Disparities in cardiovascular disease prevalence among middle-aged and older adults: Roles of socioeconomic position, social connection, and behavioral and physiological risk factors

Ji Zhang; Yian Fang; Yao Yao; Yang Zhao; Dahai Yue; Meekang Sung; Yinzi Jin; Zhi-Jie Zheng

doi:10.3389/fcvm.2022.972683

Disparities in cardiovascular disease prevalence among middle-aged and older adults: Roles of socioeconomic position, social connection, and behavioral and physiological risk factors

Front Cardiovasc Med. 2022 Oct 14:9:972683. doi: 10.3389/fcvm.2022.972683. eCollection 2022.

Authors

Ji Zhang^{1

2}, Yian Fang³, Yao Yao⁴, Yang Zhao^{5

6}, Dahai Yue⁷, Meekang Sung⁸, Yinzi Jin^{2

9}, Zhi-Jie Zheng^{2

9}

Affiliations

¹ School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of Global Health, School of Public Health, Peking University, Beijing, China.
³ Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China.
⁴ China Center for Health Development Studies, Peking University, Beijing, China.
⁵ The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
⁶ The George Institute for Global Health China, Beijing, China.
⁷ Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD, United States.
⁸ Seoul National University, Seoul, South Korea.
⁹ Institute for Global Health and Development, Peking University, Beijing, China.

Abstract

Introduction: Cardiovascular disease (CVD) remains the leading cause of premature death globally and a major contributor to decreasing quality of life. In the present study, we investigated the contribution of social, behavioral, and physiological determinants of CVD and their different patterns among middle-aged and older adults.

Methods: We used harmonized data from 6 nationally representative individual-level longitudinal studies across 25 countries. We restricted the age to ≥50 years and defined cases as a self-reported history of CVD. The exposure variables were the demographic status (age and sex), socioeconomic position (education level, employment, and household income level), social connections (marital status and family size), behavioral factors (smoking, alcohol drinking, and frequency of moderate to vigorous physical activity), and physiological risk factors (obesity, presence of hypertension, and presence of diabetes). Mixed logistic regression models were fitted to investigate the associations, and dominance analysis was conducted to examine the relative contributions.

Results: In total, 413,203 observations were included in the final analysis, with the CVD prevalence ranging from 10.4% in Mexico to 28.8% in the United States. Physiological risk factors were the main driver of CVD prevalence with the highest dominance proportion, which was higher in developing countries (China, 57.5%; Mexico, 72.8%) than in developed regions (United States, England, 10 European countries, and South Korea). Socioeconomic position and behavioral factors also highly contributed but were less significant in developing countries than in developed regions. The relative contribution of socioeconomic position ranged from 9.4% in Mexico to 23.4% in the United States, and that of behavioral factors ranged from 5.7% in Mexico to 26.1% in England.

Conclusion: The present study demonstrated the different patterns of determinant contributions to CVD prevalence across developing and developed countries. With the challenges produced by different risk factors, the implementation of tailored prevention and control strategies will likely narrow disparities in the CVD prevalence by promoting health management and enhancing the capacity of health systems across different countries.

Keywords: cardiovascular disease(s); country-level disparity; dominance analysis; prevalence; risk factors.