Evaluation of age- and sex-related alteration in Haller index and other thoracic measurements among Saudi population using computerized tomography scan - 18/01/26

Évaluation des modifications liées à l’âge et au sexe de l’indice de Haller et d’autres mesures thoraciques chez la population saoudienne à l’aide d’un scanner informatisé

Doi : 10.1016/j.aolm.2026.200658

Asmaa F. Sharif ^a,^b,⁎ , Mohammed A. Abuelnor ^c, Faiz Yosuf ^c, Khaled A. Alattar ^a, Layan Alfaridi ^d, Sherefah Alsayafi ^e, Zainab Alsumayen ^f, Noura Al Bohassan ^g, Hawraa Almusallam ^g, Asmaa F.A. Maagouze ^h

^a Department of Clinical Medical Science, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia

^b Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt

^c Department of Basic Medical Science, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia

^d Department of Family Medicine, King Fahad military medical complex, Dharhan, Saudi Arabia

^e Department of General Surgery, King Fahd hospital, Hufof, Saudi Arabia

^f Department Pediatrics, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia

^g College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia

^h Department of Radiology, Alymamah Hospital, Second Health Cluster, Al-Takassusi Alliance Medical, Riyadh, Saudi Arabia

^⁎ Corresponding author. Department of Clinical Medical Sciences, College of Medicine, Dar AL-Uloom University, Al Falah, 13314 Riyadh, Saudi Arabia. Department of Clinical Medical Sciences, College of Medicine, Dar AL-Uloom University, Al Falah Riyadh 13314 Saudi Arabia

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Highlights

•	Saudi show Haller index means between 2 and 3.9 in females & 2.3–3.7 in males.
•	Males show higher transverse dimensions of thoracic dimensions at levels T1–T10.
•	Females show significantly higher Haller indices at T4 and T5 than males.
•	Haller index inversely correlates with the age at multiple thoracic levels.
•	Haller index is a significant age but less significant sex predictor.

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Summary

Objectives

Estimating age and sex is a challenging aspect of human identification. Most of the studies investigating age and sex influence on thoracic bony measurements were conducted in isolated ethnic groups and exclusively involving children. Therefore, this study aimed to investigate the age and sex-related alterations in the Haller Index (HI) and thoracic-related dimensions. The adapted HI is a ratio between the maximal transverse diameter and the minimal anteroposterior diameter of the rib cage.

Subjects and methods

This is a cross-sectional retrospective study analyzes HI and other related dimensions across various vertebral levels (T1–T10) using computerized tomography images of 269 Saudi participants.

Results

Mean HI ranged from 2 to 3.9 in females and 2.3–3.7 in males across different vertebrae. Males showed significantly higher transverse diameters across all studied levels except T6, and T7. Females showed slightly higher means of HIs at several levels. There was an inverse correlation between the HIs and age at both sexes at T1, T3, T4, T8, T9, and T10 levels. Although the HIs declined with the advancement of age, these indices demonstrated sex-specific trends. The HI was the most powerful predictor of age when adjusted for sex. The HI showed a weak correlation with sex.

Conclusions

While the HI is a significant negative predictor for age, the influence of sex on HI remains a subject of debate. Future research should continue to explore the interplay of age and sex on thoracic dimensions using larger cohorts in different populations.

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Keywords : Haller index, Thoracic cage, Sex, Age, Saudi, Computerized tomography