Racial/ethnic disparities in cardiovascular health persist in U.S. adults

1. Trends from 1988 to 2014 data suggest that for U.S. adults, cardiovascular health has worsened, and health disparities in race/ethnicity and nativity continue to exist.

2. Although cardiovascular health disparities between whites and African Americans or Mexican Americans have decreased, declining cardiovascular health among whites appears to be the reason for these decreases rather than health improvements among African Americans or Mexican Americans.

Evidence Rating Level: 2 (Good)          

Study Rundown: In the United States, cardiovascular disease (CVD) is one of the top causes of morbidity and mortality.  Although efforts are being made to lessen cardiovascular health disparities nationwide, health trends among various racial/ethnic groups continue to be insufficiently understood.  Using data from the National Health and Nutrition Examination Survey (NHANES) from 1988 to 2014, researchers carried out a repeated cross-sectional study to examine trends in racial/ethnic disparities in cardiovascular health.  Adults ≥25 years of age without reported CVD were categorized by race/ethnicity and nativity (U.S.-born vs non-U.S.-born).  The authors found that health disparities still exist for races/ethnicities and nativity, but absolute disparities between whites and African Americans or Mexican Americans had decreased.  However, rather than cardiovascular health improving among African Americans and Mexican Americans, reductions in disparities appear to be caused by deteriorating cardiovascular health among whites.  Based on their findings, the authors suggested that multilayered approaches are necessary for improvements in public cardiovascular health and health disparities.

Strengths of the study include use of NHANES data with samples representative of the U.S. population and sample sizes that provided a power of at least 80% (5% Type I error rate) to detect a reduction of 5% (between racial/ethnic groups and whites) that is clinically meaningful.  A limitation of the study is that the only races/ethnicities studied were white, African American, and Mexican American.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Changing trends in the prevalence and disparities of obesity and other cardiovascular disease risk factors in three racial/ethnic groups of USA adults

In-Depth [cross-sectional study]: Using data from NHANES III (1988 to 1994) and continuous NHANES from 1999 to 2014 (in four 4-year waves), researchers created 5 4-year periods for analysis.  The authors studied adults who were ≥25 years of age, had no previous reports of CVD, and were white (non-Hispanic), African American (non-Hispanic), or Mexican American.  Mexican Americans were also separated by nativity, and ages were separated into three groups: 20 to 44 years, 45 to 64 years, and ≥65 years.  Researchers measured Life’s Simple 7 (LS7) health factors and behaviors: blood pressure, body mass index, cholesterol, diet, hemoglobin A_1c, physical activity, and smoking.  Cardiovascular health optimal composite scores (LS7 score ≥10) were also measured.

Optimal cardiovascular health rates were less than 40%, 25%, and 15% among whites, Mexican Americans, and African Americans, respectively.  From 1988 to 1994, optimal LS7 scores for adults 25 to 44 years of age were 22.8 percentage points lower for African Americans than whites, and optimal LS7 scores for adults ≥65 years of age were 8.0 percentage points lower for African Americans than whites.  By 2011 to 2014, disparities had declined to 10.6 percentage points and 3.8 percentage points for these respective groups.  Optimal LS7 scores had smaller differences between whites and Mexican Americans, but the differences had also lessened.  The reduced disparities were caused by declines in optimal cardiovascular health among whites.  In comparison to the period 1988 to 1994, optimal cardiovascular health from 2011 to 2014 for whites had declined 15.3 percentage points and 4.6 percentage points for those 25 to 44 years of age and those ≥65 years of age, respectively.

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