Adverse childhood experiences and arthritis risk: exploring behavioral and psychological mediators in the behavioral risk factor surveillance system

Objective: This study examined the association between adverse childhood experiences (ACEs) and arthritis among U.S. adults and explores underlying biological and psychosocial mechanisms using data from the Behavioral Risk Factor Surveillance System (BRFSS). Methods: Data from the 2023 cycle of the BRFSS, managed by the CDC, was utilized to analyze the association between ACEs and arthritis. ACEs were categorized into five groups (0, 1, 2, 3, ≥4). Logistic regression models, adjusted for demographics, socio-economic status, and health behaviors, examined this association. Counterfactual-based mediation analyses estimated the extent to which smoking and depression mediate the ACE-arthritis relationship using logistic regression with 5,000 bootstrap samples. Results: The research included analysis of 32,594 adults, revealing significant differences in arthritis prevalence among individuals with varying categories of ACEs exposure. Higher ACE exposure was associated with increased odds of arthritis in a dose-response manner. In fully adjusted models, participants with ≥4 ACEs had 55% higher odds of arthritis (OR = 1.55, 95% CI: 1.43-1.67) compared with those with no ACEs. Smoking and depression partially mediated this association, accounting for 8.70 and 25.00% of the total effect, respectively. Conclusion: ACEs were associated with higher odds of arthritis, and this association was partially mediated by smoking and depression. The findings underscore the importance of addressing early-life adversity in public health strategies to reduce the long-term risk of arthritis.