Variations in the association of height with mortality, cardiovascular disease and cancer in low-, middle- and high-income countries
Authors
Aditya K. Khetan, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
Darryl P. Leong, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
Rajeev Gupta, Eternal Heart Care Center and Research Institute, Jaipur, India.
Yibing Zhu, Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China.
Sidong Li, Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China.
Weida Liu, Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China.
Iolanthé M. Kruger, Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom Campus, South Africa.
Koon K. Teo, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
Andreas Wielgosz, University of Ottawa Heart Institute, Ottawa, ON, Canada.
Rita Yusuf, Independent University, Dhaka, Bangladesh.
Nor-Ashikin Mohamed Noor Khan, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia.
Rasha Khatib, Advocate Aurora HealthFollow
Khalid F. Alhabib, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.Follow
Kubilay Karsidag, Department of Internal Medicine, Medical Faculty of Istanbul University, Istanbul, Turkey.
Jephat Chifamba, Department of Biomedical Sciences, Physiology Unit, Faculty of Medicine and Sciences, University of Zimbabwe, Harare, Zimbabwe.Follow
Noushin Mohammadifard, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Pamela Serón, Faculty of Medicine, Universidad de La Frontera, Claro Solar, Temuco, Chile.
Patricio Lopez-Jaramillo, Masira Research Institute, Medical School, Universidad de Santander (UDES), Bucaramanga, Colombia.
Andres Orlandini, ECLA (Estudios Clínicos Latino America), Instituto Cardiovascular de Rosario, Rosario, Argentina.
Andrzej Szuba, Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Wroclaw, Poland.
Afzalhussein Yusufali, Hatta Hospital/Dubai Medical College, Dubai Health Authority, Dubai, UAE.
Sanjeev Nair, Health Action by People, Trivandrum and Government Medical College, Thrissur, India.
Annika Rosengren, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, VGR Region, Gothenburg, Sweden.
Karen Yeates, Department of Medicine, Queen's University, Kingston, ON, Canada.
Antonio Miguel Dans, Department of Medicine, University of Philippines, Manila, Philippines.Follow
Romaina Iqbal, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
Álvaro Avezum, International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.Follow
Sumathy Rangarajan, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
Salim Yusuf, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
Recommended Citation
Khetan AK, Leong DP, Gupta R, et al. Variations in the association of height with mortality, cardiovascular disease and cancer in low-, middle- and high-income countries. Int J Epidemiol. 2022;51(4):1304-1316. doi:10.1093/ije/dyab268
Abstract
Background: Final adult height is a useful proxy measure of childhood nutrition and disease burden. Tall stature has been previously associated with decreased risk of all-cause mortality, decreased risk of major cardiovascular events and an increased risk of cancer. However, these associations have primarily been derived from people of European and East Asian backgrounds, and there are sparse data from other regions of the world.
Methods: The Prospective Urban-Rural Epidemiology study is a large, longitudinal population study done in 21 countries of varying incomes and sociocultural settings. We enrolled an unbiased sample of households, which were eligible if at least one household member was aged 35-70 years. Height was measured in a standardized manner, without shoes, to the nearest 0.1 cm. During a median follow-up of 10.1 years (interquartile range 8.3-12.0), we assessed the risk of all-cause mortality, major cardiovascular events and cancer.
Results: A total of 154 610 participants, enrolled since January 2003, with known height and vital status, were included in this analysis. Follow-up event data until March 2021 were used; 11 487 (7.4%) participants died, whereas 9291 (6.0%) participants had a major cardiovascular event and 5873 (3.8%) participants had a new diagnosis of cancer. After adjustment, taller individuals had lower hazards of all-cause mortality [hazard ratio (HR) per 10-cm increase in height 0.93, 95% confidence interval (CI) 0.90-0.96] and major cardiovascular events (HR 0.97, 95% CI 0.94-1.00), whereas the hazard of cancer was higher in taller participants (HR 1.23, 95% CI 1.18-1.28). The interaction p-values between height and country-income level for all three outcomes were
Conclusions: Unlike high- and middle-income countries, tall stature has a strong inverse association with all-cause mortality and major cardiovascular events in low-income countries. Improved childhood physical development and advances in population-wide cardiovascular treatments in high- and middle-income countries may contribute to this gap. From a life-course perspective, we hypothesize that optimizing maternal and child health in low-income countries may improve rates of premature mortality and cardiovascular events in these countries, at a population level.
