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.     

Childhood conditions and education as determinants of adult height and obesity among Greenland Inuit

Height and obesity are risk factors for cardiovascular disease and other physical and mental health conditions. Their association with childhood socioeconomic position has been demonstrated in studies among European and a few third world populations. In a random sample of adult Greenland Inuit (N = 2302) we studied the association between childhood socioeconomic conditions and height as well as prevalence of obesity (BMI ≥ 30) in a cross sectional design. In block recursive graphical independence models, height was associated with mother's place of birth, birth cohort, childhood residence, alcohol problems in childhood home, and education among both men and women. Obesity was associated with mother's place of birth (for men) and with alcohol problems (for women). In General Linear Models, men with an all rural background and no education beyond primary school measured on average 165.1 cm compared with 172.1 cm for men with an all urban background (P < 0.001); women measured 153.9 and 161.1 cm (P < 0.001). Rural‐urban differences in prevalence of obesity were not statistically significant. The height differences were considerably larger than between educational groups in European countries and of the same order of magnitude as those reported between men from the 17th century and men from 400 BC in the European and Mediterranean region. The rural‐urban gradient in height follows the socioeconomic gradient and may negatively affect cardiovascular risk among the rural Greenlanders, while their physically active lifestyle and high consumption of n‐3 fatty acids may counteract this. Am. J. Hum. Biol., 2010. © 2009 Wiley‐Liss, Inc.     

Income, educational level and body height.

The relation between adult body height and two socio-economic factors (income and educational level) was studied in a large, ethnically homogenous population. In the period 1980-1983 all persons aged 40-54 years (born 1926-1941) in two Norwegian counties were invited to a cardiovascular screening. Ninety per cent (or 38162 persons) of those invited attended and had their height measured. Information concerning income and education was available at an individual level from the 1980 national census. Strong, positive relations were found between mean body height and the socio-economic factors, relations that probably are due to conditions during growth influencing both height, attained education and income abilities. The difference between highest and lowest educational class was 3.3 cm in men and 3.2 cm in women, and between highest and lowest income group 3.5 cm in men and 4.2 cm in women. These differences could not be explained by the strong cohort effect of increasing height in the successive birth cohorts from 1926 to 1941 which also was evident. It should be emphasized that height only could explain a small fraction of the variance in the socio-economic factors and is thus not a usable indicator of an individual's socio-economic status. However, it might contribute with important information concerning social inequalities in groups or population.     

The height increments and BMI values of elite Central European children and youth in the second half of the 19th century

BACKGROUND: Longitudinal height measurements on children and youth are very rare prior to the 20th century, as are BMI values. AIM: Growth increments and BMI values were determined among elite (select) Habsburg children and youth in the late 19th century and compared with other extant historical and contemporary data. SUBJECT AND METHODS: Archival data on height and weight were collected for approximately 3500 students attending Habsburg Military schools. The students were measured once a year for 4 years. Because of the minimum height requirement, truncated regression was used in order to estimate height trends, but standard procedures were used to determine height increments and BMI values. RESULTS: Heights increased at most 0.9-1.6 cm between the birth cohorts of circa 1870s and 1900. These future officers were about the same size as their counterparts in the USA and France, but smaller than those attending the Royal Military Academy in Sandhurst, England, who were taller and probably the tallest in the world at the time. Height increments were markedly smaller than those experienced by German students in the 18th century after age 15. Central European BMI values were above those obtained in the USA in the 19th century but well below modern values. CONCLUSION: Although peak height velocity was experienced as early as ages 13 and 14, the height increments were very small compared even to other historical populations. The military academy selected mainly precocious applicants (with probably larger height increments at younger ages and smaller increments at older ages). BMI values in this sample were well below modern standards, but they were unexpectedly as high as those of contemporary US West Point cadets, a well nourished group. There were significant differences in the height of elites in Central Europe in the 19th century, pointing to substantial socio-economic inequality, but at least the elites were as well nourished as the US population.     

Social relationships,gender, and allostatic load across two age cohorts

OBJECTIVE: This article addresses the question of biological pathways through which social integration and support may affect morbidity and mortality risks. A new concept of cumulative biological risk, allostatic load, is used to test the hypothesis that social experiences affect a range of biological systems. Data from two community-based cohorts are examined to evaluate the consistency of findings across two different age groups. METHODS: One cohort included older adults aged 70 to 79 years (N = 765); the other cohort included persons aged 58 to 59 years (N = 106). Allostatic load was assessed using identical protocols in the two cohorts. Measures of social experience were similar but not identical, reflecting levels of social integration and support for the older cohort vs. childhood and adult experiences of loving/caring relationships with parents and spouse for the younger cohort. Gender-specific analyses were examined to evaluate possible gender differences in patterns of association. RESULTS: In the younger cohort, positive cumulative relationship experiences were associated with lower allostatic load for men and women. In the older cohort, men who were more socially integrated and those reporting more frequent emotional support from others had lower allostatic load scores; similar but nonsignificant associations were seen for women. CONCLUSIONS: Evidence from two cohorts provides support for the hypothesis that positive social experiences are associated with lower allostatic load. These findings are consistent with the hypothesis that social experiences affect a range of biological systems, resulting in cumulative differences in risks that in turn may affect a range of health outcomes.     

The height of women in Sub-Saharan Africa: the role of health, nutrition, and income in childhood

BACKGROUND: Adult height in individuals has been linked to health and nutrition in childhood, and to health outcomes in later life. Economists have used average adult height as an indicator of the biological standard of living and as a measure of health human capital. However, it is unclear to what extent childhood health and nutrition are reflected in adult height at the population level. AIM: The study examined the proximate determinants of population adult height for countries in Sub-Saharan Africa. SUBJECTS AND METHODS: A database was created of adult female height for 24 countries in Sub-Saharan Africa for birth cohorts born between 1945 and 1985. The present study examined the effect of infant mortality rate, GDP per capita, and average protein and calorie consumption on cohort adult height. RESULTS: Most of the variation in height across countries in Sub-Saharan Africa is due to fixed effects; however, it was found that variations in cohort height over time are sensitive to changes in infant mortality rate, GDP per capita, and protein intake, both at birth and in adolescence. CONCLUSIONS: Changes in cohort adult height over time in Sub-Saharan Africa are related to changes childhood health and nutrition, although variation across countries appears to be determined mainly by unexplained fixed factors.     

Social status and adult heights in the two Germanies

BACKGROUND: Lack of evidence prevented hitherto the systematic comparison of physical stature across East and West Germany. AIM: The aim of this study is to compare heights by social status in the two Germanies with very different socio-economic and political systems prior to unification. DATA: The German Federal Health Survey of 1998 (Public Use File BGS98), a cross-sectional random sample of 7124 adult males and females between ages 18 and 79 (birth cohorts of 1919-1980) is used in the analysis. RESULTS: There are considerable and persistent differences by social status in both East and West Germany over time. The West German height advantage among men increases with social status, whereas among women the opposite is the case. East German men born after the Berlin Wall was built became significantly shorter, but East Germans regained equality with West Germans after unification. In contrast, East German females were markedly shorter than their West German counterparts throughout the period considered. CONCLUSIONS: The West German capitalistic welfare state provided a more propitious environment for the physical growth of the human organism than did the socialist East German government. There were substantial social differences in height in the officially classless German Democratic Republic.     

Social status and adult heights in the two Germanies

Background : Lack of evidence prevented hitherto the systematic comparison of physical stature across East and West Germany. Aim : The aim of this study is to compare heights by social status in the two Germanies with very different socio-economic and political systems prior to unification. Data : The German Federal Health Survey of 1998 (Public Use File BGS98), a cross-sectional random sample of 7124 adult males and females between ages 18 and 79 (birth cohorts of 1919-1980) is used in the analysis. Results : There are considerable and persistent differences by social status in both East and West Germany over time. The West German height advantage among men increases with social status, whereas among women the opposite is the case. East German men born after the Berlin Wall was built became significantly shorter, but East Germans regained equality with West Germans after unification. In contrast, East German females were markedly shorter than their West German counterparts throughout the period considered. Conclusions : The West German capitalistic welfare state provided a more propitious environment for the physical growth of the human organism than did the socialist East German government. There were substantial social differences in height in the officially classless German Democratic Republic.     

Common mental disorders and ethnicity in England: the EMPIRIC study

BACKGROUND: There is little population-based evidence on ethnic variation in the most common mental disorders (CMD), anxiety and depression. We compared the prevalence of CMD among representative samples of White, Irish, Black Caribbean, Bangladeshi, Indian and Pakistani individuals living in England using a standardized clinical interview. METHOD: Cross-sectional survey of 4281 adults aged 16-74 years living in private households in England. CMD were assessed using the Revised Clinical Interview Schedule (CIS-R), a standardized clinical interview. RESULTS: Ethnic differences in the prevalence of CMD were modest, and some variation with age and sex was noted. Compared to White counterparts, the prevalence of CMD was higher to a statistically significant degree among Irish [adjusted rate ratios (RR) 2.09, 95% CI 1.16-2.95, p = 0.02] and Pakistani (adjusted RR 2.38, 95 % CI 1.25-3.53, p = 0.02) men aged 35-54 years, even after adjusting for differences in socio-economic status. Higher rates of CMD were also observed among Indian and Pakistani women aged 55-74 years, compared to White women of similar age. The prevalence of CMD among Bangladeshi women was lower than among White women, although this was restricted to those not interviewed in English. There were no differences in rates between Black Caribbean and White samples. CONCLUSIONS: Middle-aged Irish and Pakistani men, and older Indian and Pakistani women, had significantly higher rates of CMD than their White counterparts. The very low prevalence of CMD among Bangladeshi women contrasted with high levels of socio-economic deprivation among this group. Further study is needed to explore reasons for this variation.     

The height of women in Sub-Saharan Africa: The role of health,nutrition, and income in childhood

Background: Adult height in individuals has been linked to health and nutrition in childhood, and to health outcomes in later life. Economists have used average adult height as an indicator of the biological standard of living and as a measure of health human capital. However, it is unclear to what extent childhood health and nutrition are reflected in adult height at the population level.

Aim: The study examined the proximate determinants of population adult height for countries in Sub-Saharan Africa.

Subjects and methods: A database was created of adult female height for 24 countries in Sub-Saharan Africa for birth cohorts born between 1945 and 1985. The present study examined the effect of infant mortality rate, GDP per capita, and average protein and calorie consumption on cohort adult height.

Results: Most of the variation in height across countries in Sub-Saharan Africa is due to fixed effects; however, it was found that variations in cohort height over time are sensitive to changes in infant mortality rate, GDP per capita, and protein intake, both at birth and in adolescence.

Conclusions: Changes in cohort adult height over time in Sub-Saharan Africa are related to changes childhood health and nutrition, although variation across countries appears to be determined mainly by unexplained fixed factors.     

Trends in cutaneous malignant melanoma in Denmark 1943-1982 by anatomic site

Time trends in the incidence of cutaneous malignant melanoma were examined by analysing data from the Danish Cancer Registry, 1943-1982, by sex and subsite for 3509 male and 5305 female cases. The age-standardized incidence rate for cutaneous malignant melanoma for men and women in Denmark increased by five- to six-fold between 1943 and 1982. The increase varied by site; a particularly pronounced elevation was seen for tumours of the trunk in both men and women and of the leg in women. A statistical analysis of the effects of age, time and cohort showed steep increases in risk for progressively younger birth cohorts. This association was particular pronounced for sites other than the face, scalp and neck; for the latter sites, there was a much smaller increase for younger cohorts.     

Socio-economic inequalities in smoking: an examination of generational trends in Great Britain

This article examines pseudo-cohort trends in socio-economic inequalities in smoking behaviour. People born in 1926-1950 living in manual households were more likely to become smokers than those in non-manual households, but both groups subsequently gave up smoking at similar rates. Those in the 1956-1985 birth cohorts were less likely to smoke than people born earlier, but they were also less likely to give up. The rates of giving up among the non-manual group declined slightly compared with those born earlier. However there was a dramatic change for the manual group compared with earlier cohorts; the vast majority remained smokers, with rates stabilising around 45 per cent for men and 40 per cent for women.     

Clinical characteristics and echocardiographic features of black men vs. black women with systolic heart failure

PURPOSE: We sought to determine whether significant differences exist in clinical characteristics and echocardiographic features between black men and black women who presented to an outpatient heart failure clinic. METHODS: A retrospective review of the charts of 114 consecutive patients with systolic dysfunction who presented to a heart failure clinic in Brooklyn from 1999--2003 was performed. The first echocardiogram within six months of presentation to the clinic was used for analysis. The clinical characteristics included are: age, sex, body mass index (BMI) and diabetes status. A significance level of <0.05 was used throughout. SUMMARY: Based on the analysis of 108 black men and women, overall, men have a significantly larger left ventricular end-diastolic diameter (LVEDD) compared to women (p<0.006). Younger men (7.17 cm) had a larger LVEDD compared to older men (6.37 cm) and both younger and older women (6.22 cm and 6.40 cm, respectively). This difference in LVEDD between the sexes decreased with aging. Men (22.17) had a lower ejection fraction (EF) than women (25.37). No significant differences were noted in the BMI (30.45 for men and 28.60 for women) and the albumin level (3.59 for men and 3.44 for women) between the sexes. However, the younger age group (particularly younger men) had a higher BMI than the older age group (p=0.008).     

Psychosocial adjustment during pregnancy for older couples conceiving through assisted reproductive technology

BACKGROUND: The trend to older maternal age at first birth is well established in Western countries and biological risk factors, particularly declining fertility, are well documented. Less is known, however, about the psychosocial well-being of older first time parents. This study explores differences in psychosocial adjustment during pregnancy in older (maternal age >or= 38 years) and younger (maternal age < 35 years) couples after assisted reproductive technology (ART) conception. METHODS: Questionnaire data were collected from a consecutive cohort of pregnant nulliparous women and their partners recruited over a 12-month period from ART clinics in Sydney, Australia. RESULTS: There were more similarities than differences when comparing older and younger couples. Older couples took longer to conceive and were more likely to use donor eggs. Older pregnant women scored higher on a measure of psychological hardiness/resilience and reported a lower identification with motherhood compared with younger pregnant women. Older men differed only in reporting a less satisfying social orientation during pregnancy (lower satisfaction with sex life, relationship with partner and social life). CONCLUSIONS: Findings do not indicate problematic adjustment during pregnancy in older couples, but differences found need further investigation using larger samples and prospective designs.     

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.     

Gender and adult undernutrition in developing countries

BACKGROUND: Information on the prevalence of undernutrition in adults in developing countries is mainly restricted to data on women. Literature reporting on the occurrence of female deprivation in developing countries, in particular in South Asia, suggests that differences between undernutrition prevalence in adult men and adult women might occur, but systematic information on the subject is lacking. AIM: The study compares undernutrition prevalence rates, based on prevalence of low body mass index (BMI < 18.5), in adult men and adult women in developing countries. Regional comparison is made between the main developing regions: Sub-Saharan Africa, South/Southeast Asia and Latin America. SUBJECTS AND METHODS: The study uses data as reported in 75 samples from 31 countries(divided over the three developing regions), in which anthropometric information has been collected in adult men and women within one and the same community. RESULTS: Results indicate that, in general, prevalence rates of undernutrition are rather similar in adult men and women. However, there are regional differences. In communities in Sub-Saharan Africa, prevalence of low BMI is, on average, a few percent higher in men than in women; in South/Southeast Asia the reverse is the case. In some communities differences in undernutrition prevalence between men and women are exceptionally large. CONCLUSIONS: It can be concluded that, in general, information on undernutrition prevalence in women can be considered a proxy for undernutrition prevalence in all adults, men and women together. However, the finding that in South/Southeast Asia women's nutritional status relative to men's nutritional status compares unfavourably with results from other developing regions, in particular Sub-Saharan Africa, provides some support for the concept of female deprivation in South/Southeast Asia. Where large differences between prevalence of low BMI in men and women occur, gender-specific policies aimed at reducing under-nutrition should be considered.     

Socio-economic status over the life-course and depressive symptoms in men and women in Eastern Europe

OBJECTIVE: Research into social inequalities in depression has studied western populations but data from non-western countries are sparse. In this paper, we investigate the extent of social inequalities in depression in Eastern Europe, the relative importance of social position at different points of the life-course, and whether social patterning of depression differs between men and women. METHOD: A cross-sectional study examined 12,053 men and 13,582 women in Russia, Poland and the Czech Republic. Depressive symptoms (16 or above on the CESD-20) were examined in relation to socio-economic circumstances at three phases of the life-course: childhood (household amenities and father's education); own education; current circumstances (financial difficulties and possession of household items). RESULTS: Pronounced social differences in depression exist in men and women throughout Eastern Europe. Depression was largely influenced by current circumstances rather than by early life or education, with effects stronger in Poland and Russia. Odds ratios in men for current disadvantage were 3.16 [95% CI: 2.57-3.89], 3.16 [2.74-3.64] and 2.17 [1.80-2.63] in Russia, Poland and the Czech Republic respectively. Social variables did not explain the female excess in depression, which varied from 2.91 [2.58-3.27] in Russia to 1.90 [1.74-2.08] in Poland. Men were more affected by adult disadvantage than women, leading to narrower sex differentials in the presence of disadvantage. LIMITATIONS: Cross-sectional data with recall of childhood conditions were used. CONCLUSION: Current social circumstances are the strongest influence on increased depressive symptoms in countries which have recently experienced social changes.     

Return of depressed men: changes in distribution of depression and symptom cases in Norway between 1990 and 2001

BACKGROUND: Women's elevated risk of depression compared to men is a common finding in psychiatric epidemiology. Studies conducted in the 1950s and 1970s, however, documented approximately equal prevalence of sex rates. AIM: This study investigated changes in depression rates between 1990 and 2001 in Norway. Further, differences in severity were examined between men and women. METHOD: A study population (later to be called OsLof) was established in 1990, supplemented in 2001, and analysed as two cross-sectional datasets to compare sex and age differences in ICD-10 diagnoses and HSCL-25> or =1.75 caseness. Organic depression and the DSM-IV Major Depressive Episode were also examined in 2001. RESULTS: There was no significant change in the prevalence of depression or HSCL-25 caseness from 1990 to 2001. However, a major shift in prevalence occurred over time within the 18-34 year old age category with significantly higher rates among younger men (1% to 10%) and lowered rates among younger women (10% to 4%). Among persons depressed, no significant differences were found for severity between the sexes. LIMITATIONS: A selection of healthier participants than found in the source population might have resulted in lower prevalence than real. CONCLUSION: There was no indication of an overall increase in depression from 1990 to 2001, neither by diagnosis nor by symptom checklist scores. However, a major shift in prevalence occurred within the 18-34 year old age category with significantly higher rates among younger men and lowered rates among younger women. No sex differences existed in terms of severity of depression.     

The effect of rainfall during gestation and early childhood on adult height in a foraging and horticultural society of the Bolivian Amazon.

Recent research documents the effects of adverse conditions during gestation and early childhood on growth responses and health throughout life. Most research linking adverse conditions in early life with adult health comes from industrial nations. We know little about the plasticity of growth responses to environmental perturbations early in life among foragers and horticulturalists. Using 2005 data from 211 women and 215 men 20+ years of age from a foraging-horticultural society of native Amazonians in Bolivia (Tsimane'), we estimate the association between (a) adult height and (b) rainfall amount and variability during three stages in the life cycle: gestation (year 0), birth year (year 1), and years 2-5. We control for confounders such as height of the same-sex parent. Rainfall amount and variability during gestation and birth year bore weak associations with adult height, probably from the protective role of placental physiology and breastfeeding. However, rainfall variability during years 2-5 of life bore a negative association with adult female height. Among women, a 10% increase in the coefficient of variation of rainfall during years 2-5 was associated with 0.7-1.2% lower adult height (1.08-1.93 cm). Environmental perturbations that take place after the cessation of weaning seem to leave the strongest effect on adult height. We advance possible explanations for the absence of effects among males.     

Gender and adult undernutrition in developing countries

Background: Information on the prevalence of undernutrition in adults in developing countries is mainly restricted to data on women. Literature reporting on the occurrence of female deprivation in developing countries, in particular in South Asia, suggests that differences between undernutrition prevalence in adult men and adult women might occur, but systematic information on the subject is lacking. Aim: The study compares undernutrition prevalence rates, based on prevalence of low body mass index (BMI &lt; 18.5), in adult men and adult women in developing countries. Regional comparison is made between the main developing regions: Sub-Saharan Africa, South/Southeast Asia and Latin America. Subjects and methods: The study uses data as reported in 75 samples from 31 countries (divided over the three developing regions), in which anthropometric information has been collected in adult men and women within one and the same community. Results: Results indicate that, in general, prevalence rates of undernutrition are rather similar in adult men and women. However, there are regional differences. In communities in Sub-Saharan Africa, prevalence of low BMI is, on average, a few percent higher in men than in women; in South/Southeast Asia the reverse is the case. In some communities differences in undernutrition prevalence between men and women are exceptionally large. Conclusions: It can be concluded that, in general, information on undernutrition prevalence in women can be considered a proxy for undernutrition prevalence in all adults, men and women together. However, the finding that in South/Southeast Asia women's nutritional status relative to men's nutritional status compares unfavourably with results from other developing regions, in particular Sub-Saharan Africa, provides some support for the concept of female deprivation in South/Southeast Asia. Where large differences between prevalence of low BMI in men and women occur, gender-specific policies aimed at reducing undernutrition should be considered.