ORIGINAL RESEARCH article
Front. Public Health
Sec. Life-Course Epidemiology and Social Inequalities in Health
The Association Between Adverse Childhood Experiences and Arthritis: Exploring Behavioral and Psychological Mediators in the Behavioral Risk Factor Surveillance System
Provisionally accepted
- 1Shaoxing Hospital of Traditional Chinese Medicine, Shaoxing, China
- 2First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- 3Yunnan Provincial Hospital of Chinese Medicine, Kunming, China
- 4First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Nankai District, China
- 5Shaoxing Shangyu District Hospital of Traditional Chinese Medicine, Shaoxing City, China
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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 categorys 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.
Keywords: Adverse childhood experiences, Arthritis, BRFSS, Depression, Mediation analysis
Received: 01 Sep 2025; Accepted: 08 Dec 2025.
Copyright: © 2025 Zhou, Shen, Cao, Yu and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jixin Chen
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