Adverse childhood and adult experiences, intrinsic capacity decline, and subsequent physical-psychological-cognitive multimorbidity: a prospective cohort study from China

BACKGROUND: Life-course adversities are important determinants of unhealthy aging. Intrinsic capacity (IC) may capture early functional vulnerability before disease onset, but evidence linking adverse childhood and adulthood experiences (ACEs and AAEs) to IC and later physical-psychological-cognitive multimorbidity (PPC-MM) remains limited. This study aimed to examine whether ACEs and AAEs are associated with intrinsic capacity and subsequent PPC-MM in a nationally representative cohort. METHODS: We analyzed 2,559 middle-aged and older adults from the China Health and Retirement Longitudinal Study who were free of multimorbidity at baseline. ACEs and AAEs were assessed retrospectively. IC was constructed across cognitive, locomotor, psychological, sensory, and vitality domains and treated as the primary outcome. PPC-MM was examined as a secondary outcome using Cox regression and multistate models. RESULTS: Higher cumulative ACE exposure was significantly associated with lower IC (β = -0.04 per additional ACE; 95% CI -0.07 to -0.00), whereas AAEs showed no significant association with IC. Among specific adversities, childhood physical abuse was strongly associated with reduced IC (β = -0.12; 95% CI -0.22 to -0.02). Both ACEs and AAEs were independently associated with increased risks of PPC-MM. Each additional ACE increased the hazard of PPC-MM by 19% (HR 1.19; 95% CI 1.06-1.33), while each additional AAE increased risk by 18% (HR 1.18; 95% CI 1.03-1.34). Individuals exposed to both ACEs and AAEs exhibited the highest risk of physical-psychological multimorbidity (HR 1.77; 95% CI 1.28-2.46). Multistate analyses showed that multimorbidity accumulated progressively, most commonly transitioning from physical-psychological combinations to PPC-MM. CONCLUSION: Childhood adversity is associated with reduced intrinsic capacity in later life, reflecting early functional vulnerability, while both childhood and adulthood adversities contribute to downstream multimorbidity. These findings support IC as an early, adversity-sensitive marker linking life-course stress to multimorbidity and highlight opportunities for upstream intervention to promote healthy aging.