The life course impact of adverse childhood experiences on chronic pulmonary disease: the roles of inflammatory response and social buffering

Background and Objectives: Identifying modifiable risk factors for chronic lung diseases (CLDs) is crucial for promoting healthy aging, preventing disease progression, and improving the quality of life for affected individuals. We aimed to assess the association between 2 types of adverse childhood experiences (ACEs) and CLDs, considering inflammation and childhood friendships. Research Design and Methods: = 12 542, aged ≥45 years), with data on ACEs, high-sensitivity C-reactive protein (hs-CRP), childhood friendship, and CLDs collected at baseline. Logistic regression was used to examine the associations between ACEs, childhood friendship, and CLDs. Generalized structural equation modeling was conducted to assess the mediating effects of hs-CRP on the ACE-CLD associations. Results: Compared to no threat-related ACEs, exposure to 1 (OR = 1.16) or ≥2 (OR = 1.47) threat-related ACEs was associated with increased odds of CLDs; exposure to 1 (OR = 1.47) or ≥2 (OR = 1.53) deprivation-related ACEs was also associated with increased odds of CLDs. Hs-CRP could account for 3.0% of the threat-related ACE-CLD association. Among participants with deprivation-related ACEs, compared to 0 points for childhood friendship, 1, 2, and 3 points could decrease 19% (0.81; 0.58, 1.12), 22% (0.78; 0.57, 1.07), and 45% (0.55; 0.40, 0.77) in CLDs, respectively. The additive and multiplicative interaction between childhood friendship and deprivation-related ACEs on CLDs was statistically significant. Discussion and Implications: Both threat-related and deprivation-related ACEs were associated with the increased odds of CLDs. Hs-CRP could partially mediate the relationship between threat-related ACEs and CLDs. Good childhood friendships could mitigate the risk of CLDs related to deprivation-related ACEs.