童年逆境对我国中老年人健康的多重影响:单一、累积和组合效应

Multiple Impacts of Adverse Childhood Experiences on Health among Middle-Aged and Older Adults:Single,Cumulative and Combined Effects

研究基于中国健康与养老追踪调查(CHARLS)数据,考察了中老年人经历童年逆境的异质性,利用潜类别分析方法识别出中年人和老年人内部存在五类童年逆境组合的子群体。在此基础上,采用多元回归方法分析了童年逆境对中老年多维度健康的单一、累积和组合效应,并比较了其对不同生命阶段多维度健康影响的变化和差异性。研究发现,身体/精神虐待、相对贫困等童年逆境对心理健康的影响作用在老年期更加凸显;童年逆境对中年人各个健康维度都存在累积的负面效应,相对于常规型童年逆境的中年人,其他4类童年逆境组合中年人的健康状况较差;受死亡选择效应的影响,经历多种童年逆境与没有经历童年逆境的老年人的ADL和IADL并没有呈现显著差异,甚至在不同童年逆境组合的老年人ADL状况中,出现“队列倒置”现象,即相对于常规型老年人,身体/情感虐待型和父母身心障碍型的老年人的ADL状况反而更好。

Based on the data of China Health and Retirement Longitudinal Survey(CHARLS),this paper examines the heterogeneity of adverse childhood experiences among middle-aged and older adults,and identifies the subgroups with five combinations of adverse childhood experiences(ACEs)in the middle-aged population and the elderly population by using latent class analysis(LCA).On this basis,the multiple regression result has indicated that the single,cumulative and combined effects of ACEs on the multi-dimensional health of the middle-aged and elderly,and compared the changes and differences of its impact in the life course.It has found that the impacts of some ACEs on mental health are more prominent in the elderly,such as physical/mental abuse,relative poverty,etc;ACEs have significant and cumulative negative impacts on all health dimensions of the middle-aged population;compared with the normative class of ACEs,the health status of the middle-aged population with the other four classes of ACEs combinations is poor;affected by mortality selection effects,there is no significant difference in ADL and IADL between the elderly who have experienced various childhood adversities and those who have not experienced any childhood adversity.Even in the elderly population with different combinations of ACEs,there is a“cohort inversion”phenomenon,that is,compared with the elderly population of the normative class,the ADL status of the population of the physical/emotional abuse class and the parental physical and mental disorder class is better.