Lu Liyong, Li Sicheng, Chen Ting, Zhang Wenqiang, Gao TianFu, Lan Tianjiao
Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, Shandong, China.
Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China.
Soc Sci Med. 2025 Jan;364:117528. doi: 10.1016/j.socscimed.2024.117528. Epub 2024 Nov 16.
Previous research has explored the links between later-life health and various childhood conditions, such as socioeconomic status, adverse childhood experiences, and trauma. However, numerous other childhood life circumstances and their relative significance have yet to be examined. This study investigated the association between childhood life circumstance factors and chronic diseases among middle-aged and elderly individuals.
Participants were sourced from the China Health and Retirement Longitudinal Study (CHARLS), a nationwide survey spanning 2011 to 2020. This study utilized 42,181 observations from 16,681 middle-aged and older adults, averaging around 60 years of age. Females constituted 58.12% of the sample. We examined 50 life circumstance factors across six domains: childhood socioeconomic status, wartime experiences during childhood, childhood health, childhood trauma, childhood relationships, and parental health. Data on these factors were derived from CHARLS's 2014 life history survey, alongside chronic disease and demographic information obtained from baseline surveys in 2011 and subsequent follow-ups through 2020. Chronic disease status relied on self-reported physician diagnoses. Logistic regression was employed to investigate the association between childhood life circumstance factors and adult chronic disease status. The study utilized the Least Absolute Shrinkage and Selection Operator (LASSO) method to identify significant factors, followed by quantile g-computation (QGC) to assess their relative importance. Additionally, the K-Means cluster method was used to categorize individuals based on similar childhood life circumstances, exploring susceptibility to chronic diseases within these subpopulations using logistic regression, LASSO, and QGC analyses.
Of the 42,181 observations from 16,681 middle-aged and older adults, over 71.36% reported chronic diseases. Out of the 50 childhood life circumstance factors examined, 17 were found to have a statistically significant positive association with chronic diseases. LASSO identified 20 factors with non-zero coefficients, with parental deformity emerging as the most significant contributor to chronic disease development, accounting for 23.50% of the variance according to QGC. Four distinct subpopulations were identified, with Subpopulation 1 representing the most disadvantaged group.
Our findings underscored the enduring impact of childhood life circumstances on chronic disease development later in life, with parental deformity identified as the most influential childhood factor. The most disadvantaged subpopulation includes individuals with higher prevalence of health problems during childhood, born during wartime, and with parents having a history of health issues.
以往研究探讨了晚年健康与各种童年状况之间的联系，如社会经济地位、童年不良经历和创伤。然而，许多其他童年生活环境及其相对重要性尚未得到研究。本研究调查了中年和老年个体童年生活环境因素与慢性病之间的关联。
参与者来自中国健康与养老追踪调查（CHARLS），这是一项涵盖2011年至2020年的全国性调查。本研究使用了来自16681名中年及以上成年人的42181份观察数据，平均年龄约为60岁。女性占样本的58.12%。我们考察了六个领域的50个生活环境因素：童年社会经济地位、童年时期的战争经历、童年健康状况、童年创伤、童年人际关系以及父母健康状况。这些因素的数据来自CHARLS 2014年的生活史调查，以及从2011年基线调查和随后至2020年的随访中获得的慢性病和人口统计学信息。慢性病状况依赖于自我报告的医生诊断。采用逻辑回归研究童年生活环境因素与成人慢性病状况之间的关联。该研究利用最小绝对收缩和选择算子（LASSO）方法识别显著因素，随后采用分位数g计算（QGC）评估其相对重要性。此外，使用K均值聚类方法根据相似的童年生活环境对个体进行分类，通过逻辑回归、LASSO和QGC分析探索这些亚人群中慢性病的易感性。
在来自16681名中年及以上成年人的42181份观察数据中，超过71.36%的人报告患有慢性病。在所考察的50个童年生活环境因素中，有17个与慢性病存在统计学上显著的正相关。LASSO识别出20个系数非零的因素，父母残疾是慢性病发展的最主要因素，根据QGC，其占变异的23.50%。识别出四个不同的亚人群，亚人群1代表最弱势的群体。
我们的研究结果强调了童年生活环境对晚年慢性病发展的持久影响，父母残疾被确定为最具影响力的童年因素。最弱势的亚人群包括童年时期健康问题患病率较高、战时出生且父母有健康问题史的个体。
