Social and Psychosocial Determinants of Racial and Ethnic Differences in Cardiovascular Health in the United States Population
Social and psychosocial factors are associated with cardiovascular health (CVH). Our objective was to examine the contributions of individual-level social and psychosocial factors to racial and ethnic differences in population CVH in the NHANES (National Health and Nutrition Examination Surveys) 201...
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Published in | Circulation (New York, N.Y.) Vol. 147; no. 3; pp. 190 - 200 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
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United States
Lippincott Williams & Wilkins
17.01.2023
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Abstract | Social and psychosocial factors are associated with cardiovascular health (CVH). Our objective was to examine the contributions of individual-level social and psychosocial factors to racial and ethnic differences in population CVH in the NHANES (National Health and Nutrition Examination Surveys) 2011 to 2018, to inform strategies to mitigate CVH inequities.
In NHANES participants ages ≥20 years, Kitagawa-Blinder-Oaxaca decomposition estimated the statistical contribution of individual-level factors (education, income, food security, marital status, health insurance, place of birth, depression) to racial and ethnic differences in population mean CVH score (range, 0-14, accounting for diet, smoking, physical activity, body mass index, blood pressure, cholesterol, blood glucose) among Hispanic, non-Hispanic Asian, or non-Hispanic Black adults compared with non-Hispanic White adults.
Among 16 172 participants (representing 255 million US adults), 24% were Hispanic, 12% non-Hispanic Asian, 23% non-Hispanic Black, and 41% non-Hispanic White. Among men, mean (SE) CVH score was 7.45 (2.3) in Hispanic, 8.71 (2.2) in non-Hispanic Asian, 7.48 (2.4) in non-Hispanic Black, and 7.58 (2.3) in non-Hispanic White adults. In Kitagawa-Blinder-Oaxaca decomposition, education explained the largest component of CVH differences among men (if distribution of education were similar to non-Hispanic White participants, CVH score would be 0.36 [0.04] points higher in Hispanic, 0.24 [0.04] points lower in non-Hispanic Asian, and 0.23 [0.03] points higher in non-Hispanic Black participants;
<0.05). Among women, mean (SE) CVH score was 8.03 (2.4) in Hispanic, 9.34 (2.1) in non-Hispanic Asian, 7.43 (2.3) in non-Hispanic Black, and 8.00 (2.5) in non-Hispanic White adults. Education explained the largest component of CVH difference in non-Hispanic Black women (if distribution of education were similar to non-Hispanic White participants, CVH score would be 0.17 [0.03] points higher in non-Hispanic Black participants;
<0.05). Place of birth (born in the United States versus born outside the United States) explained the largest component of CVH difference in Hispanic and non-Hispanic Asian women (if distribution of place of birth were similar to non-Hispanic White participants, CVH score would be 0.36 [0.07] points lower and 0.49 [0.16] points lower, respectively;
<0.05).
Education and place of birth confer the largest statistical contributions to the racial and ethnic differences in mean CVH score among US adults. |
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AbstractList | BACKGROUNDSocial and psychosocial factors are associated with cardiovascular health (CVH). Our objective was to examine the contributions of individual-level social and psychosocial factors to racial and ethnic differences in population CVH in the NHANES (National Health and Nutrition Examination Surveys) 2011 to 2018, to inform strategies to mitigate CVH inequities.METHODSIn NHANES participants ages ≥20 years, Kitagawa-Blinder-Oaxaca decomposition estimated the statistical contribution of individual-level factors (education, income, food security, marital status, health insurance, place of birth, depression) to racial and ethnic differences in population mean CVH score (range, 0-14, accounting for diet, smoking, physical activity, body mass index, blood pressure, cholesterol, blood glucose) among Hispanic, non-Hispanic Asian, or non-Hispanic Black adults compared with non-Hispanic White adults.RESULTSAmong 16 172 participants (representing 255 million US adults), 24% were Hispanic, 12% non-Hispanic Asian, 23% non-Hispanic Black, and 41% non-Hispanic White. Among men, mean (SE) CVH score was 7.45 (2.3) in Hispanic, 8.71 (2.2) in non-Hispanic Asian, 7.48 (2.4) in non-Hispanic Black, and 7.58 (2.3) in non-Hispanic White adults. In Kitagawa-Blinder-Oaxaca decomposition, education explained the largest component of CVH differences among men (if distribution of education were similar to non-Hispanic White participants, CVH score would be 0.36 [0.04] points higher in Hispanic, 0.24 [0.04] points lower in non-Hispanic Asian, and 0.23 [0.03] points higher in non-Hispanic Black participants; P<0.05). Among women, mean (SE) CVH score was 8.03 (2.4) in Hispanic, 9.34 (2.1) in non-Hispanic Asian, 7.43 (2.3) in non-Hispanic Black, and 8.00 (2.5) in non-Hispanic White adults. Education explained the largest component of CVH difference in non-Hispanic Black women (if distribution of education were similar to non-Hispanic White participants, CVH score would be 0.17 [0.03] points higher in non-Hispanic Black participants; P<0.05). Place of birth (born in the United States versus born outside the United States) explained the largest component of CVH difference in Hispanic and non-Hispanic Asian women (if distribution of place of birth were similar to non-Hispanic White participants, CVH score would be 0.36 [0.07] points lower and 0.49 [0.16] points lower, respectively; P<0.05).CONCLUSIONSEducation and place of birth confer the largest statistical contributions to the racial and ethnic differences in mean CVH score among US adults. Social and psychosocial factors are associated with cardiovascular health (CVH). Our objective was to examine the contributions of individual-level social and psychosocial factors to racial and ethnic differences in population CVH in the NHANES (National Health and Nutrition Examination Surveys) 2011 to 2018, to inform strategies to mitigate CVH inequities. In NHANES participants ages ≥20 years, Kitagawa-Blinder-Oaxaca decomposition estimated the statistical contribution of individual-level factors (education, income, food security, marital status, health insurance, place of birth, depression) to racial and ethnic differences in population mean CVH score (range, 0-14, accounting for diet, smoking, physical activity, body mass index, blood pressure, cholesterol, blood glucose) among Hispanic, non-Hispanic Asian, or non-Hispanic Black adults compared with non-Hispanic White adults. Among 16 172 participants (representing 255 million US adults), 24% were Hispanic, 12% non-Hispanic Asian, 23% non-Hispanic Black, and 41% non-Hispanic White. Among men, mean (SE) CVH score was 7.45 (2.3) in Hispanic, 8.71 (2.2) in non-Hispanic Asian, 7.48 (2.4) in non-Hispanic Black, and 7.58 (2.3) in non-Hispanic White adults. In Kitagawa-Blinder-Oaxaca decomposition, education explained the largest component of CVH differences among men (if distribution of education were similar to non-Hispanic White participants, CVH score would be 0.36 [0.04] points higher in Hispanic, 0.24 [0.04] points lower in non-Hispanic Asian, and 0.23 [0.03] points higher in non-Hispanic Black participants; <0.05). Among women, mean (SE) CVH score was 8.03 (2.4) in Hispanic, 9.34 (2.1) in non-Hispanic Asian, 7.43 (2.3) in non-Hispanic Black, and 8.00 (2.5) in non-Hispanic White adults. Education explained the largest component of CVH difference in non-Hispanic Black women (if distribution of education were similar to non-Hispanic White participants, CVH score would be 0.17 [0.03] points higher in non-Hispanic Black participants; <0.05). Place of birth (born in the United States versus born outside the United States) explained the largest component of CVH difference in Hispanic and non-Hispanic Asian women (if distribution of place of birth were similar to non-Hispanic White participants, CVH score would be 0.36 [0.07] points lower and 0.49 [0.16] points lower, respectively; <0.05). Education and place of birth confer the largest statistical contributions to the racial and ethnic differences in mean CVH score among US adults. |
Author | Ning, Hongyan Lloyd-Jones, Donald M. Kandula, Namratha R. Kershaw, Kiarri N. Cameron, Natalie A. Carnethon, Mercedes R. Petito, Lucia C. Bancks, Michael P. Shah, Nilay S. Huang, Xiaoning Khan, Sadiya S. |
AuthorAffiliation | Division of General Internal Medicine (N.A.C., N.R.K.), Northwestern University Feinberg School of Medicine, Chicago, IL Department of Medicine, Department of Preventive Medicine (N.S.S., X.H., L.C.P., H.N., K.N.K., N.R.K., M.R.C., D.M.L.-J., S.S.K.), Northwestern University Feinberg School of Medicine, Chicago, IL Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC (M.P.B.) |
AuthorAffiliation_xml | – name: Division of General Internal Medicine (N.A.C., N.R.K.), Northwestern University Feinberg School of Medicine, Chicago, IL – name: Department of Medicine, Department of Preventive Medicine (N.S.S., X.H., L.C.P., H.N., K.N.K., N.R.K., M.R.C., D.M.L.-J., S.S.K.), Northwestern University Feinberg School of Medicine, Chicago, IL – name: Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC (M.P.B.) – name: 2 Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL – name: 4 Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL – name: 1 Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL – name: 3 Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC |
Author_xml | – sequence: 1 givenname: Nilay S. surname: Shah fullname: Shah, Nilay S. organization: Division of Cardiology (N.S.S., D.M.L.-J., S.S.K.), Northwestern University Feinberg School of Medicine, Chicago, IL – sequence: 2 givenname: Xiaoning surname: Huang fullname: Huang, Xiaoning organization: Department of Medicine, Department of Preventive Medicine (N.S.S., X.H., L.C.P., H.N., K.N.K., N.R.K., M.R.C., D.M.L.-J., S.S.K.), Northwestern University Feinberg School of Medicine, Chicago, IL – sequence: 3 givenname: Lucia C. surname: Petito fullname: Petito, Lucia C. organization: Department of Medicine, Department of Preventive Medicine (N.S.S., X.H., L.C.P., H.N., K.N.K., N.R.K., M.R.C., D.M.L.-J., S.S.K.), Northwestern University Feinberg School of Medicine, Chicago, IL – sequence: 4 givenname: Michael P. surname: Bancks fullname: Bancks, Michael P. organization: Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC (M.P.B.) – sequence: 5 givenname: Hongyan surname: Ning fullname: Ning, Hongyan organization: Department of Medicine, Department of Preventive Medicine (N.S.S., X.H., L.C.P., H.N., K.N.K., N.R.K., M.R.C., D.M.L.-J., S.S.K.), Northwestern University Feinberg School of Medicine, Chicago, IL – sequence: 6 givenname: Natalie A. surname: Cameron fullname: Cameron, Natalie A. organization: Division of General Internal Medicine (N.A.C., N.R.K.), Northwestern University Feinberg School of Medicine, Chicago, IL – sequence: 7 givenname: Kiarri N. surname: Kershaw fullname: Kershaw, Kiarri N. organization: Department of Medicine, Department of Preventive Medicine (N.S.S., X.H., L.C.P., H.N., K.N.K., N.R.K., M.R.C., D.M.L.-J., S.S.K.), Northwestern University Feinberg School of Medicine, Chicago, IL – sequence: 8 givenname: Namratha R. surname: Kandula fullname: Kandula, Namratha R. organization: Division of General Internal Medicine (N.A.C., N.R.K.), Northwestern University Feinberg School of Medicine, Chicago, IL – sequence: 9 givenname: Mercedes R. surname: Carnethon fullname: Carnethon, Mercedes R. organization: Department of Medicine, Department of Preventive Medicine (N.S.S., X.H., L.C.P., H.N., K.N.K., N.R.K., M.R.C., D.M.L.-J., S.S.K.), Northwestern University Feinberg School of Medicine, Chicago, IL – sequence: 10 givenname: Donald M. surname: Lloyd-Jones fullname: Lloyd-Jones, Donald M. organization: Division of Cardiology (N.S.S., D.M.L.-J., S.S.K.), Northwestern University Feinberg School of Medicine, Chicago, IL – sequence: 11 givenname: Sadiya S. surname: Khan fullname: Khan, Sadiya S. organization: Division of Cardiology (N.S.S., D.M.L.-J., S.S.K.), Northwestern University Feinberg School of Medicine, Chicago, IL |
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Snippet | Social and psychosocial factors are associated with cardiovascular health (CVH). Our objective was to examine the contributions of individual-level social and... BACKGROUNDSocial and psychosocial factors are associated with cardiovascular health (CVH). Our objective was to examine the contributions of individual-level... |
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SubjectTerms | Adult Diet Ethnicity Female Hispanic or Latino Humans Male Nutrition Surveys Racial Groups United States - epidemiology Young Adult |
Title | Social and Psychosocial Determinants of Racial and Ethnic Differences in Cardiovascular Health in the United States Population |
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