The relationship between childhood SES and health in middle and old age: evidence from China

Drawing from the extended Grossman health capital and demand theory and the life course theory, this study examined whether childhood SES has direct and significant correlation with health in middle and old age in a specific historical context in China.

A sample of 9,861 respondents was obtained from the China Health and Retirement Longitudinal Study (CHARLS). Childhood SES was measured by objective indices of recall. Health was assessed by self-reported, physician diagnosis and the Center for Epidemiologic Studies Depression Scale (CESD). The Propensity Score Matching (PSM) was used to estimate the treatment effect between childhood SES and later life health. The Karlson-Holm-Breen (KHB) method was employed to examine the associative mediation effects.

Compared to respondents with low SES in childhood, respondents with high SES in childhood had, on average, 5.1% more likely to report their health as good, an average 2.4% lower prevalence of chronic diseases and an average 7.6% lower in the score of depression in middle and old age. The indirect relationships of childhood health, adulthood SES and adulthood lifestyle with health in middle and old age were all significant. SES upward mobility in adulthood can diminish the association between childhood disadvantage and poor health in middle and old age.

The health effects of childhood SES can persist into middle and old age, this is more noticeable in rural areas, particularly in females. The critical period, cumulative risk and social mobility models produce synergistic effects in China. Our results also promote a paradigm shift in health interventions from old age to early life for health-vulnerable populations.