The long-term association of childhood neighborhood quality on cognitive function in later life: the mediating role of domestic violence

BACKGROUND: Dementia and cognitive decline represent pressing public health challenges worldwide, particularly in rapidly aging societies such as China. Evidence from life course epidemiology suggests that early-life adversities—including poor CNQ and CDV—may have long-term consequences for cognitive health. However, the mediating role of CDV in the association between CNQ and later-life cognition remains underexplored. OBJECTIVE: This study aimed to investigate the long-term associations of CNQ on cognitive function and impairment among middle-aged and older adults in China, and to examine whether CDV mediates this association. METHODS: Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS), combining the 2014 Life History Survey with the 2018 follow-up. A total of 10,741 participants aged ≥ 45 years were included. CNQ and CDV (witnessing, parental, and sibling violence) were retrospectively assessed. Cognitive function was measured using tests of orientation, memory, calculation, and drawing, and cognitive impairment was defined at the 22.24th percentile cutoff. Multivariate regression analyses and Karlson-Holm-Breen (KHB) mediation analysis were conducted, adjusting for demographic, socioeconomic, and health-related covariates. RESULTS: Higher CNQ was significantly associated with better cognitive function (β = 0.113, p < 0.001) and lower risk of cognitive impairment (β = −0.065, p < 0.001). CDV was associated with poorer cognitive function (β = −0.083, p < 0.01) and greater risk of cognitive impairment (β = 0.035, p < 0.01). Mediation analysis revealed that parental violence (β = 0.007, p < 0.01) and witnessing violence (β = 0.004, p < 0.1) partially mediated the CNQ–cognitive function relationship, while sibling violence (β = −0.004, p < 0.01) mediated the CNQ–cognitive impairment association. The indirect pathways accounted for 8.33% and 5.80% of the total effects, respectively. CONCLUSIONS: A positive childhood neighborhood quality is associated with better cognitive health in later life, and childhood domestic violence may partially mediate this association. These findings underscore the importance of improving community environments, strengthening family violence prevention, and ensuring equitable access to education and healthcare resources to promote healthy cognitive aging.