# Risk, Resilience, and Timing: The Impact of War on Later-Life Pain

## TL;DR

This study examines how early-life war experiences affect later-life chronic pain, finding that children are more vulnerable to long-term health impacts than older age groups.

## Contribution

The study provides novel insights into heterogeneous war impacts on later-life pain across age cohorts and identifies both risk and protective factors.

## Key findings

- Vietnam War exposure significantly increases the risk of later-life chronic pain.
- War generates both risk factors (e.g., lower education, higher smoking) and protective factors (e.g., greater social engagement).
- Children are more vulnerable to wartime violence effects on later-life pain than adolescents or young adults.

## Abstract

Life course theories predict that early-life war experiences will impact later-life health through both risk and resilience processes, which may vary by age cohorts. However, limited research has empirically examined the resilience process following war and the heterogeneous pathways across age cohorts. This study uses data on older adults from the 2018 Vietnam Health and Aging Study (N = 1,826) to explore associations between early-life war experiences and later-life moderate/severe chronic pain, highlighting the role of war-related risk or protective factors (socioeconomic status, health behaviors, social engagement, and health conditions), and testing for heterogeneity of war impacts between child (aged 6-11), adolescent (aged 12-17), and young adult cohorts (aged 18-23) during the wartime (1965). Regression models reveal that Vietnam War exposures dramatically increase the risk of later-life pain, and that war generates both risk factors (e.g., lower educational attainment, higher smoking risk, greater physical disease count, larger distress, and PTSD score) and protective factors (e.g., greater social engagement). However, KHB mediation analyses show that the impact of war on pain is primarily driven by increases in physical and mental health problems. Children were more vulnerable to the effects of wartime violence on later-life pain than older age groups. As for risk/protective factors generated by war, the child cohort tends to exhibit poorer coping under the effect of war (as indicated by a higher risk of smoking), whereas this group appears to have a better outcome in terms of a greater increase in occupational prestige and less deterioration in physical health.