Childhood Exposure to Multiple Types of Violence and Adult Cardiovascular Disease

Cancan Cui; Lin Liu; Zheng Guo; Jiayin Song; Yulu Zheng; Zhenming Zhang; Ning Han; Yitian Qi; Yuanmei Chen; Chunyan Wang; Chen Sheng; Lois Balmer; Zhijia Wang; LinLin Liu; Zhiyuan Wu

doi:10.1093/eurjpc/zwaf292

Childhood Exposure to Multiple Types of Violence and Adult Cardiovascular Disease

Eur J Prev Cardiol. 2025 May 20:zwaf292. doi: 10.1093/eurjpc/zwaf292. Online ahead of print.

Authors

Cancan Cui¹, Lin Liu¹, Zheng Guo², Jiayin Song¹, Yulu Zheng², Zhenming Zhang¹, Ning Han¹, Yitian Qi¹, Yuanmei Chen¹, Chunyan Wang¹, Chen Sheng³, Lois Balmer⁴, Zhijia Wang¹, LinLin Liu¹, Zhiyuan Wu³

Affiliations

¹ Department of Radiology, China-Japan Union Hospital of Jilin University, Jilin University, Jilin, China.
² Vanderbilt University of Medical Center, Nashville, United States.
³ Harvard T H Chan School of Public Health, Boston, United States.
⁴ School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.

PMID: 40390600
DOI: 10.1093/eurjpc/zwaf292

Abstract

Aims: To explore the associations between childhood experience of violence from parents, siblings, and peers and the subsequent risk of cardiovascular disease (CVD) and to examine whether adult depressive symptoms modify these associations.

Methods and results: This population-based cohort study used data from the China Health and Retirement Longitudinal Study (CHARLS). Childhood exposures to violence from parents, siblings, and peers were assessed through a life history questionnaire. Depressive symptoms were measured using the validated 10-item Center for Epidemiologic Studies Depression Scale. The primary outcome was self-reported, physician-diagnosed CVD. Multivariate Cox proportional hazards models with age as the time scale were used. The study included 11,398 participants, with a mean (SD) age of 58 (9) years, of whom 5622 (49.3%) were men. Among participants, 1101 (9.7%) reported frequent childhood violence exposure, including violence from parents (623, 5.5%), siblings (117, 1.0%), and peers (515, 4.5%). Frequent exposures to violence from parents, siblings, peers, or any type were associated with increased risks of CVD, with hazard ratios (HRs) of 1.23 (95% CI: 1.04-1.45), 1.24 (0.87-1.75), 1.25 (1.05-1.49), and 1.22 (1.06-1.40), respectively. The associations were consistent across subgroups and multiple sensitivity analyses. Adult depressive symptoms mediated 23.0% of the association between frequent exposure to violence and CVD (P for mediation = 0.03).

Conclusion: Childhood exposure to violence from parents, siblings, and peers is associated with an elevated risk of adult-onset CVD. Addressing mental health may help mitigate the long-term CVD risk linked to childhood violence exposure.

Keywords: Cardiovascular disease; Childhood adversity; Depression; Peer bullying; Physical abuse; Violence.

Plain language summary

In a large study of 11,398 participants from the China Health and Retirement Longitudinal Study, we found that experiencing violence during childhood from parents, siblings, or peers was linked to a higher risk of developing cardiovascular disease in adulthood. Individuals exposed to childhood violence were more likely to experience depressive symptoms, which partially explained the link between frequent violence exposure and cardiovascular disease. These findings highlight the need for early interventions within families, schools, and communities to reduce childhood violence and its long-term health consequences.

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