He Ping, Luo Yanan, Ding Ruoxi, Zheng Xiaoying
China Center for Health Development Studies, Peking University, Beijing, China.
Department of Global Health, School of Public Health, Peking University, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China.
Soc Sci Med. 2022 Dec;314:115487. doi: 10.1016/j.socscimed.2022.115487. Epub 2022 Nov 1.
Very limited studies focused on the early-life adversities on infectious diseases. Taking the Great Chinese famine as a natural experiment, this study re-evaluated the long-term effect of prenatal famine exposure on infectious diseases by using nationally representative data.
Using difference-in-difference (DID) models, we analyzed 215,216 adults who participated in the Second National Sample Survey on Disability in 2006 across 734 counties of China to detect the effects of prenatal exposure to the Great Chinese Famine on the risk of infectious diseases in adulthood. Infectious diseases were ascertained by using the combination of self-reports or family members' reports and on-site medical diagnosis by experienced specialists, and the severity of famine was measured by the cohort size shrinkage index (CSSI) at the county level.
All DID estimates of the effects of famine on the probability of infectious diseases were insignificant, with a coefficient of 0.0007 (-0.0024, 0.0026) for all participants and coefficients of 0.0001 (-0.0041, 0.0043) and -0.0002 (-0.0036, 0.0033) for males and females, respectively. That is, the famine cohort dwelling in regions with a greater intensity of famine had similar levels of infectious disease risks than the cohorts with post-famine prenatal exposure experience in less affected famine regions. Furthermore, there were no significant famine and post-famine cohort differences in the DID estimates by examining the variations in subgroups with different types of infectious diseases (trachoma, poliomyelitis, tuberculosis, maternal infections and other infectious diseases).
No significant impact of prenatal exposure to the Chinese famine was observed on the risk of infectious diseases in adulthood. Famine survivors may be "cured" by the famine and were resilient to adverse environments in their life course because selective mortality may weaken the association between adverse prenatal exposure and later health.
关注早期生活逆境对传染病影响的研究非常有限。本研究以中国大饥荒作为自然实验，利用全国代表性数据重新评估产前饥荒暴露对传染病的长期影响。
我们使用双重差分（DID）模型，分析了2006年参与第二次全国残疾人抽样调查的215,216名成年人，这些成年人来自中国734个县，以检测产前暴露于中国大饥荒对成年后传染病风险的影响。传染病通过自我报告或家庭成员报告与经验丰富的专家现场医学诊断相结合的方式确定，饥荒的严重程度通过县级队列规模缩减指数（CSSI）来衡量。
饥荒对传染病患病概率影响的所有DID估计均不显著，所有参与者的系数为0.0007（-0.0024，0.0026），男性和女性的系数分别为0.0001（-0.0041，0.0043）和-0.0002（-0.0036，0.0033）。也就是说，居住在饥荒强度较大地区的饥荒队列与受饥荒影响较小地区有产后产前暴露经历的队列相比，传染病风险水平相似。此外，通过检查不同类型传染病（沙眼、脊髓灰质炎、结核病、孕产妇感染和其他传染病）亚组的差异，在DID估计中没有发现显著的饥荒和产后队列差异。
未观察到产前暴露于中国饥荒对成年后传染病风险有显著影响。饥荒幸存者可能因饥荒而“治愈”，并且在其生命历程中对不利环境具有复原力，因为选择性死亡可能会削弱产前不良暴露与后期健康之间的关联。
