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A total of 28,974 observations regarding individuals aged 2–22 years were included in the final analysis. Among them, 15,227 observations (52.55%) pertained to males and 13,747 observations (47.45%) pertained to females, as shown in Table 1. The proportion of observations in each age group was relatively balanced. Looking at the investigation period, the number of observations was highest in 1991 (accounting for 16.77% of all observations) and 1993 (accounting for 14.75% of all observations). The years with the lowest number of observations were 1989 and 2009, accounting for 6.40% and 6.46% of the total observations, respectively. Regarding the birth year, the highest number of observations (24.51% of the total observations) occurred in the group born in the 1985–1989 period.
Table 1. Distribution of the study population across study variables
Item Overall population (N = 28,974) Male (N = 15,227) Female (N = 13,747) Frequency Percent (%) Height (cm) Frequency Percent (%) Height (cm) Frequency Percent (%) Height (cm) Age (A) (years) 2–4 4,231 14.60 94.85 ± 8.94 2,301 15.11 95.56 ± 8.99 1,930 14.04 94.01 ± 8.80 5–7 4,568 15.77 114.02 ± 8.98 2,467 16.20 114.54 ± 9.07 2,101 15.28 113.41 ± 8.84 8–10 4,528 15.63 130.99 ± 9.23 2,381 15.64 131.05 ± 9.01 2,147 15.62 130.92 ± 9.47 11–13 4,743 16.37 147.08 ± 10.41 2,475 16.25 146.97 ± 11.02 2,268 16.50 147.20 ± 9.70 14–16 4,049 13.97 159.47 ± 9.10 2,110 13.86 162.88 ± 9.40 1,939 14.10 155.76 ± 7.09 17–19 3,051 10.53 163.42 ± 8.73 1,619 10.63 168.54 ± 7.21 1,432 10.42 157.63 ± 6.35 20–22 3,804 13.13 162.76 ± 8.48 1,874 12.31 168.55 ± 6.61 1,930 14.04 157.13 ± 5.93 Year of survey (P) 1989 1,853 6.40 121.34 ± 32.48 935 6.14 121.50 ± 34.23 918 6.68 121.18 ± 30.61 1991 4,859 16.77 134.94 ± 26.07 2,486 16.33 136.03 ± 27.72 2,373 17.26 133.79 ± 24.17 1993 4,273 14.75 136.08 ± 24.84 2,224 14.61 137.37 ± 26.09 2,049 14.91 134.68 ± 23.33 1997 3,643 12.57 139.90 ± 22.91 1,943 12.76 141.26 ± 24.39 1,700 12.37 138.36 ± 20.99 2000 3,420 11.80 142.77 ± 23.09 1,821 11.96 144.35 ± 24.48 1599 11.63 140.97 ± 21.26 2004 2,279 7.87 142.22 ± 24.98 1,221 8.02 144.22 ± 26.34 1,058 7.70 139.91 ± 23.10 2006 1,925 6.64 139.41 ± 26.20 1,040 6.83 140.98 ± 27.84 885 6.44 137.57 ± 24.01 2009 1,872 6.46 139.80 ± 25.35 1,024 6.72 141.78 ± 26.56 848 6.17 137.40 ± 23.59 2011 2,537 8.76 135.71 ± 26.70 1,314 8.63 136.45 ± 28.53 1,223 8.90 134.92 ± 24.58 2015 2,313 7.98 137.43 ± 26.52 1,219 8.01 138.49 ± 28.34 1,094 7.96 136.24 ± 24.30 Birth cohort (C) before 1975 2,837 9.79 160.87 ± 8.06 1,359 8.92 166.54 ± 6.19 1,478 10.75 155.65 ± 5.71 1975–1979 3,097 10.69 157.48 ± 10.46 1,621 10.65 160.65 ± 11.66 1,476 10.74 154.00 ± 7.56 1980–1984 4,609 15.91 141.55 ± 20.26 2,387 15.68 142.99 ± 21.71 2,222 16.16 140.00 ± 18.47 1985–1989 7,102 24.51 128.52 ± 28.11 3,885 25.51 130.18 ± 29.23 3,217 23.40 126.52 ± 26.55 1990–1994 3,598 12.42 137.31 ± 25.67 1,835 12.05 138.35 ± 27.27 1,763 12.82 136.22 ± 23.86 1995–1999 3,077 10.62 136.08 ± 25.78 1,653 10.86 137.27 ± 26.80 1,424 10.36 134.71 ± 24.49 2000–2004 2,456 8.48 126.50 ± 22.92 1,293 8.49 126.74 ± 23.19 1,163 8.46 126.24 ± 22.62 2005 and after 2,198 7.59 110.82 ± 17.71 1,194 7.84 110.70 ± 17.55 1,004 7.30 110.97 ± 17.90 -
Like the general rule of growth, the results for different APC models showed that age (A) had a steady and continuous effect on height (Table 2). As individuals’ heights increased with age (P < 0.0001), height growth estimates were used as a reference for each age group. However, the height of the 20–22 years age group did not increase significantly compared with the 17–19 years age group. Moreover, when using the 2–4 years age group as the reference group, the height growth of females in the 5–7 years, 8–10 years, and 11–13 years age groups exceeded that of males in the same age groups. Furthermore, beginning from the 14–16 years age group, the height growth of males exceeded that of females in the same age group, with the height growth of males in the 17–19 years age group estimated to be 9.37 cm greater than that of females (72.98 cm vs. 63.61 cm) in the same age group.
Table 2. Comparison of the estimated effects among different groups of indices
Item Overall population Male Female A
(210769.97)*A + P
(208728.44)A + C
(209288.2886)A
(110158.19)A + P
(108902.30)A + C
(109232.21)A
(97142.19)A + P
(96167.30)A + C
(96414.11)E CL E CL E CL E CL E CL E CL E CL E CL E CL INCPT 94.85 (94.57, 95.13) 91.60 (91.15, 92.05) 88.77 (88.22, 89.31) 95.56 (95.19, 95.92) 92.23 (91.62, 92.83) 89.56 (88.81, 90.30) 94.01 (93.64, 94.38) 91.19 (90.61, 91.77) 88.89 (88.18, 89.59) Age (A) (years) 2–4 Ref. Ref. Ref. Ref. Ref. Ref. Ref. Ref. Ref. Ref. Ref. Ref. Ref. Ref. Ref. Ref. Ref. Ref. 5–7 19.17 (18.78, 19.55) 18.82 (18.45, 19.19) 19.49 (19.11, 19.87) 18.98 (18.47, 19.50) 18.64 (18.15, 19.14) 19.26 (18.76, 19.76) 19.40 (18.88, 19.91) 19.08 (18.58, 19.58) 19.71 (19.20, 20.21) 8–10 36.14 (35.75, 36.52) 35.50 (35.12, 35.88) 36.88 (36.49, 37.27) 35.49 (34.98, 36.01) 34.98 (34.47, 35.49) 36.23 (35.71, 36.75) 36.91 (36.40, 37.42) 36.25 (35.75, 36.76) 37.59 (37.07, 38.10) 11–13 52.23 (51.85, 52.61) 51.65 (51.27, 52.03) 53.79 (53.39, 54.19) 51.41 (50.90, 51.92) 50.90 (50.39, 51.40) 52.97 (52.45, 53.50) 53.19 (52.69, 53.69) 52.66 (52.16, 53.16) 54.68 (54.16, 55.21) 14–16 64.62 (64.23, 65.02) 64.15 (63.76, 64.55) 66.83 (66.40, 67.25) 67.33 (66.80, 67.86) 66.96 (66.44, 67.49) 69.73 (69.16, 70.30) 61.75 (61.23, 62.27) 61.30 (60.78, 61.81) 63.69 (63.13, 64.25) 17–19 68.57 (68.14, 68.99) 68.42 (68.00, 68.84) 72.06 (71.58, 72.53) 72.98 (72.41, 73.56) 72.88 (72.32, 73.44) 76.53 (75.90, 77.16) 63.61 (63.05, 64.18) 63.52 (62.97, 64.08) 66.70 (66.07, 67.33) 20–22 67.91 (67.50, 68.31) 68.21 (67.82, 68.60) 72.28 (71.79, 72.76) 72.99 (72.44, 73.54) 73.33 (72.80, 73.86) 77.46 (76.80, 78.12) 63.12 (62.60, 63.64) 63.40 (62.90, 63.91) 66.87 (66.24, 67.50) Year of survey (P) 1989 − Ref. Ref. − − Ref. Ref. − − Ref. Ref. − 1991 − 0.80 (0.31, 1.29) − − 0.76 (0.09, 1.43) − − 0.60 (−0.03, 1.23) − 1993 − 1.77 (1.27, 2.27) − − 1.77 (1.08, 2.45) − − 1.45 (0.81, 2.10) − 1997 − 2.64 (2.12, 3.16) − − 2.24 (1.53, 2.94) − − 2.47 (1.80, 3.14) − 2000 − 3.92 (3.40, 4.45) − − 3.65 (2.94, 4.36) − − 3.70 (3.02, 4.38) − 2004 − 4.83 (4.26, 5.39) − − 4.75 (3.99, 5.51) − − 4.20 (3.47, 4.94) − 2006 − 5.05 (4.47, 5.63) − − 5.19 (4.41, 5.98) − − 4.25 (3.48, 5.01) − 2009 − 6.14 (5.56, 6.73) − − 6.70 (5.92, 7.49) − − 4.93 (4.16, 5.69) − 2011 − 6.97 (6.42, 7.51) − − 7.25 (6.50, 7.99) − − 6.40 (5.69, 7.10) − 2015 − 7.87 (7.32, 8.43) − − 8.17 (7.42, 8.93) − − 7.15 (6.43, 7.87) − Birth cohort (C) before 1975 − − Ref. Ref. − − Ref. Ref. − − Ref. Ref. 1975–1979 − − 2.09 (1.59, 2.59) − − 1.22 (0.54, 1.90) − − 1.94 (1.30, 2.58) 1980–1984 − − 2.92 (2.43, 3.42) − − 2.67 (1.99, 3.36) − − 2.27 (1.63, 2.90) 1985–1989 − − 3.76 (3.28, 4.24) − − 3.56 (2.90, 4.22) − − 2.80 (2.17, 3.42) 1990–1994 − − 5.97 (5.45, 6.49) − − 6.03 (5.31, 6.75) − − 5.14 (4.48, 5.80) 1995–1999 − − 6.62 (6.07, 7.16) − − 7.21 (6.47, 7.96) − − 5.01 (4.31, 5.71) 2000–2004 − − 8.03 (7.44, 8.61) − − 8.05 (7.24, 8.85) − − 6.99 (6.24, 7.75) 2005 and after − − 8.95 (8.33, 9.57) − − 8.61 (7.77, 9.45) − − 8.31 (7.51, 9.12) Note. *The Akaike information criterion (AIC) is shown in parentheses. P,investigation period. C -
The average heights of the investigated groups continuously increased during the investigation period (P), as shown in Table 2. Based on the average height of the groups during the 1989 survey, the analysis revealed that, by 2015, the average height of the groups increased by 7.87 cm, with an average increase of –8.17 cm in males and 7.15 cm in females. It was statistically significant to use height growth estimates as a reference for the investigation period (P < 0.001).
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Birth year (C) had a stable effect on height in the overall group, as well as in the gender-based groups (Table 2). When the height of individuals born in or before 1975 was used as the reference, the average height of each birth cohort showed an increase as compared to the previous birth cohort. For example, in the overall group of individuals born in 2005 or later, the average height increased by 8.95 cm as compared to those born in 1975 or earlier. It was statistically significant to use height growth estimates as a reference for birth years (P < 0.001).
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Figure 1 shows the estimated growth in the height of males and females by age group, survey year, and birth year, respectively, relative to their respective control groups.
doi: 10.3967/bes2021.046
Increases in Height among Chinese Children and Adolescents by Gender: An Age-Period-Cohort Analysis
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Abstract:
Objective To examine increases in average height among Chinese children and adolescents. Methods The data were obtained from the China Health and Nutrition Survey conducted during the period 1989–2015. A stratified multistage cluster sampling method was utilized to select participants aged 2–22 years in each province. Linear regression was used to examine the effects of age, birth cohort, and survey period on height. Results A total of 15,227 males and 13,737 females were included in the final analysis. Age (A) showed a continuous effect on height. The average heights of the investigated groups increased continuously during the investigation period. By 2015, the average height of the overall group increased by 7.87 cm compared to the average height during the 1989 survey. Moreover, birth year (cohort, C) also had a stable effect on height. Using the height of individuals born in or before 1975 as a reference, the average height of each birth cohort increased in comparison to the previous birth cohort. Conclusions The height of Chinese children and adolescents was affected by age, period, and cohort effects, and this effect is governed by certain rules. The age-period-cohort model can be used to analyze the trends of children’s and adolescent’s heights. The findings provide a scientific basis for the formulation of children’s and adolescents’ growth and development policies in China. -
Key words:
- Age-period-cohort analysis /
- Children and adolescents /
- Height
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Table 1. Distribution of the study population across study variables
Item Overall population (N = 28,974) Male (N = 15,227) Female (N = 13,747) Frequency Percent (%) Height (cm) Frequency Percent (%) Height (cm) Frequency Percent (%) Height (cm) Age (A) (years) 2–4 4,231 14.60 94.85 ± 8.94 2,301 15.11 95.56 ± 8.99 1,930 14.04 94.01 ± 8.80 5–7 4,568 15.77 114.02 ± 8.98 2,467 16.20 114.54 ± 9.07 2,101 15.28 113.41 ± 8.84 8–10 4,528 15.63 130.99 ± 9.23 2,381 15.64 131.05 ± 9.01 2,147 15.62 130.92 ± 9.47 11–13 4,743 16.37 147.08 ± 10.41 2,475 16.25 146.97 ± 11.02 2,268 16.50 147.20 ± 9.70 14–16 4,049 13.97 159.47 ± 9.10 2,110 13.86 162.88 ± 9.40 1,939 14.10 155.76 ± 7.09 17–19 3,051 10.53 163.42 ± 8.73 1,619 10.63 168.54 ± 7.21 1,432 10.42 157.63 ± 6.35 20–22 3,804 13.13 162.76 ± 8.48 1,874 12.31 168.55 ± 6.61 1,930 14.04 157.13 ± 5.93 Year of survey (P) 1989 1,853 6.40 121.34 ± 32.48 935 6.14 121.50 ± 34.23 918 6.68 121.18 ± 30.61 1991 4,859 16.77 134.94 ± 26.07 2,486 16.33 136.03 ± 27.72 2,373 17.26 133.79 ± 24.17 1993 4,273 14.75 136.08 ± 24.84 2,224 14.61 137.37 ± 26.09 2,049 14.91 134.68 ± 23.33 1997 3,643 12.57 139.90 ± 22.91 1,943 12.76 141.26 ± 24.39 1,700 12.37 138.36 ± 20.99 2000 3,420 11.80 142.77 ± 23.09 1,821 11.96 144.35 ± 24.48 1599 11.63 140.97 ± 21.26 2004 2,279 7.87 142.22 ± 24.98 1,221 8.02 144.22 ± 26.34 1,058 7.70 139.91 ± 23.10 2006 1,925 6.64 139.41 ± 26.20 1,040 6.83 140.98 ± 27.84 885 6.44 137.57 ± 24.01 2009 1,872 6.46 139.80 ± 25.35 1,024 6.72 141.78 ± 26.56 848 6.17 137.40 ± 23.59 2011 2,537 8.76 135.71 ± 26.70 1,314 8.63 136.45 ± 28.53 1,223 8.90 134.92 ± 24.58 2015 2,313 7.98 137.43 ± 26.52 1,219 8.01 138.49 ± 28.34 1,094 7.96 136.24 ± 24.30 Birth cohort (C) before 1975 2,837 9.79 160.87 ± 8.06 1,359 8.92 166.54 ± 6.19 1,478 10.75 155.65 ± 5.71 1975–1979 3,097 10.69 157.48 ± 10.46 1,621 10.65 160.65 ± 11.66 1,476 10.74 154.00 ± 7.56 1980–1984 4,609 15.91 141.55 ± 20.26 2,387 15.68 142.99 ± 21.71 2,222 16.16 140.00 ± 18.47 1985–1989 7,102 24.51 128.52 ± 28.11 3,885 25.51 130.18 ± 29.23 3,217 23.40 126.52 ± 26.55 1990–1994 3,598 12.42 137.31 ± 25.67 1,835 12.05 138.35 ± 27.27 1,763 12.82 136.22 ± 23.86 1995–1999 3,077 10.62 136.08 ± 25.78 1,653 10.86 137.27 ± 26.80 1,424 10.36 134.71 ± 24.49 2000–2004 2,456 8.48 126.50 ± 22.92 1,293 8.49 126.74 ± 23.19 1,163 8.46 126.24 ± 22.62 2005 and after 2,198 7.59 110.82 ± 17.71 1,194 7.84 110.70 ± 17.55 1,004 7.30 110.97 ± 17.90 Table 2. Comparison of the estimated effects among different groups of indices
Item Overall population Male Female A
(210769.97)*A + P
(208728.44)A + C
(209288.2886)A
(110158.19)A + P
(108902.30)A + C
(109232.21)A
(97142.19)A + P
(96167.30)A + C
(96414.11)E CL E CL E CL E CL E CL E CL E CL E CL E CL INCPT 94.85 (94.57, 95.13) 91.60 (91.15, 92.05) 88.77 (88.22, 89.31) 95.56 (95.19, 95.92) 92.23 (91.62, 92.83) 89.56 (88.81, 90.30) 94.01 (93.64, 94.38) 91.19 (90.61, 91.77) 88.89 (88.18, 89.59) Age (A) (years) 2–4 Ref. Ref. Ref. Ref. Ref. Ref. Ref. Ref. Ref. Ref. Ref. Ref. Ref. Ref. Ref. Ref. Ref. Ref. 5–7 19.17 (18.78, 19.55) 18.82 (18.45, 19.19) 19.49 (19.11, 19.87) 18.98 (18.47, 19.50) 18.64 (18.15, 19.14) 19.26 (18.76, 19.76) 19.40 (18.88, 19.91) 19.08 (18.58, 19.58) 19.71 (19.20, 20.21) 8–10 36.14 (35.75, 36.52) 35.50 (35.12, 35.88) 36.88 (36.49, 37.27) 35.49 (34.98, 36.01) 34.98 (34.47, 35.49) 36.23 (35.71, 36.75) 36.91 (36.40, 37.42) 36.25 (35.75, 36.76) 37.59 (37.07, 38.10) 11–13 52.23 (51.85, 52.61) 51.65 (51.27, 52.03) 53.79 (53.39, 54.19) 51.41 (50.90, 51.92) 50.90 (50.39, 51.40) 52.97 (52.45, 53.50) 53.19 (52.69, 53.69) 52.66 (52.16, 53.16) 54.68 (54.16, 55.21) 14–16 64.62 (64.23, 65.02) 64.15 (63.76, 64.55) 66.83 (66.40, 67.25) 67.33 (66.80, 67.86) 66.96 (66.44, 67.49) 69.73 (69.16, 70.30) 61.75 (61.23, 62.27) 61.30 (60.78, 61.81) 63.69 (63.13, 64.25) 17–19 68.57 (68.14, 68.99) 68.42 (68.00, 68.84) 72.06 (71.58, 72.53) 72.98 (72.41, 73.56) 72.88 (72.32, 73.44) 76.53 (75.90, 77.16) 63.61 (63.05, 64.18) 63.52 (62.97, 64.08) 66.70 (66.07, 67.33) 20–22 67.91 (67.50, 68.31) 68.21 (67.82, 68.60) 72.28 (71.79, 72.76) 72.99 (72.44, 73.54) 73.33 (72.80, 73.86) 77.46 (76.80, 78.12) 63.12 (62.60, 63.64) 63.40 (62.90, 63.91) 66.87 (66.24, 67.50) Year of survey (P) 1989 − Ref. Ref. − − Ref. Ref. − − Ref. Ref. − 1991 − 0.80 (0.31, 1.29) − − 0.76 (0.09, 1.43) − − 0.60 (−0.03, 1.23) − 1993 − 1.77 (1.27, 2.27) − − 1.77 (1.08, 2.45) − − 1.45 (0.81, 2.10) − 1997 − 2.64 (2.12, 3.16) − − 2.24 (1.53, 2.94) − − 2.47 (1.80, 3.14) − 2000 − 3.92 (3.40, 4.45) − − 3.65 (2.94, 4.36) − − 3.70 (3.02, 4.38) − 2004 − 4.83 (4.26, 5.39) − − 4.75 (3.99, 5.51) − − 4.20 (3.47, 4.94) − 2006 − 5.05 (4.47, 5.63) − − 5.19 (4.41, 5.98) − − 4.25 (3.48, 5.01) − 2009 − 6.14 (5.56, 6.73) − − 6.70 (5.92, 7.49) − − 4.93 (4.16, 5.69) − 2011 − 6.97 (6.42, 7.51) − − 7.25 (6.50, 7.99) − − 6.40 (5.69, 7.10) − 2015 − 7.87 (7.32, 8.43) − − 8.17 (7.42, 8.93) − − 7.15 (6.43, 7.87) − Birth cohort (C) before 1975 − − Ref. Ref. − − Ref. Ref. − − Ref. Ref. 1975–1979 − − 2.09 (1.59, 2.59) − − 1.22 (0.54, 1.90) − − 1.94 (1.30, 2.58) 1980–1984 − − 2.92 (2.43, 3.42) − − 2.67 (1.99, 3.36) − − 2.27 (1.63, 2.90) 1985–1989 − − 3.76 (3.28, 4.24) − − 3.56 (2.90, 4.22) − − 2.80 (2.17, 3.42) 1990–1994 − − 5.97 (5.45, 6.49) − − 6.03 (5.31, 6.75) − − 5.14 (4.48, 5.80) 1995–1999 − − 6.62 (6.07, 7.16) − − 7.21 (6.47, 7.96) − − 5.01 (4.31, 5.71) 2000–2004 − − 8.03 (7.44, 8.61) − − 8.05 (7.24, 8.85) − − 6.99 (6.24, 7.75) 2005 and after − − 8.95 (8.33, 9.57) − − 8.61 (7.77, 9.45) − − 8.31 (7.51, 9.12) Note. *The Akaike information criterion (AIC) is shown in parentheses. P,investigation period. C -
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