Abstract
Backgrounds and Objectives: The north–south height distinctions in Chinese children suggest that some geographical–climatic factors could determine height variation of short stature. In a national health survey, we aimed to explore the spatial distribution of short stature on city scales, and detect its socio-economic and geographical–climatic factors.Methods: Data on the prevalence of short stature were obtained from a 2014 cross-sectional survey of China (CNSSCH). In total, 213,795 Han Chinese students aged 7–18 years, from 106 cities across 30 provinces, were included. Both China and World Health Organization (WHO) growth references were adopted to define short stature.Results: A spatial clustering was apparent in the distribution of short stature. After multivariable adjustment, altitude and humidity significantly increased the risk of high prevalence in short stature, according to the WHO (odds ratio [OR] = 1.61 and 1.26, 95% confidence interval [CI]: 1.20–2.17 and 1.03–1.54) and China (OR = 1.54 and 1.26; 95% CI: 1.15–2.05 and 1.02–1.55) growth references. Additionally, education significantly decreased the risk of high prevalence in short stature according to the WHO (OR = 0.40; 95% CI: 0.22–0.74) and China (OR = 0.42; 95% CI: 0.22–0.77) growth references. Combining both altitude >400 m and education <9 years, as well as education <9 years and humidity >70%, received the largest effect-size estimate, and significance retained after multivariable adjustment.Conclusions: Our findings indicate that high altitude and humidity increased the risk of high prevalence in short stature, high education was associated with low prevalence. Additionally, we observed possible interactions between education and altitude/humidity. They may interactively explain spatial discrepancy and predict short stature in Chinese school children. Further validations are necessary.
Highlights
Organisms constantly adapt to external environment, for example, as people shift from a hunting–gathering lifestyle into a society based on agriculture and animal husbandry, adaptation changes such as height, fatty acid desaturase enzymes and hemoglobin concentration, begin taking place [1]
Positive Gi ∗ Z-scores means that there is a clustering of high prevalence of disease, scores close 0 represent no clustering and negative scores manifest clustering of low prevalence of disease [9, 33]
The high–high cluster and the low–low cluster are relatively easy to understand, they mean that there are a cluster of high prevalence or low prevalence of disease
Summary
Organisms constantly adapt to external environment, for example, as people shift from a hunting–gathering lifestyle into a society based on agriculture and animal husbandry, adaptation changes such as height, fatty acid desaturase enzymes and hemoglobin concentration, begin taking place [1]. A study has shown that due to limited food, high temperature and humidity, Western Africa tropical rainforest residents tended to have short stature and reached puberty earlier. In this situation, short stature was not a pathological state, but a protective mechanism for environmental acclimatization [8]. In our previous study [9], we identified a specific spatial distribution of short stature in Mainland China. What factors account for this spatial distribution of short stature in mainland of China? We will explore the spatial distribution of prevalence of short stature in smaller scale (i.e., city scale), and detect the socio-economic and geographical–climatic factors of short stature in mainland of China. We believe that the results of research can help us understand the environmental acclimatization better and it is significant contribution to prevention and control of short stature for government
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