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Association between the Great China Famine exposure in early life and risk of arthritis in adulthood
  1. Zhenghe Wang1,
  2. Zhiyong Zou1,
  3. Bin Dong1,
  4. Jun Ma1,
  5. Luke Arnold2
  1. 1 School of Public Health and Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing, China
  2. 2 Population Health, South Western Sydney Primary Health Network, Sydney, New South Wales, Australia
  1. Correspondence to Dr. Bin Dong and Professor Jun Ma, School of Public Health & Institute of Child and Adolescent Health, Peking University, Beijing 100191, China; bindong{at}, majunt{at}


Background The association between famine exposure in early life and risk of arthritis (combination of osteoarthritis and inflammatory arthritis) in adulthood is unclear. The aim of this study is to explore the association.

Methods A total of 4124 subjects were selected from the national data of the China Health and Retirement Longitudinal Study in 2011–2012. Doctor-diagnosed arthritis was self-reported in participants’ questionnaire. Birthdates were used to categorise participants into famine-exposed and non-exposed groups. Logistic regression model was used to explore the association of famine exposure in early life with the risk of arthritis in adulthood.

Results The prevalence of arthritis in both infant-exposed and preschool-exposed groups was significantly higher than those in the non-exposed group (35.0% and 30.6% vs 27.3%; p<0.05). Compared with the non-exposed group, the infant-exposed group showed a significantly elevated risk of arthritis in adulthood after adjusting for confounding factors (OR=1.65; 95% CI 1.29 to 2.11; p<0.001). In the stratified analysis, we found that participants who lived in severely affected areas (OR=1.91; 95% CI 1.41 to 2.59; p<0.001), who are female (OR=2.21; 95% CI 1.57 to 3.11; p<0.001) and those with a body mass index ≥24.0 kg/m2 (OR=2.46; 95% CI 1.70 to 3.55; p<0.001) in the infant-exposed group had increased risk of arthritis in adulthood. Similar results were additionally observed when age-balanced control group was used.

Conclusion Great China Famine exposure in infancy may be associated with an elevated risk of arthritis in adulthood, particularly in women and participants with adiposity. These findings suggest nutrition intervention in infancy and weight control in later life may reduce the risk of arthritis in adulthood.

  • arthritis
  • child health
  • epidemiology of chronic non communicable diseases
  • fetal

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  • Contributors JM, ZZ and BD designed this study and supervised the data analysis. ZW and ZZ carried out the initial analysis. LA critically reviewed the manuscript. All the authors were involved in writing the paper and had final approval of the submitted and published version.

  • Funding This work was granted by the National Natural Science Foundation of China (NSFC 81402692) awarded to ZZ and the Excellent Talents Fund Program of Peking University Health Science Center (BMU2017YJ002) awarded to BD.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The present study is a secondary analysis of the CHARLS public data, which was approved by the Medical Ethics Committee of Peking University, and the Medical Ethics Committee of Peking University has granted current study exemption from ethics review.

  • Provenance and peer review Not commissioned; externally peer reviewed.