Exposure to Chinese Famine during Early Life Increases the Risk of Fracture during Adulthood

Abstract

This study focused on identifying whether exposure to the Chinese Great Famine (1959–1961) in early life amplified the potential for fractures in adulthood. The survey was conducted using data from the 1997–2015 China Health and Nutrition Survey (CHNS)—5235 adults born between 1954 and 1964 were selected as the sample size. Fracture was defined based on self-report. Those born from 1962–1964 were treated as non-exposure group. Those with exposure to famine were divided into four subgroups: Fetal, early childhood, mid-childhood, and late childhood cohorts. The association between the groups and fracture was determined using Cox regression. In follow-up data (mean of 11 years), fractures were identified in 418 of the participants. The incidence of fracture was 8.7 in late childhood, 8.1 in mid-childhood, 8.3 in early childhood, 7.0 in fetal, and 5.4 in non-exposed cohorts per 1000 person-year. Compared with the non-exposed group, the famine-exposed groups had an increased risk of developing fracture in adulthood with hazard ratio (HR) and 95% CI of 1.29 (0.90–1.85), 1.48 (1.08–2.03), 1.45 (1.02–2.06), and 1.54 (1.08–2.20), respectively. The positive link of famine exposure to risk of fracture occurred primarily in those participants with a modern diet who lived in urban areas. In conclusion, the risk of fracture in Chinese adults is associated with famine exposure.