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Objective: This study aims to investigate the relationship between adolescent flood exposure and cognitive function trajectories among middle-aged and older adults in China from a dynamic perspective. The study addresses the gap in research on the long-term effects of flood exposure on cognitive function.
Methods: A total of 10,321 adults aged 45 and older participating in the 2011, 2013, 2015, 2018, and 2020 waves of the China Health and Retirement Longitudinal Study were included. Group-based trajectory modeling identified cognitive function trajectories, while Inverse Probability Weighted Estimates adjusted for Survival Bias.
Results: Three cognitive trajectories were identified: low-stable (22.6%), moderate-decline (43.0%), and high-stable (34.4%). Adolescent flood exposure was associated with higher likelihood of membership in the moderate-decline and high-stable trajectories relative to the low-stable group, with the strongest and most consistent associations observed for light exposure; severe exposure was not statistically significant. Inverse probability–weighted estimates were substantively similar, indicating that the results were not driven by differential survival or attrition. Mediation analyses revealed a small indirect pathway via adult social activity participation (≈5–8%), with no evidence of mediation through health behaviors or intergenerational ties.
Conclusions: In a national cohort of Chinese adults aged 45+, adolescent flood exposure was associated with a higher likelihood of more favorable cognitive aging trajectories, with results robust to adjustment for differential survival and attrition. The pattern aligns with post-traumatic growth theory, suggesting that manageable early-life adversity may contribute to later-life cognitive resilience.
Keywords: Adolescent flood exposure, Cognitive function trajectories, Group-based trajectory modeling, Post-traumatic growth theory, Chinese middle-aged and older adults