Perpetuating Health Inequalities in Mexican Adolescents: A Perspective Using Height for Age Disparities By Region, Gender, and Household Food Insecurity

Abstract

Background/Purpose:

In México, stunting, defined as linear growth failure for age, is the most prevalent form of undernutrition with short- and long-term health, cognitive, economic, and social consequences. Evidence has shown an association between stunting and lower socioeconomic status (SES) and intergenerational effect on linear growth, which perpetuates and evidences the cycle of inequalities in the country.

In México, the prevalence of stunting is higher in the southern region, being most prevalent in rural and marginalized communities. Our hypothesis is that Household food security (HFS) is a protective factor against stunting, regardless of the region, area, and gender, in adolescents in Mexico. HFS is achieved when people living in a household have physical and economic access to sufficient, innocuous, and nutritious food to meet their dietary needs and food preferences..

To inform this relationship, we use the Epidemiological Transition Theory and the Dualistic Theory of Development.

Methods:

Data and samples: We use the Mexican National Health and Nutrition Survey 2016 (ENSANUT 2016), a nationally-representative cross-sectional study with a subset data with 3,441 adolescents aged 10-19 years.

Measures: Stunting (dependent variable) was operationalized as height-for-age under –2 standard deviations (SD) of the WHO child growth standards median referred to as LfA-z- score. Measurement of HFS was estimated using the Latin American and Caribbean Food Security Scale (ELCSA), categorizing households into 4 clusters: secure, insecure mild, insecure moderate and insecure severe. Mexico was divided into 4 regions: north, center, metropolitan and south, and each region into rural or urban settings as communities with a population size of <2,500 or ≥ 2,500 individuals. A new area variable was generated with 8 categories. We performed multivariable logistic regression models, margins, and tested interaction effects by area and level of food security on stunting. We further stratified analyses by level of food security and gender.

Results:

Results indicate that adolescents living in the southern-rural area are more likely to be stunted compared to those in the northern-rural area in México (adjusted odds ratio (AOR) 2.37, 95% CI 1.13-4.97). In stratified analyses by HFS, we found that food security was not protective against adolescent stunting in the southern-rural area in Mexico (AOR 5.83, 95% CI 1.66-20.50). We also found a statistically significant interaction effect between region and HFS on stunting in females (p-value< 0.001). Female adolescents living in food insecure households in the southern-rural region had the highest probabilities for being stunted (44.05%, 95% CI 25.23-62.87%), followed by counterparts living in food secure households in that same area (28.69%, 95% CI 10.30-47.08%).  

Conclusions and Implications:

Findings do not support our hypothesis that food security would be protective against adolescent stunting in all regions in México. Results by gender in the southern-rural region portray the unequal distribution of economic and health resources in México. In sum, our findings show that growth indicators such as height for age in adolescents and the intergenerational effect of stunting will not improve unless urgent and evidence-based policies are implemented in southern México.