Exploring the effect of socioeconomic development on child growth in posttransitional Croatia: a cross-sectional study



To determine the relationship between socioeconomic development (SD) of local administrative units (LAU) and the height and body mass index (BMI) of second- and third-grade children in Croatia.


We analyzed average height-for-age and BMI-for-age z-scores of 99 LAUs, based on the measurement of 5662 children participating in the Childhood Obesity Surveillance Initiative Croatia. SD was defined according to the governmental Development index. Pearson’s correlations between average height and BMI z-scores and SD were calculated. We used ANOVA to test differences in average height and BMI z-scores among LAUs from different SD quartiles and multiple linear regression to investigate the association between average height-for-age z-scores and SD.


Height-for-age was significantly correlated with SD. We found a difference in average height-for-age between the least and more developed LAUs. A multiple linear regression model showed significant association between Development index and the average height-for-age z-score (F = 13.085, p < 0.001, R2 = 0.119).


This finding is important for creators of policies worldwide as socioeconomic inequalities in children’s height may exist in other countries that, like Croatia, have recently gone through the transition process.

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Authors would like to thank Ida Grbić Ivanović for proofreading the manuscript.


The conduct of research was funded by the World Health Organization (Grant No. 61773) Regional Office for Europe and Croatian Institute of Public Health. The work of doctoral student Martina Pezer has been fully supported by the Croatian Science Foundation.

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Correspondence to Maja Lang Morović.

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All procedures performed in this study were in accordance with the ethical standards of the institutional research committee (Croatian Institute of Public Health, reference number 80-2660/1-15) and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study as well as their parents or caretakers.

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This article is part of the special issue “Adolescent Health in Central and Eastern Europe”.

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Musić Milanović, S., Lang Morović, M., Križan, H. et al. Exploring the effect of socioeconomic development on child growth in posttransitional Croatia: a cross-sectional study. Int J Public Health 65, 1299–1307 (2020). https://doi.org/10.1007/s00038-020-01424-0

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  • Socioeconomic factors
  • Income
  • Educational status
  • Growth and development
  • Childhood obesity surveillance initiative
  • Croatia