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Distributional change of women’s adult height in low- and middle-income countries over the past half century: An observational study using cross-sectional survey data

BACKGROUND: Adult height reflects childhood circumstances and is associated with health, longevity, and maternal–fetal outcomes. Mean height is an important population metric, and declines in height have occurred in several low- and middle-income countries, especially in Africa, over the last severa...

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Autores principales: Gausman, Jewel, Meija Guevara, Ivan, Subramanian, S. V., Razak, Fahad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5947892/
https://www.ncbi.nlm.nih.gov/pubmed/29750787
http://dx.doi.org/10.1371/journal.pmed.1002568
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author Gausman, Jewel
Meija Guevara, Ivan
Subramanian, S. V.
Razak, Fahad
author_facet Gausman, Jewel
Meija Guevara, Ivan
Subramanian, S. V.
Razak, Fahad
author_sort Gausman, Jewel
collection PubMed
description BACKGROUND: Adult height reflects childhood circumstances and is associated with health, longevity, and maternal–fetal outcomes. Mean height is an important population metric, and declines in height have occurred in several low- and middle-income countries, especially in Africa, over the last several decades. This study examines changes at the population level in the distribution of height over time across a broad range of low- and middle-income countries during the past half century. METHODS AND FINDINGS: The study population comprised 1,122,845 women aged 25–49 years from 59 countries with women’s height measures available from four 10-year birth cohorts from 1950 to 1989 using data from the Demographic and Health Surveys (DHS) collected between 1993 and 2013. Multilevel regression models were used to examine the association between (1) mean height and standard deviation (SD) of height (a population-level measure of inequality) and (2) median height and the 5th and 95th percentiles of height. Mean-difference plots were used to conduct a graphical analysis of shifts in the distribution within countries over time. Overall, 26 countries experienced a significant increase, 26 experienced no significant change, and 7 experienced a significant decline in mean height between the first and last birth cohorts. Rwanda experienced the greatest loss in height (−1.4 cm, 95% CI: −1.84 cm, −0.96 cm) while Colombia experienced the greatest gain in height (2.6 cm, 95% CI: 2.36 cm, 2.84 cm). Between 1950 and 1989, 24 out of 59 countries experienced a significant change in the SD of women’s height, with increased SD in 7 countries—all of which are located in sub-Saharan Africa. The distribution of women’s height has not stayed constant across successive birth cohorts, and regression models suggest there is no evidence of a significant relationship between mean height and the SD of height (β = 0.015 cm, 95% CI: −0.032 cm, 0.061 cm), while there is evidence for a positive association between median height and the 5th percentile (β = 0.915 cm, 95% CI: 0.820 cm, 1.002 cm) and 95th percentile (β = 0.995 cm, 95% CI: 0.925 cm, 1.066 cm) of height. Benin experienced the largest relative expansion in the distribution of height. In Benin, the ratio of variance between the latest and earliest cohort is estimated as 1.5 (95% CI: 1.4, 1.6), while Lesotho and Uganda experienced the greatest relative contraction of the distribution, with the ratio of variance between the latest and earliest cohort estimated as 0.8 (95% CI: 0.7, 0.9) in both countries. Limitations of the study include the representativeness of DHS surveys over time, age-related height loss, and consistency in the measurement of height between surveys. CONCLUSIONS: The findings of this study indicate that the population-level distribution of women’s height does not stay constant in relation to mean changes. Because using mean height as a summary population measure does not capture broader distributional changes, overreliance on the mean may lead investigators to underestimate disparities in the distribution of environmental and nutritional determinants of health.
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spelling pubmed-59478922018-05-25 Distributional change of women’s adult height in low- and middle-income countries over the past half century: An observational study using cross-sectional survey data Gausman, Jewel Meija Guevara, Ivan Subramanian, S. V. Razak, Fahad PLoS Med Research Article BACKGROUND: Adult height reflects childhood circumstances and is associated with health, longevity, and maternal–fetal outcomes. Mean height is an important population metric, and declines in height have occurred in several low- and middle-income countries, especially in Africa, over the last several decades. This study examines changes at the population level in the distribution of height over time across a broad range of low- and middle-income countries during the past half century. METHODS AND FINDINGS: The study population comprised 1,122,845 women aged 25–49 years from 59 countries with women’s height measures available from four 10-year birth cohorts from 1950 to 1989 using data from the Demographic and Health Surveys (DHS) collected between 1993 and 2013. Multilevel regression models were used to examine the association between (1) mean height and standard deviation (SD) of height (a population-level measure of inequality) and (2) median height and the 5th and 95th percentiles of height. Mean-difference plots were used to conduct a graphical analysis of shifts in the distribution within countries over time. Overall, 26 countries experienced a significant increase, 26 experienced no significant change, and 7 experienced a significant decline in mean height between the first and last birth cohorts. Rwanda experienced the greatest loss in height (−1.4 cm, 95% CI: −1.84 cm, −0.96 cm) while Colombia experienced the greatest gain in height (2.6 cm, 95% CI: 2.36 cm, 2.84 cm). Between 1950 and 1989, 24 out of 59 countries experienced a significant change in the SD of women’s height, with increased SD in 7 countries—all of which are located in sub-Saharan Africa. The distribution of women’s height has not stayed constant across successive birth cohorts, and regression models suggest there is no evidence of a significant relationship between mean height and the SD of height (β = 0.015 cm, 95% CI: −0.032 cm, 0.061 cm), while there is evidence for a positive association between median height and the 5th percentile (β = 0.915 cm, 95% CI: 0.820 cm, 1.002 cm) and 95th percentile (β = 0.995 cm, 95% CI: 0.925 cm, 1.066 cm) of height. Benin experienced the largest relative expansion in the distribution of height. In Benin, the ratio of variance between the latest and earliest cohort is estimated as 1.5 (95% CI: 1.4, 1.6), while Lesotho and Uganda experienced the greatest relative contraction of the distribution, with the ratio of variance between the latest and earliest cohort estimated as 0.8 (95% CI: 0.7, 0.9) in both countries. Limitations of the study include the representativeness of DHS surveys over time, age-related height loss, and consistency in the measurement of height between surveys. CONCLUSIONS: The findings of this study indicate that the population-level distribution of women’s height does not stay constant in relation to mean changes. Because using mean height as a summary population measure does not capture broader distributional changes, overreliance on the mean may lead investigators to underestimate disparities in the distribution of environmental and nutritional determinants of health. Public Library of Science 2018-05-11 /pmc/articles/PMC5947892/ /pubmed/29750787 http://dx.doi.org/10.1371/journal.pmed.1002568 Text en © 2018 Gausman et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Gausman, Jewel
Meija Guevara, Ivan
Subramanian, S. V.
Razak, Fahad
Distributional change of women’s adult height in low- and middle-income countries over the past half century: An observational study using cross-sectional survey data
title Distributional change of women’s adult height in low- and middle-income countries over the past half century: An observational study using cross-sectional survey data
title_full Distributional change of women’s adult height in low- and middle-income countries over the past half century: An observational study using cross-sectional survey data
title_fullStr Distributional change of women’s adult height in low- and middle-income countries over the past half century: An observational study using cross-sectional survey data
title_full_unstemmed Distributional change of women’s adult height in low- and middle-income countries over the past half century: An observational study using cross-sectional survey data
title_short Distributional change of women’s adult height in low- and middle-income countries over the past half century: An observational study using cross-sectional survey data
title_sort distributional change of women’s adult height in low- and middle-income countries over the past half century: an observational study using cross-sectional survey data
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5947892/
https://www.ncbi.nlm.nih.gov/pubmed/29750787
http://dx.doi.org/10.1371/journal.pmed.1002568
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