Association of parental adverse childhood experiences and educational level with offspring mortality: findings from the China Health and Retirement Longitudinal Study

Background
Despite growing interest in the intergenerational impacts of adversity, evidence on the association between parental adverse childhood experiences (ACEs) on offspring mortality remains limited, and the potential mediating role of parental education is underexplored.

Objectives
To investigate associations of parental ACEs with offspring mortality, and to explore whether parental educational level mediates these associations.

Participants and setting
This cross-sectional study included 6052 fathers (corresponding to 15,493 offspring) and 6679 mothers (corresponding to 17,687 offspring) from the 2014 life history survey of the China Health and Retirement Longitudinal Study.

Methods
Data on parental exposure to 12 ACEs, educational levels, and offspring mortality were collected via questionnaire. Multilevel logistic regression models were constructed to examine the associations of paternal and maternal ACEs with offspring mortality, respectively. Mediation analyses were conducted using generalized structural equation models.

Results
Parents with four or more ACEs had the highest odds of offspring mortality compared to those with no ACEs (paternal ACEs: odds ratio [OR] = 1.98, 95 % confidence interval [CI] [1.44, 2.74]; maternal ACEs: OR = 1.98, 95 % CI [1.52, 2.57]). Parental educational level partially mediated these associations, accounting for 23.8 % and 35.3 % of the total effects for paternal and maternal ACEs, respectively.

Conclusions
Both paternal and maternal ACEs were intergenerationally associated with increased risk of offspring mortality, with part of the association explained by parental educational disadvantage. These findings underscore the need for trauma-informed, family-based interventions that support both mothers and fathers with ACE histories, and for policies that promote educational equity.