Famine Exposure Has Disease‐Specific, Age‐Specific and Sex‐Specific Effects on Different Non‐Communicable Diseases in Later Life: Longitudinal Evidence From China

ABSTRACT

Malnutrition is a major global challenge with both short‐ and long‐term health impacts. Studies of historical famines have provided evidence of an association between famine exposure and risk of non‐communicable diseases (NCDs) in later life. However, whether famine exposure has heterogeneous effects on different later‐life NCDs remains unclear. In this study, we investigated whether the effects of exposure to the Chinese Famine of 1959–1961 on later‐life NCDs were disease‐specific, age‐specific, and sex‐specific. We conducted a secondary analysis of data from a large‐scale, nationally representative panel study, i.e., the China Health and Retirement Longitudinal Study (CHARLS, 2011–2020, N  = 11,047 adults aged 45 years and older). We measured famine exposure using self‐reported famine experience, life stage using age at famine exposure, and NCDs using 14 chronic conditions. Three main findings emerged. First, the effects of famine exposure for developing NCDs in later life were disease‐specific, with 20%–29% higher odds of digestive disease, memory‐related disease, arthritis, kidney disease and dyslipidemia, versus 10% higher odds of heart disease and diabetes. Second, the effects of famine exposure were age‐specific, with exposure in utero or at ages 0–2 years having the largest impacts on 8 of the 14 later‐life conditions (diabetes, stroke, lung disease, liver disease, digestive disease, cancer, kidney disease, and arthritis), whereas exposure at ages 3–5 years having the largest impact on psychiatric disease and memory‐related disease in later life. Conversely, famine exposure during adulthood was associated with lower odds of various NCDs. This divergence reflects a balance of competing forces: for individuals exposed prior to adulthood, severe developmental damage overshadows the healthy survivor effect, increasing later‐life NCD risk; for individuals exposed during adulthood, completed physiological development minimized programming damage, allowing the healthy survivor effect to dominate. Third, the famine effects were sex‐specific for later‐life cardiometabolic diseases (dyslipidemia, heart disease and stroke), with famine exposure having larger impacts on women than men, pointing to the survivor advantage among men. Future studies should investigate underlying biological mechanisms, intergenerational pathways of transmission, and long‐term growth and body composition in survivors.