Gender differences in the long-term impact of early-life exposure to war on physical and mental health: Evidence from China.

Background: Several studies have examined the impact of exposure to war in early life on long-term health outcomes. However, few studies have examined differences in these effects by gender and type of war. This study examines the impact of exposure to multiple war events before the age of 10 on the long-term physical and mental health of adults aged 65 years and older in China, as well as differences these effects between wars of aggression and civil wars. Data and methods: This study employed an Ordinary Least Squares model with year and household fixed effects, using data from six waves (2002-2018) of the Chinese Longitudinal Healthy Longevity Survey. First, the study examined the impact of war shocks and war intensity on individual health. Second, we incorporated interaction terms between war shocks and gender and between war intensity and gender into the model to investigate gender differences in the health effects of war. Subsequently, this study tested the heterogeneity based on the nature of war and explored strategies to mitigate war-related trauma. Results: The findings indicate that, compared with individuals not exposed to war, the physical and mental health of those exposed to war declined by 17.5% and 12.1%, respectively. Among those exposed to war, women had lower physical and mental health than men. Additionally, aggressive wars had a stronger negative impact on individual health than civil wars. They also worsened both physical and mental health among women to a greater extent than among men, whereas civil wars only caused greater harm to women's physical health. This result may be attributed to two interconnected factors. First, aggressive wars, characterized by plunder and widespread violence, are inherently destructive and cause severe trauma. Second, women's vulnerability in conflict amplifies their risk of experiencing such trauma. The study also explored whether active social participation and adequate health care in adulthood could alleviate war-related trauma. No evidence of such a compensatory effect was identified. Discussion: The study concludes that war inflicts severe health damage, with aggressive wars causing greater trauma and women suffering disproportionately. These findings extend beyond existing medical frameworks, identifying women as a critical group requiring targeted, structural interventions. This study reveals new research directions for mitigating war-related health consequences and informs policies aimed at improving public well-being in post-conflict settings.