Separate and combined effects of famine exposure and menarche age on hypertension among the middle-aged and elderly Chinese: a population-based cross-sectional study
Authors: Wang Congzhi , Wan Rui , Yuan Ting , Yang Liu , Zhang Dongmei , Li Xiaoping , Liu Haiyang , Zhang Lin 
Published: August 2022

Abstract
Background: Numerous epidemiologic studies had explored the relationship between hunger experience or menarche age and the risk of hypertension independently, and there is no consensus about this study. The objective of this paper was to probe the single and combined effect of famine exposure and menarche age among the middle-aged and elderly Chinese who were exposed to the famine (1959-1961).Methods: 6512 participants in this research were chosen from the China Health and Retirement Longitudinal Study (CHARLS), the study sample included 6512 individuals aged 45 to 90 years. The differences between baseline characteristics of famine exposure/menarche age were evaluated using thet-test and F-test. Finally, multivariable-adjusted logistic regression models examined association of famine exposure and menarche age with the odds of prevalence of hypertension.Results: Among the 6512 individuals, 502(7.71%) people had not been exposed to the Chinese famine, 459(7.05%) people had been exposed to the Chinese famine in fetal life, 1760(27.03%) people, and 1645(25.26%) people had been exposed to the famine during childhood and adolescence/adulthood, respectively. 2118(32.53%) people reported having hypertension. Furthermore, 4109(63.10%) people reported menarche age was under 15 years, while 2403(36.90%) people reported menarche age was above 16 years. In multivariable-adjusted model, famine exposure and menarche age were associated with hypertension [(1) separate association famine exposure, menarche age with hypertension: the fetal exposed vs. no exposed group, 1.22 (95% CI 0.98, 1.51); childhood-exposed vs. no exposed group, 1.58 (95% CI 1.33, 1.88); the adolescence/adult-exposed vs. no exposed group, 3.32 (95%CI 2.77, 3.99); P for trend=0.000; less than 15 years vs More than 16 years group, 1.19 (95%CI 1.07,1.33). (2) The combined associations of menarche age and famine exposure with the hypertension. The fetal exposed vs. no exposed group among the menarche age less than 15 years 1.24 (95%CI 0.92,1.68), childhood-exposed vs. no exposed group among the menarche age less than 15 years 1.64 (95%CI 1.29,2.08), the adolescence/adult-exposed vs no exposed group among the menarche age less than 15 years 3.54 (95%CI 2.78, 4.51); P for trend 0.000. The group less than 15 years vs more than 16 years group 1.34 (95%CI 1.00, 1.81), the fetal exposed vs. no exposed group among the menarche age more than 16 years group 1.62 (95%CI 2.18, 2.22), childhood-exposed vs no exposed group among the menarche age more than 16 years 2.13(95%CI 1.65, 2.74), the adolescence/adult-exposed vs no exposed group among the menarche age more than 16years 4.43(95%CI 3.38, 5.80); P for trend=0.000. In general, compared with the combination of the menarche age less than 15 years and no-exposed famine stage, interaction analysis in the multivariable-adjusted model, other groups trended towards higher odds of hypertension [the most significant increase in odds, adolescence/adult exposed stage with menarche age more than 16 years 4.43(95%CI 3.38, 5.80)].Conclusions: Our study data support a strongly positive separate and combined effects of menarche age and famine exposure on hypertension in the middle-aged and elderly Chinese.