Racial, Ethnic Differences in Cardiovascular Health Reported Among US Adults

Nilay S. Shah, MD, MPH

Both social and psychosocial factors have been associated with cardiovascular health among adults in the United States, with significant differences among racial and ethnic groups being persistent in the population.

New research presented at the American Heart Association Scientific Sessions 2022 in Chicago indicated that education and place of birth each statistically contributed substantially to differences in cardiovascular health among racial and ethnic groups.

“Overall, given the significant association of CVH with incident cardiovascular disease (CVD), the statistical contributions of the studied individual-level factors to racial and ethnic differences in CVH suggest that these social and psychosocial determinants may contribute to racial and ethnic differences in CVD incidence in the US population.,” wrote study author Nilay S. Shah, MD, MPH Department of Preventive Medicine, Northwestern University Feinberg School of Medicine.

As race and ethnicity exist as social constructs and are not biological, underlying social and structural determinants of health are the likely cause of differences in cardiovascular disease (CVD) risk among different groups.

Clinical and behavioral factors are aggregated in the American Heart Association Life’s Simple 7 CVH score and include dietary quality, smoking, physical activity, body mass index (BMI), blood pressure, cholesterol, and blood glucose.

Investigators quantified the racial and ethnic differences in CVH statistically explained by individual-level social and psychosocial determinants among Hispanic, non-Hispanic Asian, and non-Hispanic Black adults compared with non-Hispanic White adults in the National Health and Nutrition Examination Surveys (NHANES) between 2011 to 2018.

The sample consisted of non-institutionalized adults aged ≥20 years who participated in the Mobile Examination Center (MEC) exams. A composite CVH score ranged from 0 to 14 and was calculated as the sum of points across the seven categories, with a higher score suggesting better CVH.

Individual-level factors linked to CVH and CVD were additionally measured, including educational attainment, food insecurity, health insurance, depression, and participant place of birth. The Kitagawa-Blinder-Oaxaca (KBO) decomposition was used to statistically quantify the amount of differences in mean CVH between racial and ethnic groups associated with “explained differences” (observable factors) and “unexplained differences” (unobserved factors) that lead to differential magnitudes of association of the individual-level factors with CVH within each racial and ethnic group.

Of 16,172 participants in NHANES representing 255 million adults in the US, there were 7,969 males, of whom 24% were Hispanic, 12% were non-Hispanic Asian, 23% were non-Hispanic Black, and 41% were non-Hispanic White. There were 8,203 females of whom 25% were Hispanic, 12% were non-Hispanic Asian, 23% were non-Hispanic Black, and 40% were non-Hispanic White.

Of the male participants, the mean CVH score ranged from 7.45 in Hispanic adults, 7.48 in non-Hispanic Black adults, 7.58 in non-Hispanic White adults, and 8.71 in non-Hispanic Asian adults.

Among the female participants, the mean CVH score was 8.03 in Hispanic adults, 9.34 in non-Hispanic Asian adults, 7.43 in non-Hispanic Black adults, and 8.00 in non-Hispanic White adults.

In the KBO decomposition, education was noted to explain the largest component of CVH difference among males. Data show if the the distribution of education were similar to Non-Hispanic White adults, the CVH score would be 0.36 points higher in Hispanic adults, 0.24 lower in non-Hispanic Asian adults, and 0.23 points higher in non-Hispanic Black adults; P <.05).

Moreover, the findings suggest education explained the largest component of CVH difference in non-Hispanic Black females. If non-Hispanic Black females had the same distribution of education attainment as non-Hispanic White females, the mean CVH score would be significantly higher by 0.17 points (P < .05).

An individual’s place of birth (US-born versus born outside the US) explained the largest component of CVH difference in Hispanic and non-Hispanic Asian females, according to investigators. If the distribution of place of birth were similar to non-Hispanic White females, the CVH score would be 0.36 points lower and 0.49 points lower, respectively (P <.05).

The contribution of individual-level factors to the unexplained component of the differences in mean CVH were minimal.

“Our findings are intended to be a foundation for potential community- and population-level interventions and policies to address differences and disparities in CVH,” Shah said. “Future research with longitudinal data allowing for statistical mediation analyses will supplement our findings about the role of social and psychosocial factors in racial and ethnic differences in CVH.”

The study, “Social and Psychosocial Determinants of Racial and Ethnic Differences in Cardiovascular Health in the United States Population,” was published in Circulation.