The Impact of Childhood Health and Relationships on Well-Being Among Older Adults in China

Background and Purpose: Extensive research has documented the negative impacts of adverse childhood experiences on individual well-being. There continues to be a need to conduct longitudinal data analysis to specify the early life factors that support healthy aging among older adults. Applying the Life Course Perspective, this study aims to connect early life health and relationships with late life well-being. Therefore, we used the China Health and Retirement Longitudinal Study (CHARLS), a nationwide survey of representative residents aged 50 and over to test how childhood health and social relationship indicators affect well-being.

Methods: This study combines data from three datasets: Wave 1 (2011); The Life History Survey Data (2014), and Wave 5 (2020). The study sample (N=9,941) included respondents 50 and over at baseline, without cognitive impairment in the baseline, and still living at Wave 5. Outcome variables were derived from Wave 5 data: (1) Depression (CES-D) and (2) Self-rated memory. We controlled for demographic information (e.g., age, gender), number of chronic diseases, alcohol use, smoking status, and baseline depression and cognitive functioning. We used the following indicators of childhood health and relationships: (1) health status; (2) illness; (3) Vaccination access; (4) starvation and food insecurity; and (5) social relationships (e.g., relationship with parents, friendship, loneliness, neighborhood quality and social cohesion). We used STATA 18 to analyze data and conduct univariate, bivariate (e.g., correlation, chi-square), and multivariate regressions.

Results: Women constituted 52.4% of the sample, and the mean age was 60.2 (SD=6.77). The mean score for depression was 10.53 (SD=6.17). Nearly 90% of the sample rated their memory as “fair/poor,” with a mean of 1.77 (SD=0.75). The multivariate analyses results showed that weak neighborhood quality and social cohesion, poor childhood health status were associated with worse self-reported memory. Meanwhile, having better quality childhood friendships were associated with late-life self-rated memory. Multivariate regression showed several childhood indicators were associated with depression. Individuals with childhood access to food, access to childhood vaccinations, and experienced loneliness in childhood endorsed higher levels of depression. Conversely, better neighborhood quality and social cohesion, having close childhood friends, and access to childhood vaccinations were associated with lower levels of depression.

Conclusions and Implications: This longitudinal study demonstrates the effects of early childhood events on late-life well-being. Access to food during a China-wide famine was a major historical event that affected the study cohort. Childhood social relationships have significant effects on late-life mood and perceived cognitive function. As aging in China accounts for most global aging, public health approaches that stimulate positive childhood memories can have a meaningful protective effect for older adult well-being. A major strength of this study was the use of longitudinal, representative data of Chinese aging that is harmonized for global comparisons. Our findings underscore the global importance of childhood health and social relationships, which are not only those older adults in China but is strongly connected to U.S. populations. Further research is needed to understand the diversity in sociohistorical experiences across global aging populations.