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. 2018 Apr 17;168(8):541-549.
doi: 10.7326/M17-0996. Epub 2018 Mar 20.

Trends in Racial/Ethnic and Nativity Disparities in Cardiovascular Health Among Adults Without Prevalent Cardiovascular Disease in the United States, 1988 to 2014

Arleen F Brown  1 , Li-Jung Liang  2 , Stefanie D Vassar  2 , Jose J Escarce  2 , Sharon Stein Merkin  2 , Eric Cheng  2 , Adam Richards  2 , Teresa Seeman  2 , W T Longstreth Jr  3
Affiliations

Trends in Racial/Ethnic and Nativity Disparities in Cardiovascular Health Among Adults Without Prevalent Cardiovascular Disease in the United States, 1988 to 2014

Arleen F Brown et al. Ann Intern Med. .

Abstract

Background: Trends in cardiovascular disparities are poorly understood, even as diversity increases in the United States.

Objective: To examine U.S. trends in racial/ethnic and nativity disparities in cardiovascular health.

Design: Repeated cross-sectional study.

Setting: NHANES (National Health and Nutrition Examination Survey), 1988 to 2014.

Participants: Adults aged 25 years or older who did not report cardiovascular disease.

Measurements: Racial/ethnic, nativity, and period differences in Life's Simple 7 (LS7) health factors and behaviors (blood pressure, cholesterol, hemoglobin A1c, body mass index, physical activity, diet, and smoking) and optimal composite scores for cardiovascular health (LS7 score ≥10).

Results: Rates of optimal cardiovascular health remain below 40% among whites, 25% among Mexican Americans, and 15% among African Americans. Disparities in optimal cardiovascular health between whites and African Americans persisted but decreased over time. In 1988 to 1994, the percentage of African Americans with optimal LS7 scores was 22.8 percentage points (95% CI, 19.3 to 26.4 percentage points) lower than that of whites in persons aged 25 to 44 years and 8.0 percentage points (CI, 6.4 to 9.7 percentage points) lower in those aged 65 years or older. By 2011 to 2014, differences decreased to 10.6 percentage points (CI, 7.4 to 13.9 percentage points) and 3.8 percentage points (CI, 2.5 to 5.0 percentage points), respectively. Disparities in optimal LS7 scores between whites and Mexican Americans were smaller but also decreased. These decreases were due to reductions in optimal cardiovascular health among whites over all age groups and periods: Between 1988 to 1994 and 2011 to 2014, the percentage of whites with optimal cardiovascular health decreased 15.3 percentage points (CI, 11.1 to 19.4 percentage points) for those aged 25 to 44 years and 4.6 percentage points (CI, 2.7 to 6.5 percentage points) for those aged 65 years or older.

Limitation: Only whites, African Americans, and Mexican Americans were studied.

Conclusion: Cardiovascular health has declined in the United States, racial/ethnic and nativity disparities persist, and decreased disparities seem to be due to worsening cardiovascular health among whites rather than gains among African Americans and Mexican Americans. Multifaceted interventions are needed to address declining population health and persistent health disparities.

Primary funding source: National Institute of Neurological Disorders and Stroke and National Center for Advancing Translational Sciences of the National Institutes of Health.

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Figures

Appendix Figure.
Appendix Figure.. Study flow diagram.
Prior CVD event included self-reported stroke, myocardial infarction, heart failure, or angina. CVD = cardiovascular disease; MEC = mobile examination center; NHANES = National Health and Nutrition Examination Survey.
Figure 1.
Figure 1.. Adjusted, weighted percentage of participants with poor control of individual components for Life’s Simple 7.
Percentages were adjusted for age, sex, education, and income-poverty ratio. Appropriate NHANES (National Health and Nutrition Examination Survey) sample weights were used. The figure represents repeated analyses of cross-sectional data for the periods indicated. They do not represent longitudinal surveys of the same respondents. BMI = body mass index; HbA1c= hemoglobin A1c.
Figure 1.
Figure 1.. Adjusted, weighted percentage of participants with poor control of individual components for Life’s Simple 7.
Percentages were adjusted for age, sex, education, and income-poverty ratio. Appropriate NHANES (National Health and Nutrition Examination Survey) sample weights were used. The figure represents repeated analyses of cross-sectional data for the periods indicated. They do not represent longitudinal surveys of the same respondents. BMI = body mass index; HbA1c= hemoglobin A1c.
Figure 2.
Figure 2.. Adjusted, weighted percentage of participants with optimal cardiovascular health.
Percentages were adjusted for age, sex, education, and income-poverty ratio. Appropriate NHANES (National Health and Nutrition Examination Survey) sample weights were used. Optimal cardiovascular health was defined as Life’s Simple 7 score ≥10. The figure represents repeated analyses of cross-sectional data for the periods indicated. They do not represent longitudinal surveys of the same respondents.
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