The impact of adverse childhood experiences on the development of multimorbidity in older adults in Nigeria.

BACKGROUND: Adverse Childhood Experiences (ACEs) are established life-course determinants of adult health, yet evidence linking ACEs to multimorbidity in sub-Saharan Africa remains limited. Nigeria is undergoing rapid demographic and epidemiological transitions characterized by population ageing and a rising burden of non-communicable diseases (NCDs). This study examined whether cumulative ACE exposure predicts multimorbidity among older adults in North-Central Nigeria. METHODS: A cross-sectional study was conducted among 734 adults aged ≥60 years in Niger State, Nigeria. ACE exposure before age 18 was assessed using the Adverse Childhood Experiences International Questionnaire (ACE-IQ) across 13 domains. Multimorbidity was defined as the presence of two or more chronic conditions (NICE criteria) from a list of 24 conditions and analyzed both as a count and dichotomized (≥3 vs. < 3 conditions). Descriptive statistics summarized participant characteristics. Chi-square tests examined bivariate associations. Hierarchical logistic regression models estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to determine independent predictors of multimorbidity. RESULTS: High cumulative ACE exposure was observed, with 68.4% reporting ≥4 ACEs. Multimorbidity was common: 38.4% reported three or more chronic conditions. ACE exposure was strongly associated with multimorbidity (χ² = 116.07, p < 0.001). In unadjusted analysis, participants reporting ≥4 ACEs had significantly higher odds of multimorbidity (OR = 67.14; 95% CI: 9.25-487.04). After adjusting for socio-demographic covariates, cumulative ACE exposure remained an independent predictor (OR = 15.58; 95% CI: 1.33-182.21). Advanced age (≥80 years) and living in three-generation households were also independently associated with multimorbidity. CONCLUSIONS: Cumulative childhood adversity significantly predicts multimorbidity among older Nigerian adults, demonstrating a clear dose-response relationship. These findings underscore the importance of life-course approaches and trauma-informed strategies in public health policy. Early identification and prevention of childhood adversity may contribute to reducing the long-term burden of multimorbidity in low- and middle-income settings.