Socioeconomic Status and Cardiovascular Risk

Study Questions:

What are the temporal trends in 10-year predicted cardiovascular risk among different socioeconomic strata in the United States?


Data from the 1999-2014 National Health and Nutrition Examination Survey (NHANES) were used for the present analysis. Adults ages 40-79 years were included. Socioeconomic status was determined from family income to poverty ratio. Subjects were grouped into three categories: high income (family income to poverty ratio ≥4), middle income (>1 and <4), or at or below the federal poverty level (≤1). Cardiovascular risk was calculated using the pooled cohort equation, systolic blood pressure (SBP), smoking status, diabetes, and total cholesterol.


A total of 17,199 adults (mean age 54.4 years) were included in the analysis, including 8,828 women. 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 including 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 = 0.41. The same was true for mean SBP (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 = 0.44), 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 = 0.87). In contrast, among adults in the high income strata, risk factors decrease over time including 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 = 0.003), SBP (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 < 0.001), 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 = 0.001). Trends in the percentage of adults with diabetes and the mean total cholesterol level did not vary by income.


The authors concluded that adults in each socioeconomic stratum have not benefited equally from efforts to control cardiovascular risk factors.


These data suggest that a greater effort to address cardiovascular risk prevention among adults who are at a socioeconomic disadvantage is an important public health goal.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Smoking

Keywords: Blood Pressure, Cholesterol, Diabetes Mellitus, Metabolic Syndrome X, Poverty, Primary Prevention, Public Health, Risk Factors, Smoking, Social Class, Socioeconomic Factors

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