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

Jia Ma; Zhixin Zhang; Wenquan Niu; Jie Chen; Sihui Guo; Shufang Liu; Yanhui Dong; Zhaogeng Yang; Wenlai Wang; Ci Song; Jun Ma; Tao Pei

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

Front Pediatr. 2019 Oct 30:7:425. doi: 10.3389/fped.2019.00425. eCollection 2019.

Authors

Jia Ma^{1

2}, Zhixin Zhang², Wenquan Niu³, Jie Chen⁴, Sihui Guo⁴, Shufang Liu^{1

2}, Yanhui Dong⁵, Zhaogeng Yang⁵, Wenlai Wang⁴, Ci Song⁴, Jun Ma⁵, Tao Pei⁴

Affiliations

¹ Graduate School, Beijing University of Chinese Medicine, Beijing, China.
² Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China.
³ Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China.
⁴ State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China.
⁵ Institute of Child and Adolescent Health and School of Public Health, Peking University, Beijing, China.

Abstract

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 cross-sectional survey of China (CNSSCH). 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; 95% CI: 0.22-0.74) and China (OR = 0.42; 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. They may interactively explain spatial discrepancy and predict short stature in Chinese school children. Further validations are necessary.

Keywords: prediction; prevalence; risk factor; short stature; spatial discrepancy.