Association between early-life exposure to the Great Chinese Famine and poor physical function later in life: a cross-sectional study

Abstract

OBJECTIVES: This study aimed to evaluate the association between early-life exposure to the Great Chinese Famine (1959-1961) and the prevalence of poor physical function in midlife. DESIGN: A population-based historical prospective study was performed as part of a wider cross-sectional survey. Exposure to famine was defined by birthdate, and participants were divided into non-exposed group, fetal-exposed group and infant-exposed group. SETTING AND PARTICIPANTS: A total of 3595 subjects were enrolled into the study from the China Health and Retirement Longitudinal Study (CHARLS) 2015 based on random selection of households that had at least one member aged 45 years old and older in 28 provinces of mainland China. MAIN OUTCOME MEASURES: Physical function status was assessed by a six-item self-report on the Barthel scale which rated basic activities of daily living (BADL). RESULTS: 743 (20.7%) out of all participants were exposed to the Great Chinese Famine in their fetal periods, while 1550 (43.1%) participants were exposed at the age of an infant. The prevalence of poor physical function in the non-exposed group, fetal period-exposed group and infant period-exposed group were 12.3%, 15.5% and 17.0%, respectively. Among males, after stratification by gender and severity of famine, the prevalence of poor physical function in the fetal period was significantly higher (OR 2.40, 95% CI 1.18 to 4.89, p=0.015) than the non-exposed group in severely affected areas, even after adjusting for the number of chronic diseases, place of residence, smoking and alcohol drinking habits, marital status, educational level and body mass index. A similar connection between prenatal and early postnatal exposure to the Great Chinese Famine and the prevalence of poor physical function in midlife, however, was not observed from female adults. CONCLUSIONS: Males who were exposed to the Great Chinese Famine (1959-1961) present considerably decreased physical function in their later life.