Postgraduate Programme in Epidemiology, Federal University of Pelotas, RuaMarechal Deodoro 1160, Pelotas, Brazil.
Paediatr Perinat Epidemiol. 2012 May;26(3):236-49. doi: 10.1111/j.1365-3016.2011.01251.x. Epub 2012 Jan 13.
Socio-economic inequalities in attained height have been reported in many countries. The aim of this study was to explore the age at which maternal education inequalities in child height emerge among children from a middle-income country. Using data from the 2004 Pelotas cohort study from Brazil we modelled individual height growth trajectories in 2106 boys and 1947 girls from birth to 4 years using a linear spline mixed-effects model. We examined the associations of maternal education with birth length and trajectories of growth in length/height, and explored the effect of adjusting for a number of potential confounder or mediator factors. We showed linear and positive associations of maternal education with birth length and length/height growth rates at 0-3 months and 12-29/32 months with very little association at 3-12 months, particularly in boys. By age 4 years the mean height of boys was 101.06 cm (SE = 0.28) in the lowest and 104.20 cm (SE = 0.15) in the highest education category (mean difference 3.14 cm, SE = 0.32, P < 0.001). Among girls the mean height was 100.02 cm (SE = 0.27) and 103.03 cm (SE = 0.15) in the lowest and highest education categories, respectively (mean difference 3.01 cm, SE = 0.31, P < 0.001). For both boys and girls there was on average a 3-cm difference between the extreme education categories. Adjusting for maternal height reduced the observed birth length differences across maternal education categories, but differences in postnatal growth rates persisted. Our data demonstrate an increase in the absolute and relative inequality in height after birth; inequality increases from approximately 0.2 standard deviations of birth length to approximately 0.7 standard deviations of height at age 4, indicating that height inequality, which was already present at birth, widened through differential growth rates to age 2 years.
社会经济不平等在许多国家的身高都有报道。本研究旨在探讨中等收入国家儿童身高的母亲教育不平等现象出现的年龄。本研究使用了巴西 2004 年佩洛塔斯队列研究的数据,我们使用线性样条混合效应模型,对 2106 名男孩和 1947 名女孩从出生到 4 岁的个体身高增长轨迹进行建模。我们研究了母亲教育与出生时的身高以及身高/长度增长轨迹之间的关系,并探讨了调整多个潜在混杂或中介因素的效果。我们发现母亲教育与出生时的身高以及 0-3 个月和 12-29/32 个月时的身高/长度增长率呈线性正相关,而在 3-12 个月时的相关性很小,特别是在男孩中。到 4 岁时,最低和最高教育类别的男孩身高均值分别为 101.06 cm(SE=0.28)和 104.20 cm(SE=0.15)(均值差 3.14 cm,SE=0.32,P<0.001)。在女孩中,最低和最高教育类别的身高均值分别为 100.02 cm(SE=0.27)和 103.03 cm(SE=0.15)(均值差 3.01 cm,SE=0.31,P<0.001)。对于男孩和女孩,极端教育类别之间的平均差异为 3 cm。调整母亲身高后,出生时的长度差异有所缩小,但出生后的生长率差异仍然存在。我们的数据表明,出生后身高的绝对和相对不平等程度增加;出生时的身高不平等程度从大约 0.2 个标准差增加到 4 岁时的大约 0.7 个标准差,表明出生时已经存在的身高不平等现象,通过不同的生长率在 2 岁时进一步扩大。