To examine whether adverse childhood experiences(ACEs) predict frailty in middle-aged and elderly Chinese adults, and whether social participation or education level moderates this association.

Four waves (2011—2018) of the China Health and Retirement Longitudinal Study were combined with the 2014 life-history module to construct panel data. Based on the Hausman test(χ²=261.490, P<0.001), a fixed-effects model was applied to examine the association between ACEs and frailty, with particular attention to social participation and educational attainment and potential moderating effects.

A total of 9 354 individuals were retained, 61.71% had experienced two or more ACEs, and the prevalence of frailty was 15.01%. A significant positive correlation was observed between ACEs and frailty, with the effect intensifying as the number of ACEs increased (ACEs=2: β=1.45, 95% CI: 0.64~-2.26; ACEs=3: β=2.90, 95% CI: 2.00-3.86; ACEs=4: β=3.52,95% CI: 2.48-4.56). Social participation (β=-0.50, 95% CI: -0.63-0.30) and high school or vocational education (β=-1.71, 95% CI: -2.62-0.80) were cross-sectionally associated with lower frailty. However, neither social participation nor education level significantly moderated the relationship between ACEs and frailty (P>0.05).

Within the middle-aged and elderly population in China, ACEs had been identified as a significant risk factor for the development of frailty. Although both social participation and high school or vocational education were negatively associated with frailty, neither of these factors significantly moderated the relationship between ACEs and frailty.