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Cited by 155Cardiovascular Health and Risk FactorsHealth Promotion and Cardiovascular PreventionHealth disparities and outcomes

Income disparities in absolute cardiovascular risk and cardiovascular risk factors in the United States, 1999-2014

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Odutayo, Ayodele, Gill, Peter, Shepherd, Shaun, Akingbade, Aquila, Hopewell, Sally, Tennankore, Karthik, Hunn, Benjamin H., Emdin, Connor A.·2017·JAMA Cardiology
DOI 10.1001/jamacardio.2017.1658PMC PMC5710615
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Abstract

Importance: Large improvements in the control of risk factors for cardiovascular disease have been achieved in the United States, but it remains unclear whether adults in all socioeconomic strata have benefited equally. Objective: To assess temporal trends in 10-year predicted absolute cardiovascular risk and cardiovascular risk factors among US adults in different socioeconomic strata. Design, Setting, and Participants: A cross-sectional analysis was conducted using data on adults 40 to 79 years of age without established cardiovascular disease from the 1999 to 2014 National Health and Nutrition Examination Survey. Exposures: Socioeconomic status was based on the family income to poverty ratio and participants were divided into the following 3 groups: high income (family income to poverty ratio, ≥4), middle income (>1 and <4), or at or below the federal poverty level (≤1). Main Outcomes and Measures: We assessed predicted absolute cardiovascular risk using the pooled cohort equation. We assessed the following 4 risk factors: systolic blood pressure, smoking status, diabetes, and total cholesterol. Results: Of the 17 199 adults whose data were included in the study (8828 women and 8371 men; mean age, 54.4 years), from 1999-2014, trends in the percentage of adults with predicted absolute cardiovascular risk of 20% or more, mean systolic blood pressure, and the percentage of current smokers varied by income strata (P ≤ .02 for interaction). For adults with incomes at or below the federal poverty level, there was little evidence of a change in any of these outcomes across survey years (cardiovascular risk ≥20%, 14.9% [95% CI, 12.9%-16.8%] in 1999-2004; 16.5% [95% CI, 13.7%-19.2%] in 2011-2014; P = .41; mean systolic blood pressure, 127.6 [95% CI, 126.1-129.0] mm Hg in 1999-2004; 126.8 [95% CI, 125.2-128.5] mm Hg in 2011-2014; P = .44; and smoking, 36.5% [95% CI, 32.1%-41.0%] in 1999-2004; 36.0% [95% CI, 31.1%-40.8%] in 2011-2014; P = .87). For adults in the high-income stratum, these variables decreased across survey years (cardiovascular risk ≥20%, 12.0% [95% CI, 10.7%-13.3%] in 1999-2004; 9.5% [95% CI, 8.2%-10.7%] in 2011-2014; P = .003; systolic blood pressure, 126.0 [95% CI, 125.0-126.9] mm Hg in 1999-2004; 122.3 [95% CI, 121.3-123.3] mm Hg in 2011-2014; P < .001; and smoking, 14.1% [95% CI, 12.0%-16.2%] in 1999-2004; 8.8% [95% CI, 6.6%-11.0%] in 2011-2014; P = .001). Trends in the percentage of adults with diabetes and the mean total cholesterol level did not vary by income. Conclusions and Relevance: Adults in each socioeconomic stratum have not benefited equally from efforts to control cardiovascular risk factors.

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  • Disparities between socioeconomic classes have worsened in recent decades.

    “These disparities between socioeconomic classes have only worsened in recent decades [8,24].”

    From Income disparity and utilization of cardiovascular preventive care services among U.S. adults (2021) · cites this paper as [24]

    The discussion reports a growing income disparity in control of cardiovascular risk factors from 1999 to 2014: predicted cardiovascular risk, systolic blood pressure, and smoking improved in the highest-income group but not in the group at or below poverty level. It also says the income gap did not change for diabetes or cholesterol. The source therefore supports worsening disparities for specific cardiovascular measures, not an unqualified worsening of disparities between socioeconomic classes generally. (LLM, conf=0.86)

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Authors
Odutayo, A., Gill, P., Shepherd, S., Akingbade, A., Hopewell, S., Tennankore, K., Hunn, B. H., & Emdin, C. A.
Affiliations
  • St. Michael's Hospital (CA)
  • University of Oxford (GB)
  • Nova Scotia Health Authority (CA)
  • University of Tasmania (AU)
Corresponding author
Odutayo, Ayodele
ORCID
Venue
JAMA Cardiology
Publisher
American Medical Association (AMA)
Published
2017-07-01
Volume
2
Issue
7
Pages
782
ISSN
2380-6583 (ISSN-L)
DOI
10.1001/jamacardio.2017.1658
PMC
PMC5710615
OpenAlex
W2624433297
Cited by
155
References
30
Citations by year
2026: 8 · 2025: 25 · 2024: 37 · 2023: 20 · 2022: 14 · 2021: 12 · 2020: 14 · 2019: 10 · 2018: 10 · 2017: 5
FWCI
8.25
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • JAMA Cardiology (publishedVersion, other-oa)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • UTAS Research Repository (acceptedVersion)
  • eCite Digital Repository (University of Tasmania) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
  • Social Sciences › Health › Health disparities and outcomes
Keywords
socioeconomic status, poverty income ratio, absolute cardiovascular risk, Pooled Cohort Equations, systolic blood pressure, smoking, diabetes mellitus, total cholesterol, temporal trends, low-income adults, cardiovascular risk factors, health equity, federal poverty level, cardiovascular disease prevention
MeSH terms
Adult, Aged, Blood Pressure, Cardiovascular Diseases, Cholesterol, Cross-Sectional Studies, Diabetes Mellitus, Female, Humans, Hypercholesterolemia, Hypertension, Income, Male, Middle Aged, Nutrition Surveys, Poverty, Risk Factors, Smoking, Social Class, United States, Cohort Studies, Health Status Disparities

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