Cao Shiwei, Wu Yao, Niu Tengfei, Chen Xiyu, Xiang Jie, Li Hao, Chen Ziyi, Shi Qianying, Du Yu
The Second Clinical College, Chongqing Medical University, Chongqing, China.
International Medical College, Chongqing Medical University, Chongqing, China.
Front Public Health. 2025 Jul 9;13:1587680. doi: 10.3389/fpubh.2025.1587680. eCollection 2025.
Due to ethical constraints, famines, which can lead to severe malnutrition, are often viewed as natural experiments to assess the impact of early-life nutritional malnutrition on adverse health outcomes in adulthood. However, evidence regarding the effect of early-life famine exposure on later-life physical disability remains scarce. This study aims to investigate the association between early-life famine exposure and physical disability in the Chinese population.
This study is based on survey data from the China Health and Retirement Longitudinal Study released in 2018. Famine exposure was determined based on participants' birth years, and all individuals were categorized into four groups: non-exposed, fetal exposed, preschool exposed, and school-age exposed. Logistic regression analysis was conducted to examine the association between early-life famine exposure and physical disability. Stratified analyses were further performed by gender, residence, and severity of early-life famine exposure.
After adjusting for all covariates, fetal exposure to famine was associated with a 1.57-fold increased risk of severe disability compared to the non-exposed group. Among males, older people with fetal exposure to famine was significantly associated with a 1.69-fold increased risk of severe disability compared to the non-exposed group. Among females, older populations with famine exposure during the school-age period was associated with a 1.52-fold increased risk of severe disability compared to the non-exposed group. In areas with less severe famine exposure, those with fetal exposure was linked to a 1.66-fold increased risk of severe disability compared to the non-exposed group. In areas with more severe famine exposure, older individuals exposed during the preschool period had a 1.57-fold higher risk of mild disability. In rural areas, older adults who were exposed to famine during the fetal period had a 1.65-fold increased risk of severe disability compared to their non-exposed counterparts. In urban areas, those exposed to famine during the preschool period exhibited a 1.63-fold higher risk of mild disability than their non-exposed counterparts.
The findings underscore the critical role of early-life adversity and nutritional status in shaping health outcomes in later life, highlighting the need for public health policies to prioritize nutritional interventions during early developmental stages.
由于伦理限制，饥荒可导致严重营养不良，常被视为评估早年营养不足对成年期不良健康结局影响的自然实验。然而，关于早年饥荒暴露对晚年身体残疾影响的证据仍然稀少。本研究旨在调查中国人群中早年饥荒暴露与身体残疾之间的关联。
本研究基于2018年发布的中国健康与养老追踪调查的调查数据。根据参与者的出生年份确定饥荒暴露情况，所有个体分为四组：未暴露、胎儿期暴露、学龄前暴露和学龄期暴露。进行逻辑回归分析以检验早年饥荒暴露与身体残疾之间的关联。进一步按性别、居住地和早年饥荒暴露严重程度进行分层分析。
在调整所有协变量后，与未暴露组相比，胎儿期暴露于饥荒的严重残疾风险增加了1.57倍。在男性中，胎儿期暴露于饥荒的老年人与未暴露组相比，严重残疾风险显著增加了1.69倍。在女性中，学龄期暴露于饥荒的老年人群与未暴露组相比，严重残疾风险增加了1.52倍。在饥荒暴露较轻的地区，与未暴露组相比，胎儿期暴露者的严重残疾风险增加了1.66倍。在饥荒暴露较严重的地区，学龄前暴露的老年人轻度残疾风险高1.57倍。在农村地区，胎儿期暴露于饥荒的老年人与未暴露的同龄人相比，严重残疾风险增加了1.65倍。在城市地区，学龄前暴露于饥荒的人群轻度残疾风险比未暴露的同龄人高1.63倍。
研究结果强调了早年逆境和营养状况在塑造晚年健康结局中的关键作用，突出了公共卫生政策在早期发育阶段优先进行营养干预的必要性。
