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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Pediatr. | doi: 10.3389/fped.2019.00425

Education, Altitude and Humidity Can Interactively Explain Spatial Discrepancy and Predict Short Stature in 213,795 Chinese School Children

 Jia Ma1, 2, zhixin zhang2*,  Wenquan Niu3, Jie Chen4,  Shufang Liu1, 2,  Yanhui Dong5, Zhaogeng Yang5, Wenlai Wang4, Ci Song4, Jun Ma5* and Tao Pei4*
  • 1Beijing University of Chinese Medicine, China
  • 2China-Japan Friendship Hospital, China
  • 3Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, China
  • 4Institute of Geographic Sciences and Natural Resources Research (CAS), China
  • 5Peking University, China

Backgrounds and Objectives: The north–south height distinctions in Chinese children suggest that some geographical–climatic factors could determine height variation of short stature. In a national health survey, we aimed to explore the spatial distribution of short stature on city scales, and detect its socio-economic and geographical–climatic factors.
Methods: Data on the prevalence of short stature were obtained from a 2014 (CNSSCH) cross-sectional survey of China. In total, 213,795 Han Chinese students aged 7–18 years, from 106 cities across 30 provinces, were included. Both China and World Health Organization (WHO) growth references were adopted to define short stature.
Results: A spatial clustering was apparent in the distribution of short stature. After multivariable adjustment, altitude and humidity significantly increased the risk of high prevalence in short stature, according to the WHO (odds ratio [OR] = 1.61 and 1.26, 95% confidence interval [CI]: 1.20–2.17 and 1.03–1.54) and China (OR = 1.54 and 1.26; 95% CI: 1.15–2.05 and 1.02–1.55) growth references. Additionally, education significantly decreased the risk of high prevalence in short stature according to the WHO (OR = 0.40 and 95% CI: 0.22–0.74) and China (OR = 0.42 and 1.26, 95% CI: 0.22–0.77) growth references. Combining both altitude >400 m and education <9 years, as well as education <9 years and humidity >70%, received the largest effect-size estimate, and significance retained after multivariable adjustment.
Conclusions: Our findings indicate that high altitude and humidity increased the risk of high prevalence in short stature, high education was associated with low prevalence. Additionally, we observed possible interactions between education and altitude/humidity. Further validations are necessary.

Keywords: short stature, Prevalence, risk factor, Spatial discrepancy, prediction

Received: 13 May 2019; Accepted: 04 Oct 2019.

Copyright: © 2019 Ma, zhang, Niu, Chen, Liu, Dong, Yang, Wang, Song, Ma and Pei. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Mx. zhixin zhang, China-Japan Friendship Hospital, Beijing, 100029, Beijing Municipality, China, zhangzhixin032@163.com
Mx. Jun Ma, Peking University, Beijing, 100871, Beijing Municipality, China, majunt@bjmu.edu.cn
Mx. Tao Pei, Institute of Geographic Sciences and Natural Resources Research (CAS), Beijing, 100101, Beijing Municipality, China, peit@lreis.ac.cn