A Study on the Association Between Early-Life Exposure to Famine and Sleep Quality in Adulthood：evidence from the China health and retirement longitudinal study database

Background Sleep plays an important role in regulating endocrine function and forming memory in the human body. However, there are few studies on the impact of early-life exposure to famine on sleep. Therefore, the purpose of this study is to assess the effects of early-life exposure to famine on sleep in middle-aged and elderly populations. Methods Using the validated China Health and Retirement Longitudinal Study(CHARLS) baseline questionnaire, a logistic regression model was used to assess the association between famine exposure and sleep. The influence of demographic and health behavior factors on the association was evaluated through stratified analysis and interaction tests. Results Exposure to famine in early life increases the risk of poor sleep in middle-aged and older populations. Compared with the unexposed group, all famine-exposed groups showed a significantly higher risk of poor sleep. Specifically, the ORs (95% CI) for the fetal exposure, childhood exposure, and adolescent/adult exposure were 1.24 (1.10–1.40), 1.21 (1.11–1.32), and 1.58 (1.43–1.75), respectively, with all P-values < 0.001. The co-occurrence of depression and childhood famine exposure further exacerbates the occurrence of poor sleep. Conclusions This population-based cross-sectional study indicates that early-life famine exposure has lasting effects on sleep in middle-aged and older adults. It identifies high-risk groups, including women, those with limited educational attainment, and those with disabilities or depression. These findings underscore the need for public health policies that extend beyond current risk factors and adopt a life-course perspective.