Multi-State Analysis of the Impact of Childhood Starvation on the Healthy Life Expectancy of the Elderly in China

Impact of access to childhood health services on healthy life expectancy of the older population

Background

Life course theory provides new perspectives on the impact of early experiences on health in old age, where unfortunate childhood experiences can alter an individual's health trajectory. This study aims to calculate the healthy life expectancy of the older population in China under different childhood experiences, and to explore the influence of childhood medical and health services on the health level of older adults.

Methods

Differences in healthy life expectancy of the older population under different childhood experiences were analyzed using the multi-state life table method to calculate the healthy life expectancy by sex and place of birth, based on the cohort data of Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018.

Results

The probability of the transition risk from health to non-health gradually increased with age, while the probability of the transition risk from non-health to health decreased with age; In both urban and rural areas, on the probability of the transition risk from health to non-health, the older adults who were able to receive timely medical and health services in childhood were lower than those who failed to receive medical services in time (Z = -5.833, P < 0.05), but the probability of the transition risk from non-health to health was the opposite (Z = -5.334, P < 0.05); The probability of the transition risk from health to death is also higher in older adults who were unable to receive timely medical care in childhood (Z = -5.88, P < 0.05); The healthy life expectancy and its proportion in the remaining life expectancy of older people who received medical and health services in time during childhood were significantly higher than those of their peers (Z = -5.88, P < 0.05).

Conclusions

The lack of medical services in childhood has a negative effect on the health of older adults. The healthy life expectancy and its proportion of remaining life expectancy were higher for rural older adults than for urban older adults under the same health care conditions in childhood; the health benefits of good access to health care environment or conditions in childhood were greater for rural older females.

Early socioeconomic status, social mobility and cognitive trajectories in later life: A life course perspective

Using the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018 accompanied by the growth curve model, we examined the association between early socioeconomic status, social mobility, and divergent cognitive trajectories in later life within a society undergoing significant transformation. The study confirmed a positive relationship between socioeconomic status in early life and cognitive ability in later life. However, socioeconomic status in adulthood is associated with better cognitive ability in old age compared to that in childhood. Meanwhile, upward social mobility mitigates the negative correlation between socioeconomic disadvantage in early life and cognitive ability in later life. In addition, the inequality in socioeconomic status at earlier stages resulted in heterogeneous cognitive trajectories, with the double cumulative disadvantage effect resulting from education being particularly noteworthy. Thus, Chinese health policy should focus on the earlier stages of life, actively promoting inclusive family policies and improving the family's role in protecting childhood from an adverse environment. Simultaneously, education and employment fairness should be strengthened to accelerate social mobility and enhance the "Health Repair Mechanism" of the second life course.

A positive association between hunger in childhood and frailty in old age: Findings from the Chinese longitudinal healthy longevity survey

Background

Childhood hunger not only directly affects the physical and mental health of children and adolescents but also has a long-term negative effect on later health outcomes. In this cross-sectional study, we used a nationally representative Chinese sample to examine the relationship between hunger in childhood and frailty in older adults.

Materials and methods

The data were obtained from the 2018 Chinese Longitudinal Healthy Longevity Survey. The frailty index with 44 health deficits was used to identify frailty. Childhood hunger was measured by the question “Did you often go to bed hungry as a child?” Insurance status was categorized as New Rural Cooperative Medical Scheme (NRCMS), Urban Basic Medical Insurance Scheme (UBMIS), others, and no insurance. Multivariate logistic regression analysis was performed to estimate the adjusted relationship between childhood hunger and frailty.

Results

A total of 7,342 older people aged 65 years and older were analyzed in this study. Older people who experienced childhood hunger were more likely to have frailty than those who did not (OR = 1.13, 95% CI: 1.02–1.26), after adjustment for sociodemographic characteristics, family/social support, socioeconomic status, insurance status, and health behaviors. The association of childhood hunger with frailty was found in the 65–79 years group (OR = 1.21, 95% CI: 1.03–1.43), women (OR = 1.25, 95% CI: 1.08–1.45), individuals with rural residence (OR = 1.16, 95% CI: 1.03–1.31), agricultural work (OR = 1.16, 95% CI: 1.00–1.34), financial dependence (OR = 1.18, 95% CI: 1.02–1.37), and those participating in NRCMS (OR = 1.35, 95% CI: 1.16–1.56). Participants with hunger in childhood who were 80 years or older (OR = 0.80, 95% CI: 0.65–0.98) had lower odds of frailty. NRCMS (OR = 1.42, 95% CI: 1.02–1.98) showed increased odds of childhood hunger-related frailty.

Conclusion

Exposure to hunger during childhood is linked to frailty among older adults, and age, financial support, and insurance status may mediate this relationship. Targeted interventions and policies to address frailty in older adults should be implemented.