Adverse Childhood Experiences, Neurocognitive Functions, and Long-Term Mortality Risk.

Importance: Higher intellectual abilities have been associated with lower mortality risk in several longitudinal cohort studies. However, these studies did not fully account for early life contextual factors or test whether the beneficial associations between higher neurocognitive functioning and mortality extend to children exposed to early adversity.

Objective: To explore how the associations of child neurocognition with mortality changed according to the patterns of adversity children experienced.

Design, Setting, And Participants: The Collaborative Perinatal Project (CPP) is a US pregnancy cohort study conducted at 12 US academic medical centers among children born between 1959 and 1966. Pregnant women at participating centers were invited to enroll in the study, and their offspring were followed up for assessments of neurocognition and mortality risk. The CPP offspring cohort was linked to the National Death Index to ascertain their later vital status. Analyses were conducted in August 2024 and June 2025.

Exposure: Nine neurocognitive test scores captured children's visual-motor, sensory-motor, auditory-vocal, intelligence quotient (IQ), and academic skills.

Main Outcome And Measure: All-cause mortality between 1979 and 2016.

Results: Among the 49 853 CPP offspring, about half were male (25 226 offspring [50.6%]). A total of 23 331 (46.8%) mothers were Black, 3739 (7.5%) were other races, and 22 783 (45.7%) were White Eight of the 9 neurocognitive scores were associated with the risk of mortality, with each SD higher score in neurocognition associated with 9% (auditory-vocal association function hazard ratio [HR], 0.91; 95% CI, 0.88-0.95) to 15% (full-scale IQ HR, 0.85; 95% CI, 0.81-0.88) lower mortality risk. Full scale and performance IQ and arithmetic skills were associated with an 11% (IQ HR, 0.91; 95% CI, 0.82-0.96) to 23% (arithmetic skills HR, 0.77; 95% CI, 0.72-0.83) lower mortality risk for children exposed to low adversity, crowded housing and poverty, and/or family instability, but not for those exposed to severe patterns of adversities.

Conclusions And Relevance: This large US cohort study found that most childhood neurocognitive functions were associated with lower risk of premature mortality through middle adulthood, although the associations of some neurocognitive functions were diminished in the context of exposure to complex patterns of adversity. Thus, developing strong neurocognitive skills may foster long-term health resilience.