How Early Migration Shapes Chronic Disease Progression in Later Life: Longitudinal Evidence From Rural China

Abstract Objectives Early-life internal migration can have lasting impacts on health in later life, particularly in rapidly urbanizing societies. This study investigates how early-life internal migration experiences are associated with chronic disease trajectories among older adults in rural China, a country that has experienced one of the largest internal migration movements in modern history. Methods Using five waves of data from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2020), we applied group-based trajectory modeling (GBTM) to identify distinct patterns of chronic disease progression among rural older adults. We then used multinomial logistic regression models to examine how internal migration during working age relates to these trajectories, adjusting for potential selection bias. Migration frequency, age at first migration, and migration distance were further analyzed to capture the heterogeneity of migration experiences. Results Three distinct chronic disease trajectories were identified: (1) low baseline and slow increase, (2) medium baseline and moderate increase, and (3) high baseline and rapid increase. Multivariate analyses revealed that individuals with early-life migration experiences had higher baseline prevalence and a faster accumulation of chronic diseases over time. More frequent, earlier, and longer-distance migration were each linked to worse health trajectories. Discussion The findings underscore the lasting health consequences of internal migration across the life course. Health policies should prioritize the health needs of older adults with migration histories, particularly those who experienced multiple, young adulthood (age 15-44), or long-distance moves, by developing targeted interventions and expanding healthcare access for this vulnerable population.