Abstract
OBJECTIVE: This study aimed to explore the relationship between exposure to the Great Chinese Famine (1959-1961) and health-related quality of life (HRQoL) in middle-aged and elderly people after adjusting for selection bias using propensity score matching (PSM). METHODS: This cross-sectional study was conducted in Ningxia, China, in 2022. A multi-stage stratified cluster-randomized design was used to obtain a representative sample in each county. We included participants aged 45 years and older, who had lived there for more than 1 year. This study included 5,793 middle-aged and elderly people in Ningxia, China as the research subjects. This study used propensity score matching (PSM) to empirically examine the association between exposure to the Great Famine and HRQoL in middle-aged and older adults. In the first step, we estimated a binary logistic regression model with Great Chinese Famine exposure as the dependent variable and 7 factors as confounding variables. In the second step, we performed propensity score analysis using the confounding variables identified in the first step to control for potential selection bias. To avoid bias due to age differences, we introduced the age variable into the regression model to explore the effect of the Great Famine impact. Different definitional criteria were used to define the exposed and control groups in order to robustly test the findings. RESULTS: The results showed that middle-aged and elderly people who reported exposure to the Great Famine had lower HRQoL than middle-aged and elderly people who were not exposed to the Great Famine, after adjusting for gender, educational background, economic level, BMI, Chronic conditions, smoking and drinking. In order to avoid the influence of age differences on the results, this study used matched samples and included the age variable in the regression analysis to minimise the bias due to age. Also, exposure was defined in different ways to test the robustness of the results. CONCLUSIONS: The health-related quality of life of middle-aged and older adults who experienced China's Great Famine (1959-1961) declined substantially in later life, but the inclusion of the age variable made the statistical results non-significant.