|Height of Nations: A Socioeconomic Analysis of Cohort Differences and Patterns among Women in 54 Low- to Middle-Income Countries|
||S. V. Subramanian, Emre O zaltin, Jocelyn E. Finlay
||PLOS ONE , 6(4): e18962. doi:10.1371/journal.pone.0018962
More than one region
Background: Adult 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/Findings: We 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.
Conclusions: Socioeconomic 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.