Expensive famine: Early hunger experience and diabetes treatment burden.

The negative effects of experiencing famine in childhood are not limited to increased morbidity. This study collected hospitalization data for diabetic patients in all hospitals in Gansu Province over a three-year period (2018-2020) and exploited the exogenous shock of the Great Famine event in China (1959-1961). We used a birth cohort DID method to assess the causal relationship between famine survivors and diabetes treatment costs. In a sample of patients with type 2 diabetes, treatment costs were higher for famine survivors than for other patients, especially those born between 1952 and 1957. However, there was no significant difference between patients born between 1959 and 1961, which may challenge the "fetal origin" hypothesis. The costs of hunger are all-encompassing, including worse health before hospitalization, a greater likelihood of surgery, and higher recovery costs after discharge. Findings also hint at differences in the burden of diabetes between insulin-insufficient and sugar-excessive. There are significant differences within survivors of different social statuses, and the low bargaining power of rural and female groups was amplified during the famine. Ethnic differences reflect more complex mechanisms of food acquisition. Even though 63-67 years old is the window period when the burden of diabetic patients who experienced famine in their early life increases significantly, these high medical burdens are effectively compensated under the medical insurance system.