Exposure to the Chinese famine of 1959–61 in early life and current health conditions: a systematic review and meta-analysis

Abstract

BackgroundMany middle-aged Chinese people have experienced the Great Leap Forward Famine of 1959–61, which could have profound long-term health consequences for exposed birth cohorts. We undertook a systematic review and meta-analysis to summarise reported famine effects on long-term health. MethodsWe searched PubMed, Embase, Chinese Wanfang Data, and Chinese National Knowledge Infrastructure databases up to December, 2015, for health outcomes related to the Chinese famine, with the keywords “China”, “famine”, “undernutrition”, “Chinese famine”, “Great Leap Forward”, and “Great famine”, and the MESH terms “starvation” or “malnutrition” combined with “China” or “Chinese”. We compared outcomes in famine births and unexposed controls. We used fixed-effects models and random-effects models to combine reports of adult overweight, obesity, type 2 diabetes, hyperglycaemia, hypertension, metabolic syndrome, and schizophrenia. We assessed heterogeneity across reports. We did subgroup analyses by reported famine severity, provincial mortality during famine, and sex. FindingsOf 3976 records identified, 36 reports met our inclusion criteria and 21 could be used for pooled meta-analysis. The number of analysed events ranged from 1029 for hyperglycemia to 9248 for hypertension. As reported by others, type 2 diabetes, hyperglycaemia, hypertension, metabolic syndrome, and schizophrenia were more common among adults born in the famine years than among controls born after the famine. By contrast, there were no increases in type 2 diabetes (odds ratio 0·96, 95% CI 0·73–1·28), hyperglycaemia (0·99, 0·72–1·36), hypertension (0·93, 0·82–1·04), or metabolic syndrome (1·11, 1·00–1·22) comparing adults born in the famine years with controls born either after or before the famine combined. For schizophrenia, the effect estimates (odds ratio 1·60, 95% CI 1·50–1·70, combining controls) were similar in the two scenarios. InterpretationUncontrolled age differences between famine and post-famine births could explain most effects commonly attributed to the famine. Further studies with better controls for age, famine severity, and sex are needed to obtain reliable estimates of long-term famine effects in China. FundingNone.