The long-term impact of childhood peer relationships on disability in later life: Causal mediation evidence from older Chinese adults

Despite the recognized importance of social connections in Chinese culture, research on how childhood peer relationship deficits impact health later in life has been limited. This study aimed to investigate the association between childhood peer relationship deficits and the odds of disability among older Chinese adults and to explore the potential mediating roles of social isolation, loneliness, and cognitive function. Using the longitudinal sample of respondents aged 60 years and older in the China Health and Retirement Longitudinal Study 2013-2018 (N = 7133), the link between peer relationship deficits in childhood and disability in late life was assessed using marginal structural models, and the potential mediating effects of social isolation, loneliness, and cognitive function were examined by the inverse odds ratio weighting technique. Participants who experienced greater childhood peer relationship deficits were more prone to disability (odds ratio: 1.19, 95% CI: 1.09, 1.29) than those with more positive childhood peer interactions. The inverse odds ratio weighting analysis indicated that social isolation, loneliness, and cognitive function individually played partial mediating roles in the association between childhood peer relationships and disability by 11.36% (95% CI: 4.04%-18.99%), 11.95 % (95% CI: 4.65%-19.23%), and 24.58% (95% CI: 17.01%-32.43%), respectively. The combined mediation effect of the three mediators was 30.57% (95% CI: 23.52%-39.91%). These findings suggest that interventions to enhance social connections and cognitive health in older adults may help mitigate the long-term impacts of childhood peer relationship deficits on disability among older Chinese adults.