Trends in Income Inequities in Cardiovascular Health Among US Adults, 1988-2018

Nicholas K Brownell; Boback Ziaeian; Nicholas J Jackson; Adam K Richards

doi:10.1161/CIRCOUTCOMES.123.010111

Trends in Income Inequities in Cardiovascular Health Among US Adults, 1988-2018

Circ Cardiovasc Qual Outcomes. 2024 Apr 3:e010111. doi: 10.1161/CIRCOUTCOMES.123.010111. Online ahead of print.

Authors

Nicholas K Brownell¹, Boback Ziaeian², Nicholas J Jackson³, Adam K Richards⁴

Affiliations

¹ Division of Cardiology, University of California, Los Angeles. (N.K.B.).
² Division of Cardiology, University of California, Los Angeles. (B.Z.).
³ Division of General Internal Medicine and Health Services Research, University of California, Los Angeles. (N.J.J.).
⁴ Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington (A.K.R.).

PMID: 38567505
DOI: 10.1161/CIRCOUTCOMES.123.010111

Abstract

Background: Mean cardiovascular health has improved over the past several decades in the United States, but it is unclear whether the benefit is shared equitably. This study examined 30-year trends in cardiovascular health using a suite of income equity metrics to provide a comprehensive picture of cardiovascular income equity.

Methods: The study evaluated data from the 1988-2018 National Health and Nutrition Examination Survey. Survey groupings were stratified by poverty-to-income ratio (PIR) category, and the mean predicted 10-year risk of a major cardiovascular event or death based on the pooled cohort equations (PCE) was calculated (10-year PCE risk). Equity metrics including the relative and absolute concentration indices and the achievement index-metrics that assess both the prevalence and the distribution of a health measure across different socioeconomic categories-were calculated.

Results: A total of 26 633 participants aged 40 to 75 years were included (mean age, 53.0-55.5 years; women, 51.9%-53.0%). From 1988-1994 to 2015-2018, the mean 10-year PCE risk improved from 7.8% to 6.4% (P<0.05). The improvement was limited to the 2 highest income categories (10-year PCE risk for PIR 5: 7.7%-5.1%, P<0.05; PIR 3-4.99: 7.6%-6.1%, P<0.05). The 10-year PCE risk for the lowest income category (PIR <1) did not significantly change (8.1%-8.7%). In 1988-1994, the 10-year PCE risk for PIR <1 was 6% higher than PIR 5; by 2015-2018, this relative inequity increased to 70% (P<0.05). When using metrics that account for all income categories, the achievement index improved (8.0%-7.1%, P<0.05); however, the achievement index was consistently higher than the mean 10-year PCE risk, indicating the poor persistently had a greater share of adverse health.

Conclusions: In this serial cross-sectional survey of US adults spanning 30 years, the population's mean 10-year PCE risk improved, but the improvement was not felt equally across the income spectrum.

Keywords: cardiovascular diseases; cross-sectional studies; nutrition surveys; poverty; socioeconomic factors.