Abstract
BackgroundAdult height is a useful biological measure of long term population health and well being. We examined the cohort differences and socioeconomic patterning in adult height in low- to middle-income countries.Methods/FindingsWe analyzed cross-sectional, representative samples of 364538 women aged 25-49 years drawn from 54 Demographic and Health Surveys (DHS) conducted between 1994 and 2008. Linear multilevel regression models included year of birth, household wealth, education, and area of residence, and accounted for clustering by primary sampling units and countries. Attained height was measured using an adjustable measuring board. A yearly change in birth cohorts starting with those born in 1945 was associated with a 0.0138 cm (95% CI 0.0107, 0.0169) increase in height. Increases in heights in more recent birth year cohorts were largely concentrated in women from the richer wealth quintiles. 35 of the 54 countries experienced a decline (14) or stagnation (21) in height. The decline in heights was largely concentrated among the poorest wealth quintiles. There was a strong positive association between height and household wealth; those in two richest quintiles of household wealth were 1.988 cm (95% CI 1.886, 2.090) and 1.018 cm (95% CI 0.916, 1.120) taller, compared to those in the poorest wealth quintile. The strength of the association between wealth and height was positive (0.05 to 1.16) in 96% (52/54) countries.ConclusionsSocioeconomic inequalities in height remain persistent. Height has stagnated or declined over the last decades in low- to middle-income countries, particularly in Africa, suggesting worsening nutritional and environmental circumstances during childhood.
Highlights
Height is highly heritable, improvements in attained height over time underscore the importance of environmental factors including nutrition, exposure to infections, and socioeconomic status, especially during childhood [1,2,3,4,5]
Nationally representative, and sample from 54 comparable surveys conducted in low- to middle-income countries with objective measurements of height, we provide an epidemiologic assessment of changes in height over a 40 year period along with its socioeconomic patterning both within and across countries
There was a strong positive association between height and household wealth; those in top two quintile of household wealth were 1.988 cm and 1.018 cm taller, compared to those in the poorest wealth quintile
Summary
Height is highly heritable, improvements in attained height over time underscore the importance of environmental factors including nutrition, exposure to infections, and socioeconomic status, especially during childhood [1,2,3,4,5]. A mother’s attained height has been shown to be a strong risk factor of her offspring’s mortality and growth failure extending into early childhood [11,12]. Viewed this way, height is a stable and useful biological measure of standard of living [2,13], that captures both current and future inequalities in population health. Similar cross-national assessments of developing countries have been limited [18], and have not considered the socioeconomic inequalities in the patterning and changes in height over time. We examined the cohort differences and socioeconomic patterning in adult height in low- to middle-income countries
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