Exposure to famine in early life and self-rated health status among Chinese adults: a cross-sectional study from the Chinese Health and Retirement Longitudinal Study (CHARLS)

Unveiling the long-term impact: exploring the link between exposure to the great Chinese famine and health-related quality of life in middle-aged and elderly populations through propensity score matching

OBJECTIVE

This study aimed to explore the relationship between exposure to the Great Chinese Famine (1959-1961) and health-related quality of life (HRQoL) in middle-aged and elderly people after adjusting for selection bias using propensity score matching (PSM).

METHODS

This cross-sectional study was conducted in Ningxia, China, in 2022. A multi-stage stratified cluster-randomized design was used to obtain a representative sample in each county. We included participants aged 45 years and older, who had lived there for more than 1 year. This study included 5,793 middle-aged and elderly people in Ningxia, China as the research subjects. This study used propensity score matching (PSM) to empirically examine the association between exposure to the Great Famine and HRQoL in middle-aged and older adults. In the first step, we estimated a binary logistic regression model with Great Chinese Famine exposure as the dependent variable and 7 factors as confounding variables. In the second step, we performed propensity score analysis using the confounding variables identified in the first step to control for potential selection bias. To avoid bias due to age differences, we introduced the age variable into the regression model to explore the effect of the Great Famine impact. Different definitional criteria were used to define the exposed and control groups in order to robustly test the findings.

RESULTS

The results showed that middle-aged and elderly people who reported exposure to the Great Famine had lower HRQoL than middle-aged and elderly people who were not exposed to the Great Famine, after adjusting for gender, educational background, economic level, BMI, Chronic conditions, smoking and drinking. In order to avoid the influence of age differences on the results, this study used matched samples and included the age variable in the regression analysis to minimise the bias due to age. Also, exposure was defined in different ways to test the robustness of the results.

CONCLUSIONS

The health-related quality of life of middle-aged and older adults who experienced China's Great Famine (1959-1961) declined substantially in later life, but the inclusion of the age variable made the statistical results non-significant.

Exposure to Chinese famine in early life and the risk of multimorbidity in adulthood

OBJECTIVES

Previous studies had reported the association between famine exposure in early life and subsequent non-communicable diseases risk. In current study, we aimed to evaluate the associations between famine exposure on multimorbidity prevalence and incidence in middle-aged and older Chinese population.

METHODS

A total of 13,254 participants from the China Health and Retirement Longitudinal Study 2011 were included in cross-sectional analyses. 5,780 participants were including in longitudinal analyses and were followed up in 2020. Based on the questionnaire, participants were divided into non-exposed, mild famine, moderate famine and severe famine subgroups.

RESULTS

In cross-sectional analyses, both mild, moderate and severe famine groups were significantly associated with higher multimorbidity prevalence. During the 9 years of follow-up, a total of 2,643(45.73%) participants with multimorbidity incident were identified. After adjusting for all covariates, individuals who experienced mild famine, moderate famine and severe famine were significantly associated with increased risk of multimorbidity incident, with the corresponding ORs (95%CI) being 1.32(1.14-1.52), 1.54(1.21-1.96) and 1.62(1.32-1.99), respectively.

DISCUSSION

Our findings indicate that famine exposure in mild, moderate and severe famine groups might be associated with an increased multimorbidity risk.

Risk factors associated with self-rated health among elderly females with different visual abilities in Chinese urban areas: a population-based study

OBJECTIVE

Self-rated health (SRH) has been documented as an important predictor of quality of life among the elderly and its risk factors are vision-specific among elderly males. The aim of this study was to clarify vision-specific risk factors to SRH among elderly females without dementia in Chinese urban areas.

METHODS

From March to November 2012, 2147 elderly women in Liaoning Province of China were selected using a stratified sampling method. After cognitive screening, 1956 participants without dementia were finally enrolled. A questionnaire including SRH, visual ability and factors including demographic characteristics, physical conditions, lifestyle factors, social psychological status and social activities were analyzed. Multivariate logistic regression was used to clarify the association of SRH with risk factors, while stepwise multivariate logistic regression was used to examine the vision-specific associations with SRH.

RESULTS

The mean age was 73.6 ± 5.82 (mean ± SD). The percentages of good SRH in good and impaired visual ability groups were 36.2% and 24.4%, respectively. Most characteristics between elderly females with different visual abilities were significantly different. Visual ability had interactions with physical conditions, lifestyle factors and social activities to affect SRH. Among elderly females with good visual ability, depressive symptoms, rather than chronic disease had the strongest association with good SRH followed by marital status, regular diet, going out alone to distant places, taking a walk, smoking and alcohol consumption. In the impaired visual ability group, going out alone to distant places had the strongest association with good SRH followed by chronic disease, filial piety, taking a walk, participating in entertainment, ethnicity, quality of sleep, worrying about falling and alcohol consumption.

CONCLUSIONS

Good SRH status was at a low level especially among elderly females with impaired visual ability and the risk factors differed between elderly females with different visual abilities. Social psychological status was crucial for SRH among elderly females with good visual ability whereas physical conditions were prominent for impaired visual ability group.

Effect of Receiving Financial Support from Adult Children on Depression among Older Persons and the Mediating Role of Social Participation

Older persons are vulnerable to depression SFduring the ageing process. Financial resources and social participation are expected to have an impact on depressive symptoms. This study investigated the relationship between financial support from children and depression among Chinese older persons, as well as the mediating effect of social participation in this relationship. Data from 7163 participants aged 60 and above were extracted from wave 2015 and 2018 of the China Health and Retirement Longitudinal Survey (CHARLS). A multivariate regression analysis was performed on both cross-sectional data and two-wave longitudinal data to test our hypotheses. The results revealed that financial support from children was negatively associated with depressive symptoms in both the short-term and the long-term. In addition, this relationship was partially mediated by social participation in the short-term association and fully mediated by social participation in the long-term, where financial support was positively related to social participation, and social participation was negatively associated with depressive symptoms. This study offers an in-depth insight into the relationship between financial support from children and depression among Chinese older persons. Policies and initiatives to stimulate social participation should be promoted to improve older persons' mental health.