Abstract

tatus in female and male children and adolescents (FeMaCA) [1]. Several studies have compared the height, through the height-forage z-score (HAZ), between FeMaCA of Mapuche ethnicity and European descent, and the results have been inconclusive [2–4]. This systematic review and meta-analysis aimed to compare the HAZ between FeMaCA of Mapuche ethnicity and descendants of Europeans. Methods: This study was registered in Prospero (CRD42017069924), and the protocol can be consulted elsewhere [5]. The search was performed in four databases until October, 2020: PubMed/Medline, Scopus, Web of Science and SciELO. Observational studies conducted on FeMaCA of Mapuche ethnicity and descendants of Europeans; providing data on HAZ reported as mean and standard deviation, or statistics that allow its estimation; published in English or Spanish, were included. The selection process was performed first, from title and abstract, and then, through full text of relevant manuscripts. The global mean difference (GMD) and the 95% confidence interval (CI) were estimated using the generic inverse variance method applying randomeffects models. To examine the influence of living in rural or urban areas, a stratified analysis was conducted. Heterogeneity was assessed by the Cochran Q-statistic and the I2 statistic, and the publication bias through the Egger’s and Begg’s test. All analyses were performed with STATA 15. Results: From 3141 records initially identified, three studies were selected [2–4]. The HAZ for FeMaCA of Mapuche ethnicity ranged from −0.96 in rural areas with high poverty to 0.38 in urban areas. Meanwhile, the HAZ for FeMaCA of European descent ranged from −0.58 in rural areas to 0.16 in urban areas. Stratified analysis based on the area of residence of Mapuche subjects showed a significantly lower HAZ in Mapuche subjects living in rural areas compared to European descent (GMD = −0.43; 95% CI: −0.58, −0.27). Conversely, FeMaCA of Mapuche ethnicity living in urban areas had a significantly higher HAZ compared to urban Europeans descendants (GMD = 0.25; 95% CI: 0.33, 0.30).The heterogeneity was undetectable in any case (I2 = 0.0%), and no evidence of publication bias was found after applying Egger’s and Begg’s tests. Conclusion: This study found a higher HAZ in FeMaCA of Mapuche ethnicity living in urban areas compared to European descent, and a lower HAZ in Mapuche FeMaCA of rural areas. Living in rural or urban environments may play a crucial role in the stature of FeMaCA of Mapuche ethnicity, possibly linked to a higher social vulnerability that this ethnic group presents, especially in rural areas.