Displacement due to armed conflict and violence in childhood and adulthood and its effects on older adult health: The case of the middle-income country of Colombia

Abstract

Large population displacement in developing economies due to internal armed conflict and violence is of international concern. There has been relatively little research on the long-term consequences of displacement on older adult health among populations characterized by rapid demographic, epidemiological, and nutritional transitions during the 20^th century. We examine displacement in the middle-income country of Colombia, which experienced these rapid transitions and a large population displacement over the last 50-60 years due to internal armed conflict and violence. Using a nationally representative survey of adults 60 years and older, SABE-Colombia (2014-2015, n = 23,694), we estimate the degree to which displacement relative to those never displaced is associated with older adult health (self-reported health, major illness/stress, at least one chronic condition, heart disease), controlling for age, gender, SES (socioeconomic status), residence, early life conditions (infectious diseases, poor nutrition, health, SES, family violence), and adult behavior (smoking, exercise, nutrition). We found (1) strong associations between poor early life conditions and older adult health with little attenuation of effects after controlling for displacement, adult SES, and lifestyle; (2) strong associations between displacement and self-reported health; along with poor early life conditions, displacement increases the chances of poor health at older ages; (3) significant positive interaction effects between childhood infections and displacement during young adulthood for older adult stress/major illness, suggesting the importance of the timing of displacement; (4) significant interaction effects between childhood infections and being displaced during childhood, indicating lower levels of older adult stress/major illness and suggesting the possibility of resilience due to childhood adversity. We conclude that displacement compounds the effects of poor early life conditions and that timing of displacement can matter. The results raise the possibility of similar patterns in the health of aging populations in low-income countries that also experience displacement and rapid demographic and epidemiological transitions.

Fig. 1

Rapid reductions in infant mortality rate (IMR) in Colombia in the 20th century. Sources: (Flórez et al., 2016, Maddison Project Database version 2013 et al., 2014); in 1990 international Geary-Khamis dollars and IMR (deaths per 1,000 live births).

Fig. 2

Year of first displacement among SABE-Colombia respondents. Notes: Graph depicts the distribution of displaced respondents according to the year of displacement. The two peaks correspond to the two major periods of violence and armed conflict in Colombia. All respondents displaced in childhood were displaced during the first major period of violence.

Fig. 3

Predicted probabilities for older Colombian male adults. Notes: Predicted probabilities for males for typical respondent. Similar results for females. X-axis shows never displaced and age at displacement (1–17 = childhood, 18–39 = young adulthood, 40–59 = mid adulthood, 60+ = older adulthood). Values for the y-axis ranges from 0-0.80. Low risk = no early life or adult risk factors (exercise, diet, smoking). Probabilities below are ordered from left to right (Low risk, +Early life, +Obesity, +Adult risks). Poor SRH: never displaced (0.04, 0.09, 0.12, 0.24), 1-17 (0.06, 0.14, 0.18, 0.33), 18–39 (0.06, 0.16, 0.20, 0.36), 40-59 (0.05, 0.14, 0.17, 0.32), 60+ (0.06, 0.14, 0.18, 0.33). Stress: never displaced (0.11, 0.36, 0.37, 0.44), 1–17 (0.16, 0.47, 0.49, 0.55), 18-39 (0.14, 0.44, 0.45, 0.52), 40–59 (0.12, 0.39, 0.41, 0.47), 60+ (0.12, 0.39, 0.40, 0.47). At least one chronic condition: never displaced (0.35, 0.66, 0.75, 0.70), 1–17 (0.41, 0.71, 0.79, 0.75), 18-39 (0.38, 0.69, 0.78, 0.73), 40–59 (0.33, 0.64, 0.73, 0.68), 60+ (0.37, 0.68, 0.77, 0.72). Heart disease: never displaced (0.11, 0.26, 0.34, 0.30), 1–17 (0.13, 0.30, 0.38, 0.34), 18-39 (0.14, 0.32, 0.40, 0.35), 40–59 (0.11, 0.26, 0.33, 0.29), 60+ (0.12, 0.28, 0.35, 0.31).

Fig. 4

Predicted probabilities for interactions between early life infections and older adult health. Notes: Predicted probabilities for typical respondent. X-axis shows never displaced and age at displacement (1–17 = childhood, 18-39 = young adulthood, 40–59 = mid adulthood, 60+ = older adulthood). Values for the y-axis ranges from 0-0.80. Probabilities below are ordered from left to right (never displaced, displaced at ages 1–17, 18–39, 40-59, 60+). Stress: no exposure (0.21, 0.32, 0.24, 0.23, 0.22), exposure (0.27, 0.23, 0.54, 0.35, 0.38). At least one chronic condition: no exposure (0.48, 0.53, 0.51, 0.45, 0.48), exposure (0.60, 0.73, 0.62, 0.60, 0.75).