童年逆境对中老年人失能轨迹的影响

The Effects of Adverse Childhood Experiences on Disability Trajectory among Middle-Aged and Older Adults

童年是个体生理功能发育的敏感期和关键期,这一时期所经历的风险环境暴露可能会导致后续生命阶段的一系列不良后果,从而产生风险连锁反应,对中老年人的身体健康产生影响,这被称为“童年的长臂”。文章基于2011-2018年中国健康与养老追踪调查的四期数据以及2014年的生命历程调查数据,采用组基轨迹模型估计中老年人随年龄增长的失能变化轨迹,发现我国中老年人的日常生活自理能力受损轨迹遵循“低起点缓慢上升型”和“高起点快速上升型”两种类型;其工具性日常生活自理能力受损轨迹呈现出“低起点缓慢上升型”“中起点快速上升型”和“高起点加速上升型”三种类型。通过使用Heckman两阶段估计方法对死亡选择性进行控制,探讨童年逆境与中老年人失能轨迹之间的关系。童年时期经历父母长期卧病在床、健康状况较差等逆境与晚年更不利的失能轨迹相关;童年逆境累积数量对中老年人失能轨迹具有显著的直接和间接影响,经历童年逆境数量越多,中老年人的生活自理能力受损概率起点更高、恶化速度更快;社会经济地位和成年期健康状况在二者关系中发挥了显著的中介效应。“潜伏期模型”和“路径模型”共同解释了童年逆境对我国中老年人失能轨迹的影响机制。

Childhood is a sensitive and critical period for the development of an individual’s physiological function.The exposure to the risk environment experienced during this period may lead to a series of adverse consequences in the subsequent life stages,thus leading to a chain reaction of risks and affecting the health of the middle-aged and older adults,which is called the“long arm of childhood”.Based on data from four-wave(2011-2018)the China Health and Retirement Longitudinal Study(CHARLS)and its2014 Life History Survey,this article uses a group-based trajectory modeling approach to estimate disability trajectories over time among middle-aged and older adults.It is found that trajectories of damaged activity of daily living among middle-aged and older adults in China follows two types:“starting low and rising slowly”and“starting high and rising quickly”.Trajectories of damaged instrumental activity of daily living present three types:“starting moderate and rising quickly”,“starting low and rising slow”and“starting high and remaining stable”.The paper explores relations of the adverse childhood experiences(ACEs)to membership in trajectory groups by using Heckman’s two-stage estimation method to control mortality selection.For the middle-aged and older adults whose parents’long-term illness on bed and poor health in childhood are associated with more unfavorable trajectories.The cumulative number of ACEs has a significant direct and indirect impact on the disability trajectory of middle-aged and older adults.The more the number of ACEs,the higher starting point of damage probability and the faster deterioration rate of activity of daily living among middle-aged and older adults.Socioeconomic status and adult health status play a significant mediating role in the relationship between the two.The“latency model”and the“pathway model”together explain the mechanism of the impact of ACEs on the trajectory of disability among middleaged and elderly in China.