Association between urinary incontinence and urinary tract infections, and fractures in postmenopausal women

Objective: The association between urinary disorders, such as ongoing urinary incontinence (UI), history of urinary incontinence (HIST-UI) and urinary tract infactions (UTI), and fractures in peri- and postmenopausal women was assessed in an epidemiological study. Subjects and methods: The sample consisted of 10 000 women from seven birth cohorts, born between 1900 and 1940, who were investigated regarding urinary disorders, fractures and reproductive history by means of a postal questionnaire. Results: The overall response rate was 74.6%. The respondents (n = 7459) represented 53% of the total population from the respective birth cohorts. There was a significant independent correlation between UI, HIST-UI and UTI, respectively, and fractures after the age of 30. In subjects with HIST-UI, tobacco smokers compared to non-smokers had significant more fractures in both the 1930 and 1940 birth cohorts (P < 0.01). Logistic multiple regression in the 1930 and 1940 cohorts demonstrated that age (P < 0.001), HIST-UI (P < 0.001) and tobacco smoking (P < 0.05), respectively, had an independent explanatory value for fractures. Conclusion: The prevalence of fractures increased with increasing age, in smokers compared to non-smokers and in women with a history of UI.     

Secular trend in age at menarche for women born between 1920 and 1979 in Rio de Janeiro, Brazil

PRIMARY OBJECTIVE: This article presents data on the secular trend in age at menarche for 1955 women from 16 to 76 years of age born between 1920 and 1979 and studied under the Nutrition and Health Survey conducted in the municipality of Rio de Janeiro, Brazil, in 1996. METHODS AND PROCEDURES: Age at menarche was defined by the retrospective method. Women were grouped according to decade of birth, and the trend was estimated using simple linear regression between age at menarche and year of birth for the following specific periods: 1920-1940, 1920-1960, 1960-1979 and 1920-1979. MAIN OUTCOMES AND RESULTS: Mean age at menarche decreased from 13.07 to 12.40 years when comparing the group of women born in the 1920s with the 1970s birth cohort, corresponding to a mean rate of -0.0123 years per year (p < 0.001). The downward trend was -0.0120 years per year (p > 0.05) for the 1920s, 30s and 40s, -0.0093 years per year (p < 0.05) for the period from 1920 to 1960, and -0.0224 years per year (p < 0.01) for the 1960s/70s. CONCLUSIONS: The results suggest a secular trend in age at menarche. The literature points to such environmental variables as improved living conditions and expanded access to health services. Within this context, age at menarche could be used as a marker for social development.     

Time-related trends of age at menopause and reproductive period of women in a Chuvashian rural population

OBJECTIVE: The objective of this study was to examine in an observational, cross-sectional, community-based study the secular trend of age at menopause among women in a rural Chuvashian population and to identify factors associated with age at menopause. DESIGN: The sample included 316 postmenopausal women born between 1920 and 1950 with mean age at menopause of 48.47 +/- 4.63 (34-58) years. Statistical analyses included simple and multiple linear regression and "whiskers" plots. RESULTS: Significant association was found between year of birth and age at menopause (beta = 0.194, P < 0.001) and reproduction period (P = 0.193, P < 0.001). Mean values of age at menopause increased from 47.0 years (born during 1920-1925) to maximal values of 49.7 years (born during 1940-1945) and 49.3 years (born during 1945-1950). Mean values of their reproductive period increased from 30.7 (born during 1920-1925) to maximal values of 34.1 (born during 1940-1945) and to 33.7 (born during 1945-1950). Multiple linear regression analysis demonstrated that year of birth was the only statistically significant (P = 0.19, P < 0.01) predictor of age at menopause. Age at menarche can also be a possible predictor of age at menopause (beta = -0.12, P = 0.04). CONCLUSIONS: The study confirmed certain secular trends of age at menopause and reproductive periods in Chuvashian women. The authors also observed a negative association between age at menarche and age at menopause. The number of children and medical abortions as well as body mass index showed no association with age at menopause.     

An epidemiological study of urinary incontinence and related urogenital symptoms in elderly women

The prevalence of urinary incontinence (UI) and related urogenital symptoms (UGS) was investigated in a random sample (n = 4206) of women from the 1900-20 birth cohorts residing in the city of G?teborg. It was reported by 16.9% of the respondents that they currently had UI and by 22.7% that they had regularly suffered from this complaint at some time in their lives. The prevalence of UI increased (P less than 0.001) with rising age, from 13.9% in the 1920 birth cohort to 24.6% in the 1900 birth cohort. Over 50% of the sufferers reported daily incontinence. An objective assessment was performed in a subsample (n = 300) of the women complaining of UI. In 14 cases (4.6%) the diagnosis could not be confirmed, while in the remainder UI was classified by type as follows: stress incontinence 24%, urge incontinence 49% and mixed incontinence 27%. The number of urinary tract infections (UTI) reported by the respondents increased (P less than 0.001) with rising age. UGS such as pruritus, burning, pain and vaginal discharge were reported by 11% of the respondents. The reported frequency of local vaginal discomfort did not increase with age, unlike that of UI and UTI. Systemic or local oestrogen treatment was being received by 9.2% of the respondents.     

SHORT REPORT: Secular trend in age at menarche for women born between 1920 and 1979 in Rio de Janeiro,Brazil

Primary objective: This article presents data on the secular trend in age at menarche for 1955 women from 16 to 76 years of age born between 1920 and 1979 and studied under the Nutrition and Health Survey conducted in the municipality of Rio de Janeiro, Brazil, in 1996.

Methods and procedures: Age at menarche was defined by the retrospective method. Women were grouped according to decade of birth, and the trend was estimated using simple linear regression between age at menarche and year of birth for the following specific periods: 1920-1940, 1920-1960, 1960-1979 and 1920-1979.

Main outcomes and results: Mean age at menarche decreased from 13.07 to 12.40 years when comparing the group of women born in the 1920s with the 1970s birth cohort, corresponding to a mean rate of -0.0123 years per year (p &lt; 0.001). The downward trend was -0.0120 years per year (p &gt; 0.05) for the 1920s, 30s and 40s, -0.0093 years per year (p &lt; 0.05) for the period from 1920 to 1960, and -0.0224 years per year (p &lt; 0.01) for the 1960s/70s.

Conclusions: The results suggest a secular trend in age at menarche. The literature points to such environmental variables as improved living conditions and expanded access to health services. Within this context, age at menarche could be used as a marker for social development.     

Serum insulin-like growth factor-I concentrations in late middle age: no association with birthweight in three UK cohorts

BACKGROUND: Small body size at birth and during infancy is associated with an increased risk of adult osteoporosis and cardiovascular disease. Fetal programming of the growth hormone-insulin-like growth factor (GH-IGF) axis may provide a mechanism for these epidemiological findings. AIMS: To determine whether measurements of GH and IGF-I in late middle age were related to size at birth and in infancy. METHODS: Overnight urinary GH excretion and fasting serum IGF-I were measured in 309 men and 193 women from Hertfordshire (born 1920-1930) for whom birthweight and weight at 1 year were recorded. Serum IGF-I was measured in men and women from Preston (n=254, born 1935-1943) and Sheffield (n=215, born 1939-1940) whose birthweight and other birth measurements were recorded. RESULTS: Urinary GH and serum IGF-I were not related to birthweight, other measurements at birth, or weight at 1 year. CONCLUSION: In contrast to previous studies in children or young adults, these data do not support the hypothesis that IGF-I concentrations are programmed by intra-uterine events, as assessed by birthweight, in late middle age.     

A longitudinal cohort study of elderly women with urinary tract infections

AIMS: the prevalence of urinary tract infections (UTI), urinary incontinence (UI), estrogen-use and overall mortality in a cohort of elderly women who had been treated for UTI in 1985-86 was re-assessed 10 years later. MATERIAL AND METHODS: a random sample of 6000 women from the birth cohorts 1900, 1905, 1910, 1915 and 1920 were invited in 1986 to complete a questionnaire about UTI, UI and estrogen use (response rate 70%; n = 4206). Treatment with antibiotics for UTI during 1985-86 was reported by 688 (17%) women. In 1995 a similar questionnaire was sent to the women from this group who were still alive (n = 434). Mortality in the women with a history of UTI was compared with an aged-matched control group of women who did not have UTI during 1985-86. RESULTS: the questionnaire was completed and returned by 361 (83%) women. Treatment for at least one UTI during the last 9 years was reported by 219 (61%) women. The number of episodes varied: 35% had one to two UTI, 28% had three to four UTI, 27% five to ten UTI and 10% had had more than 10 UTI. In 1986, the prevalence of UI was higher in women with a history of UTI than in the total population sample (30 vs. 17%; P < 0.001). The prevalence of UI had increased from 30% in 1986 to 33% in 1995 (P < 0.05). Mortality in the women with a history of UTI was higher than in the aged-matched control group (37 vs. 28%; P < 0.001). A total of 162 (45%) women had received estrogen therapy at some time after the age of 60 years and 140 (39%) reported that they were currently taking low potency estrogens. CONCLUSION: elderly women with a history of UTI had a continued high occurrence of UTI and UI, and overall mortality was higher in these women than in an age-matched control group of women from the total population.     

A longitudinal study of the treatment of hot flushes: the population study of women in Gothenburg during a quarter of a century

OBJECTIVE: To describe the prevalence and treatment of hot flushes in premenopausal and postmenopausal women from the 1960s to the 1990s. DESIGN: This prospective study, based on a random sample of the total female population of 430,000 in Gothenburg, Sweden, was started in 1968, with follow-ups in 1974, 1980, and 1992. The participants were 1,462 women born in 1930, 1922, 1918, 1914, and 1908 (participation rate 90.1%) who were representative of women of the same age in the general population. For the purpose of analyzing secular trends, we included 122 participants who were 38 years old and 47 who were 50 years old in 1980-1981. RESULTS: The prevalence of hot flushes increased from approximately 11% at 38 years to a maximal prevalence of approximately 60% at 52 to 54 years of age, then declined successively from approximately 30% at 60 years of age to approximately 15% at 66 years of age, and then to approximately 9% at 72 years of age. The predominant type of medication being prescribed changed during the observation period from sedatives/anticholinergic drugs in the 1960s to hormone replacement therapy in the 1980s. Hormone replacement therapy was considered to be an effective form of treatment for hot flushes by 70% to 87% of the women. CONCLUSIONS: Hot flushes were a common symptom, with a maximal prevalence of 64% at 54 years of age. Medical consultation and treatment did not increase in 50-year-old women from 1968-1969 to 1980-1981. Treatment changed and became more effective during the observation period.     

Recent decline in age at menarche: The Fels Longitudinal Study

A number of recent reports suggest that the average age at menarche of US girls has declined over the past 20 years. Because the putative declines in the age at menarche are concurrent with increases in childhood body mass index (BMI), it has been suggested that these two trends may be causally linked. We examined differences in mean age of menarche in Fels Longitudinal Study girls who were born in six 10‐year birth cohorts (1930s, 1940s, 1950s, 1960s, 1970s, and 1980s) and simultaneous cohort changes in mean BMI measured cross‐sectionally at selected ages from 3–35 years (n = 371). Girls born in the 1980s had a mean age at menarche of 12.34 years, which was ～3–6 months earlier than that of girls born previously (P < 0.001). While the mean BMI values at ages 25 and 35 generally increased from the 1930s to the 1970s, the mean BMI during childhood and adolescence remained constant across the six birth cohorts. In summary, we found no evidence that the recent decline in the age at menarche in the Fels Longitudinal Study girls was reflected in concurrent increases in BMI at any point in childhood or adolescence. Conversely, girls born in the 1960s and 1970s have subsequently become heavier in young and mid‐adulthood than were girls from earlier birth cohorts, without any concurrent change in the mean age at menarche over that time period. These two findings suggest that population‐level shifts in BMI and the timing of menarche are largely independent, although sometimes coincident, processes. Am. J. Hum. Biol. 16:453–457, 2004. © 2004 Wiley‐Liss, Inc.     

Osteoporosis and back pain among the elderly

Questionnaire responses from 120 men and 337 women over the age of 50 years were studied to determine the prevalence of back pain among the elderly. In order to gain a rough indication of the back pain among elderly women which might be due to osteoporosis, the prevalence was compared in the two sexes. The prevalence of back pain without radiation to the legs and concomitant morbidity was found to be similar among men and women up to the 70-79-year age-group. After this age the prevalence was higher in women. Those with exceptional loss of body height or kyphosis had a high prevalence of back pain, while those who had sustained previous hip or radius fractures did not. There was increasing prevalence of back pain among women with increasing number of previous fractures. The study gives little indication of serious morbidity of osteoporosis in the form of back pain before very old age.     

Serum insulin‐like growth factor‐I concentrations in late middle age: no association with birthweight in three UK cohorts

Background: Small body size at birth and during infancy is associated with an increased risk of adult osteoporosis and cardiovascular disease. Fetal programming of the growth hormone–insulin‐like growth factor (GH‐IGF) axis may provide a mechanism for these epidemiological findings. Aims: To determine whether measurements of GH and IGF‐I in late middle age were related to size at birth and in infancy. Methods: Overnight urinary GH excretion and fasting serum IGF‐I were measured in 309 men and 193 women from Hertfordshire (born 1920–1930) for whom birthweight and weight at 1 year were recorded. Serum IGF‐I was measured in men and women from Preston (n = 254, born 1935–1943) and Sheffield (n = 215, born 1939–1940) whose birthweight and other birth measurements were recorded. Results: Urinary GH and serum IGF‐I were not related to birthweight, other measurements at birth, or weight at 1 year. Conclusion: In contrast to previous studies in children or young adults, these data do not support the hypothesis that IGF‐I concentrations are programmed by intra‐uterine events, as assessed by birthweight, in late middle age.     

Evolution of age at menarche and at onset of regular cycling in a large cohort of French women

BACKGROUND: Early exposure to ovarian hormones is considered to increase breast cancer incidence. The age at which the ovaries become functional is thus important. METHODS: We explored the evolution of age at first menstruation and at onset of regular cycling in 86 031 women participating in the E3N-EPIC cohort study, part of the European Prospective Investigation into Cancer. RESULTS: We observed an increase in mean age at menarche among women born between 1925 and 1930, followed by a steady decrease in the youngest birth cohorts. In contrast, age at onset of regular cycling increased gradually from 1925 onwards. There was thus a steady increase in the interval between age at menarche and at onset of regular cycling, mainly due to an increase in the percentage of women in whom regular cycling started at least 5 years after menarche (from 9.0% among women born in 1925-1929 to 20.8% in those born in 1945-1950). The increase in the interval between menarche and onset of regular cycling was even greater among women with a late menarche. CONCLUSIONS: This increase might be due to a change in dietary intake and/or physical exercise aimed at achieving the slim silhouette desired by the younger generations.     

Infertility--epidemiology and referral practice.

A questionnaire-based study of infertility has been carried out in two age cohorts of women in a defined geographical region. Women were aged 36-40 years or 46-50 years at the time of the survey. The prevalence of infertility (no conception after 2 years of trying) was approximately 14% in both age cohorts. However, a significantly higher proportion of younger women had sought medical help. In both age cohorts there was a higher incidence of spontaneous abortion among infertile women. These findings suggest no significant increase in the prevalence of infertility over a decade but a considerable increase in the use of medical services.     

Childhood cognitive ability and age at menopause: evidence from two cohort studies

OBJECTIVE: To investigate whether poorer cognitive ability in childhood is associated with an earlier menopause. DESIGN: Two cohorts were included: a nationally representative British birth cohort study of 1,350 women born in March 1946 and followed up to age 54 years, and an Aberdeen cohort study of 3,465 women born in Aberdeen from 1950 to 1956 and followed up to age 44 to 50 years. Both cohorts had prospective information on childhood cognitive ability at age 7 or 8 years. RESULTS: In both cohorts, women with lower cognitive scores in childhood reached menopause earlier than women with higher scores. With follow-up of menopause to 49 years, the hazard ratio (HR) for one standard deviation of the cognitive score was 0.80 (95% CI, 0.72-0.90) in the Aberdeen cohort and 0.84 (95% CI, 0.73-0.97) in the older 1946 birth cohort. The effect was still evident in the 1946 birth cohort with follow-up of menopause to 53 years (HR = 0.87; 95% CI, 0.79-0.95). These ratios were weakly attenuated by adjustment for potential confounding effects of lifetime socioeconomic circumstances, parity, and smoking. CONCLUSIONS: The association between early cognitive ability and timing of menopause only partially reflects common risk factors, although residual confounding remains a possibility. Alternatively, early environmental or genetic programming may explain this association, perhaps through setting lifelong patterns of hormone release or causing transient hormonal changes at sensitive periods of development. These findings have implications for the interpretation of studies investigating an association between age at menopause and adult cognitive function.     

Increase in the prevalence of allergen skin sensitization in successive birth cohorts

BACKGROUND: Little is known about longitudinal trends in the prevalence of allergen skin sensitization in the general population. OBJECTIVE: We sought to measure the change in prevalence of allergen skin sensitization over a 9-year period in a cohort of adults and hence to determine whether cross-sectional differences in prevalence between age groups are due to an aging or cohort effect. METHODS: In 1991 and 2000, we measured skin sensitization, defined as a wheal diameter of 3 mm or larger than that elicited by a saline control, to Dermatophagoides pteronyssinus, cat fur, mixed grass, Aspergillus fumigatus, and Cladosporium herbarum in a cohort of 1339 adults from Nottingham aged between 18 and 71 years in 1991. Subjects were divided into six 9-year successive birth cohorts, and the effects of birth cohort and the within-subject change from 1991 to 2000 were analyzed in a generalized estimating equation logit model. RESULTS: The unadjusted prevalence of sensitization to any allergen was 30.5% in 1991 and 31.8% in 2000. In cross-sectional analyses the prevalence of sensitization decreased with increasing age at both surveys (risk ratio, 2.15; 95% confidence interval [CI], 1.45-3.17 for 18- to 26-year-old patients relative to 63- to 70-year-old patients in the 1991 survey). In longitudinal analysis there was no within-subject change in sensitization from 1991 to 2000 (adjusted odds ratio, 1.07; 95% CI, 0.97-1.19), but there was a significant cohort effect (adjusted odds ratio per successive 9 year cohort, 1.27; 95% CI, 1.18-1.37). CONCLUSION: The cross-sectional decrease in allergen sensitization with age in the general population arises predominantly from a secular increase in sensitization prevalence with successive birth cohorts and not to a loss of sensitization within subjects over time. As a result of this cohort effect, the prevalence of allergic sensitization has increased in this general adult population sample.     

Lifetime prevalence of infertility and infertility treatment in the UK: results from a population-based survey of reproduction

BACKGROUND: The aim of this study was to investigate the prevalence of infertility and the use of infertility treatment among women aged 40-55 years. METHODS: Population-based postal questionnaire survey of UK women. Over 60,000 women randomly sampled from the 2001 electoral roll were sent a questionnaire, and those aged 55 years and under who had ever been pregnant or tried to achieve a pregnancy (n = 6584) were asked to provide a reproductive history. RESULTS: Overall, 2.4% of women aged 40-55 years had unresolved infertility with no pregnancies, and a further 1.9% had been pregnant but not achieved a live birth. The prevalence of unresolved fertility did not differ among birth cohorts. Sixteen percent of women reported ever consulting a doctor because of infertility and 8% reported receiving treatment to conceive. Across the whole sample, 4.2% of women reported that they had achieved at least one pregnancy as a result of treatment. Compared with earlier birth cohorts, women born later were more likely to report consultations (18% versus 13%) and treatment (9% versus 6%) for infertility, and pregnancies as a result of infertility treatment (6.7% versus 2.7%). Among those who reported medical consultations, women born more recently first consulted at a later age compared with those born earlier. CONCLUSIONS: Although both the number of women seeking medical care for infertility and the proportion reporting pregnancies as a result of infertility treatment has increased, there is no evidence to support an overall increase in unresolved infertility over the past 15 years. The vast majority of women aged 40-55 who reported difficulties conceiving did have a child, or children, at some point in their lives.     

Persistent variations in average height between countries and between socio-economic groups: an overview of 10 European countries

PRIMARY OBJECTIVES: This paper aims to provide an overview of variations in average height between 10 European countries, and between socio-economic groups within these countries. DATA AND METHODS: Data on self-reported height of men and women aged 20-74 years were obtained from national health, level of living or multipurpose surveys for 1987-1994. Regression analyses were used to estimate height differences between educational groups and to evaluate whether the differences in average height between countries and between educational groups were smaller among younger than among older birth cohorts. RESULTS: Men and women were on average tallest in Norway, Sweden, Denmark and the Netherlands and shortest in France, Italy and Spain (range for men: 170-179 cm; range for women: 160-167 cm). The differences in average height between northern and southern European countries were not smaller among younger than among older birth cohorts. In most countries average height increased linearly with increasing birth-year (approximately 0.7-0.8 cm/5 years for men and approximately 0.4 cm/5 years for women). In all countries, lower educated men and women on average were shorter than higher educated men (range of differences: 1.6-3.0 cm) and women (range of differences: 1.2-2.2 cm). In most countries, education-related height differences were not smaller among younger than among older birth cohorts. CONCLUSIONS: The persistence of international differences in average height into the youngest birth cohorts indicates a high degree of continuity of differences between countries in childhood living conditions. Similarly, the persistence of education-related height differences indicates continuity of socio-economic differences in childhood living conditions, and also suggests that socio-economic differences in childhood living conditions will continue to contribute to socio-economic differences in health at adult ages.     

Live birth prevalence of Down syndrome in Tottori, Japan, 1980-1999

One hundred sixty-four patients with Down syndrome (DS) were confirmed in Tottori Prefecture, Japan, from 1980 to 1999. The sex ratio of 1.52 (99 males and 65 females) was comparable to that reported in previous studies. The live birth prevalence per 1,000 was 1.52 (95% CI: 1.29-1.75) from 1980 to 1999, with a prevalence of 1.34 (95% CI: 1.05-1.63) recorded between 1980 and 1989, and 1.74 (95% CI: 1.37-2.11) between 1990 and 1999. There was no statistically significant change between these two decades (chi(2)-test). Live birth prevalence in these two decades showed a significant increase (chi(2)-test, P < 0.005) compared with that recorded in 1969-1978 in Tottori Prefecture (0.803, 95% CI: 0.677-0.929). Mean ages of mothers at the birth of a DS patient were 31.0 years in 1980-1989 and 32.4 years in 1990-1999 (t-test, no significant difference). Dispersion analysis on the mean age of mothers at birth for patients born between 1969-1978, 1980-1989, and 1990-1999 showed a significant difference (t-test, P < 0.005), while comparing the mean age of mothers in 1969-1978 to those in 1990-1999 also revealed a significant difference (t-test, P < 0.001). Live birth prevalence has increased due to the rise in fertility rates among older women, although maternal age-specific risk rates remain unchanged. The widespread introduction of induced abortion following prenatal diagnosis decreased live birth prevalence of DS largely in European (and a few Asian) countries after 1990, or kept prevalence steady, despite increasing fertility rates among women aged 30 and over. In contrast, all published studies have reported an increase in live birth prevalence of this syndrome in Japan, probably resulting from the fact that prenatal diagnoses are used only exceptionally in this country (due to the negative attitude toward selection of life in Japanese culture).     

Variability of reproductive history across the Swiss SAPALDIA cohort--patterns and main determinants

BACKGROUND: Reproductive characteristics play an aetiological role for many diseases, including reproductive cancers. They have been shown to vary internationally and nationally, but have not yet been described for the whole Swiss population. AIM: The study investigated the variability of reproductive characteristics, their patterns, and main determinants across a population-based female study population in Switzerland. METHODS: Reproductive characteristics obtained from 3119 women (28-72 years) participating in the SAPALDIA cohort survey in 2001-2003 are described across birth cohorts, study areas, language regions, and levels of urbanization. Determinants of age at menopause were analysed by Cox regression. RESULTS: Reported median age at menarche was 13 years and median age at natural menopause was 52 years. The prevalence of nulliparity was 27%, and the fertility rate 1.6. Across birth cohorts there was a decline of menarcheal age and fertility rates, and an increase of nulliparity and age at last pregnancy. All characteristics varied across study areas, language regions, and levels of urbanization. Smoking, parity, and physical exercise were stronger predictors of earlier (<52 years) than older (>52 years) menopausal age. CONCLUSION: Reproductive events show secular and geographic variation within Switzerland. Smoking, parity and physical activity significantly predict age at natural menopause, particularly before age 52. The secular trend of earlier menarche and increased nulliparity may result in a higher risk of reproductive cancers in younger generations.     

Persistent variations in average height between countries and between socio-economic groups: an overview of 10 European countries

Primary objectives: This paper aims to provide an overview of variations in average height between 10 European countries, and between socio-economic groups within these countries.

Data and methods: Data on self-reported height of men and women aged 20-74 years were obtained from national health, level of living or multipurpose surveys for 1987-1994. Regression analyses were used to estimate height differences between educational groups and to evaluate whether the differences in average height between countries and between educational groups were smaller among younger than among older birth cohorts.

Results: Men and women were on average tallest in Norway, Sweden, Denmark and the Netherlands and shortest in France, Italy and Spain (range for men: 170-179 cm; range for women: 160-167 cm). The differences in average height between northern and southern European countries were not smaller among younger than among older birth cohorts. In most countries average height increased linearly with increasing birth-year (≈0.7-0.8cm/5 years for men and ≈0.4cm/5 years for women). In all countries, lower educated men and women on average were shorter than higher educated men (range of differences: 1.6-3.0 cm) and women (range of differences: 1.2-2.2 cm). In most countries, education-related height differences were not smaller among younger than among older birth cohorts.

Conclusions: The persistence of international differences in average height into the youngest birth cohorts indicates a high degree of continuity of differences between countries in childhood living conditions. Similarly, the persistence of education-related height differences indicates continuity of socio-economic differences in childhood living conditions, and also suggests that socio-economic differences in childhood living conditions will continue to contribute to socio-economic differences in health at adult ages.