Early-Life Adversity Indicators and Preferences for Family-Based Care in Later Life: Mechanisms and Cultural Moderation

Abstract

Amid China’s rapidly aging population, understanding determinants of long-term care preferences is increasingly critical. Drawing on data from the 2016 to 2023 waves of the China Longitudinal Aging Social Survey (CLASS), this study investigates how early-life adversity indicators shape older adults’ preferences for family-based care. Results indicate that individuals exposed to early-life adversity are more likely to favor family-centered care arrangements in later life. Mediation analyses reveal that this relationship is partially explained by diminished perceived social role and poorer health outcomes. Dimension-specific analyses further show that childhood experiences of nutritional deprivation and parental loss significantly increase the preference for family-based care, whereas limited medical accessibility exerts a negative association. Psychological analyses demonstrate that early-life adversity indicators strengthen older adults’ recognition of children’s caregiving responsibilities, indirectly reinforcing reliance on family support. Moderation tests indicate that the effect of early-life adversity on care preferences is amplified in regions with stronger Confucian cultural influence. Heterogeneity analyses reveal that the association is particularly pronounced among urban residents, those with higher educational attainment, and women. By integrating early-life experiences with psychological and cultural mechanisms, this study elucidates the social and cognitive foundations of long-term care decisions and offers empirical insights for designing differentiated eldercare policies.