Does height modify the risk of angina associated with economic adversity?

Abstract

Adult height partly reflects childhood exposures, and we hypothesise that some exposures impairing growth may also increase susceptibility to coronary heart disease—angina pectoris (angina)—risks, such that shorter adults may be more susceptible to some exposures in adulthood that are risks for heart disease. This hypothesis is tested among all adults who participated in the National Health Interview Survey (USA), 1997–2000 [The National Health Survey, 1997–2000. Data file documentation, National Health Interview Survey (machine-readable data file and documentation). National Center for Health Statistics, Hyattsville, Maryland, http://www.cdc.gov/nchs/nhis.htm]. In the entire study population, height was negatively associated with angina and after adjustment for potential confounding factors; the odds ratio (and 95% confidence interval) for angina risk associated with the tallest height fifth compared with the shortest fifth is 0.77 (0.97, 0.88). The association of low income (less than US$ 20,000) with angina was assessed separately in each of five height strata defined by fifths of the height distribution. The magnitude of this association is lower in the shortest than the tallest height fifth, with odds ratios of 1.18 and 1.60, respectively (effect modification). The unexpected results may be explained by the following: childhood adversity resulting in shorter stature may confer resilience against adult economic adversity; the relative disadvantage of low income may be perceived more keenly by those of taller stature thereby increasing stress and thus disease risk; or health-promoting characteristics associated with taller stature may be less effective in the face of adult economic adversity in the low-income group.