How early adversity shapes adult physical health: Structural disadvantage and gendered pathways to cardiovascular...

Adverse childhood experiences (ACEs) are well-established predictors of mental health problems, yet their long-term impact on physical health, especially cardiovascular disease (CVD), remains less well understood. Guided by a life course perspective, this study investigates the association between ACEs and adult CVD risk, with a focus on the mediating role of structural disadvantage and gender-specific pathways.

Using data from Waves I, III, and IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health), we analyzed a sample of 12,224 individuals.

Longitudinal regression models with school fixed effects were used to estimate the association between ACEs and a 30-year Framingham CVD risk score in adulthood. We examined four mediators measured in early adulthood: educational attainment, personal earnings, incarceration history, and unmet healthcare needs. Multivariate bootstrapped mediation models and gender-stratified analyses were conducted.

ACEs were significantly associated with higher CVD risk in adulthood, even after adjusting for individual, familial, and contextual factors. Structural disadvantage, most notably lower educational attainment, partially explained this association. Incarceration history and unmet healthcare needs also served as mediators. Gender-stratified models revealed distinct pathways: incarceration was a stronger mediator among men, while unmet healthcare needs were more salient for women.

Findings underscore the enduring influence of early adversity on adult cardiovascular health and highlight the importance of structural pathways in shaping health trajectories. Policy interventions targeting educational access, healthcare equity, and criminal justice reform, with attention to gender-specific mechanisms, may help mitigate the long-term health burden of childhood adversity.