Early Life Exposure to the Great Chinese Famine and Cardiometabolic Outcomes
Authors' conclusion
In this cohort study of Chinese immigrants, early life famine exposure was strongly associated with increased risks of incident T2D and hypertension, but not cardiovascular hospitalization. Early life undernutrition is a novel cardiometabolic risk factor among immigrants associated with the burden of T2D and hypertension in high-income countries.
Study context
- Population
- Adult Chinese immigrants aged 20 to 85 years living in Ontario, Canada, 1992–2019; followed up until 85 years of age, relocation or March 31, 2023T2D cohort 188,292
- Exposure
- Early life exposure to the Great Chinese Famine vs no exposure
- Outcome
- Coprimary: incident T2D, hypertension and cardiovascular hospitalization
Methodological details3 cohorts, 1 per coprimary outcome
- 3 cohorts, 1 per coprimary outcome
Main finding
As reported in the abstract
Incident T2D, hypertension and cardiovascular hospitalization
Each group vs comparisonEstimate (95% CI)
Prenatal
HR (T2D) 1.58(1.49–1.68)
Childhood
HR (T2D) 1.45(1.38–1.54)
Adolescent
HR (T2D) 1.37(1.28–1.46)
Prenatal
HR (hypertension) 1.22(1.17–1.27)
Childhood
HR (hypertension) 1.25(1.21–1.30)
Adolescent
HR (hypertension) 1.25(1.20–1.31)
Prenatalnot associated
HR (cardiovascular hospitalization) 0.92(0.76–1.12)
Childhoodnot associated
HR (cardiovascular hospitalization) 0.98(0.86–1.11)
Adolescent14% decrease in risk
HR (cardiovascular hospitalization) 0.86(0.75–0.98)
- Event rates in famine-exposed: T2D
- 13.6%
- Event rates in famine-exposed: hypertension
- 29.8%
- Event rates in famine-exposed: cardiovascular hospitalization
- 1.6%
Observational data: associations, not effects.
Original publication
Early Life Exposure to the Great Chinese Famine and Cardiometabolic Outcomes. JAMA Netw Open. Published 3 November 2025. doi:10.
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