. The researchers also did not separate different types or severities of ACEs, which might have distinct effects on health outcomes. It is possible that certain forms of early trauma are more strongly linked to long-term health risks than others.

The researchers hope future studies will examine the pathways through which early adversity affects health.

“Our next step is to uncover the biological and social mechanisms linking childhood adversity to early mortality,” Lin explained. “We plan to integrate genetic, inflammatory, and behavioral data to better understand who is most vulnerable—and how protective factors such as social support and emotion regulation might mitigate these risks. Ultimately, we hope this research informs targeted prevention strategies and more personalized mental health and medical care.

The researchers also emphasized that while the risks are real, they are not deterministic.

“Our results do not mean that childhood adversity inevitably leads to early death,” Lin said. “Risk is elevated, but not absolute. Many people show remarkable resilience despite difficult beginnings. Recognizing this nuance is important—it shifts the narrative from blame or fatalism to prevention and the promotion of protective factors that can buffer long-term health risks.”

Still, recognizing the long-term health effects of early trauma may help health professionals identify at-risk individuals.

“This study reinforces that childhood experiences have lifelong consequences for both mind and body,” Lin said. “Investing in early-life mental health support and family well-being should be considered a cornerstone of public health policy—because nurturing resilience early in life may be one of the most powerful ways to extend life itself.”

The study, “Childhood Adversity and All-Cause Mortality Risk,” was authored by Yesh Dhruva, Erick Messias, Yi-Chia Chen, and Ping-I Lin.