Rojas Alfredo J, Gray Clark L, West Colin Thor
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Popul Environ. 2023 Jun;45(2). doi: 10.1007/s11111-023-00414-7. Epub 2023 Mar 24.
Child growth failure, as indicated by low height-for-age z-scores (HAZ), is an important metric of health, social inequality, and food insecurity. Understanding the environmental pathways to this outcome can provide insight into how to prevent it. While other studies have examined the environmental determinants of HAZ, there is no agreed upon best-practices approach to measure the environmental context of this outcome. From this literature, we derive a large set of potential environmental predictors and specifications including temperature and precipitation levels, anomalies, and counts as well as vegetation anomalies and trends, which we include using linear, nonlinear, and interactive specifications. We compare these measures and specifications using four rounds of DHS survey data from Burkina Faso and a large set of fixed effects regression models, focusing on exposures from the time of conception through the second year of life and relying on joint hypothesis tests and goodness-of-fit measures to determine which approach best explains HAZ. Our analysis reveals that nonlinear and interactive transformations of climate anomalies, as opposed to climate levels or vegetation indices, provide the best explanation of child growth failure. These results underline the complex and nonlinear pathways through which climate change affects child health and should motivate climate-health researchers to more broadly adopt measures and specifications that capture these pathways.
儿童生长发育迟缓，以年龄别身高Z评分（HAZ）较低为指标，是衡量健康、社会不平等和粮食不安全的一项重要指标。了解导致这一结果的环境途径有助于洞察如何预防该情况。虽然其他研究已经考察了HAZ的环境决定因素，但对于衡量这一结果的环境背景，尚无公认的最佳实践方法。从这些文献中，我们得出了大量潜在的环境预测因素和设定，包括温度和降水水平、异常值、计数以及植被异常和趋势，我们通过线性、非线性和交互设定来纳入这些因素。我们使用来自布基纳法索的四轮 DHS 调查数据以及大量固定效应回归模型来比较这些测量方法和设定，重点关注从受孕到两岁期间的暴露情况，并依靠联合假设检验和拟合优度测量来确定哪种方法能最好地解释HAZ。我们的分析表明，与气候水平或植被指数相比，气候异常的非线性和交互转换能最好地解释儿童生长发育迟缓。这些结果突显了气候变化影响儿童健康的复杂非线性途径，应促使气候与健康研究人员更广泛地采用能够捕捉这些途径的测量方法和设定。
