The Effect of Early Adverse Health Experiences on Trajectories of Health-Related Quality of Life: Evidence from the China Health and Retirement Longitudinal Study

Background and purpose: Enhancing the trajectories of health-related quality of life (HRQoL) among middle-aged and older adults is essential to addressing the challenges of population aging, particularly in mitigating the irreversible and progressive decline in physical and mental functioning. Guided by the critical period model, early-life experiences and environments are believed to have lasting effects on health trajectories across the life course. However, limited research has examined the long-term effect of childhood health-related experiences, especially those involving the health conditions of family members, which may be closely linked to HRQoL trajectories later in life. This study aims to address this gap by examining the effects of early adverse health experiences on HRQoL trajectories among middle-aged and older adults.

Methods: Data were drawn from five waves (2011–2021) of the China Health and Retirement Longitudinal Study (CHARLS), including retrospective data from the 2014 life history survey. CHARLS is a nationally representative longitudinal study designed to support interdisciplinary research on aging. HRQoL was measured using a newly constructed scale based on items from the SF-36 and CHARLS, comprising two components: the Physical Component Score (PCS) and the Mental Component Score (MCS). This scale has demonstrated good reliability and validity in the Chinese population. Early adverse health experiences were assessed using six indicators: for respondents: (1) prolonged bed rest, (2) extended hospitalization, and (3) frequent hospitalizations (more than three times within a year) before age 15; for caregivers: (4) long-term illness, (5) severe physical disability, and (6) mental illness. Respondents were coded as having experienced early health adversity if they answered “yes” to any of the six items. Latent Growth Curve Modeling was employed to estimate HRQoL trajectories and assess the impact of early adverse health experiences, while controlling for relevant childhood and adulthood covariates.

Results: A total of 8,721 respondents (M = 57.76 years old, SD = 8.29; gender ratio: 1.11) were included in this study. Early adverse health experiences were significantly associated with lower HRQoL levels in later life. Adverse health experiences of female caregivers (PCS: b = -1.49, p < .005; MCS: b = -3.16, p < .005), male caregivers (PCS: = -1.71, p < .005; MCS: = -2.15, p < .005), and the respondent themselves (PCS: = -2.30, p < .005; MCS: = -3.63, p < .005) were all associated with significantly lower HRQL levels. In addition, early adverse health experiences of female ( = -1.19, p < .05) and male caregivers ( = -1.53, p < .05) were significantly related to a steeper decline in MCS trajectories.

Conclusions and Implications: Improving the trajectories of HRQoL among middle-aged and older adults requires a life-course perspective. The significant long-term effect of early adverse health experiences highlights the importance of early-life interventions. Policies should prioritize equitable distribution of economic and social resources, particularly for disadvantaged children and families.