McEniry M, Palloni, A, Huangfu, Y, Beltrán-Sánchez, H
Middle- and high-income settings have achieved high life expectancy at older ages but through disparate pathways. Rapid and dramatic mortality decline largely in the context of stagnant improvement in standard of living occurred during the mid-20th century in many middle-income countries leading to the current increase in the aging population in these settings. These historical circumstances produced cohorts of older adults largely characterized by their survivorship of poor early life conditions. If early life conditions are important determinants of older adult health, there will be long term consequences on adult health for these cohorts even as they have achieved gains in life expectancy at older ages. Using Waaler height-weight mortality surfaces, we find that compared with a US population of male older adults, a population of Latin American and Caribbean (LAC) older adults that (1) is heavier (obese) when attaining optimum levels of life expectancy and (2) reached modern levels of life expectancy in the absence of significant increases in height and the persistence of non-trivial levels of stunting and moderate malnutrition. These results point to differences in the relation between human physical growth, disease, and mortality in LAC. We argue that, unlike high-income countries, gains in longevity in low-middle income countries comes accompanied by increased weight (obesity) but modest increases in height with subsequent increased risk of unhealthy life expectancy at older ages.