Both social and psychosocial factors are associated with cardiovascular health among adults in the United States, with significant differences between racial and ethnic groups persisting across the population.
New research presented at American Heart Association Scientific Sessions 2022 in Chicago indicated that education and place of birth were statistically significant contributors to disparities in cardiovascular health among racial and ethnic groups.
“Overall, given the significant association of CVH with incident cardiovascular disease (CVD), the statistical contributions of the individual-level factors examined to racial and ethnic disparities in CVH suggest that these social and psychosocial determinants may contribute to racial and ethnic differences in CVD incidence in the US population,” wrote study author Nilay S. Shah, MD, MPH Department of Preventive Medicine, Northwestern University Feinberg School of Medicine.
Because race and ethnicity exist as social constructs and are not biological, the underlying social and structural determinants of health are the likely cause of differences in cardiovascular disease (CVD) risk among different groups.
Clinical and behavioral factors are summarized in the American Heart Association’s simple 7 CVH score and include diet quality, smoking, physical activity, body mass index (BMI), blood pressure, cholesterol, and blood glucose.
Researchers quantified racial and ethnic differences in CVH statistically explained by individual-level social and psychosocial determinants among Hispanic, non-Hispanic Asian, and non-Hispanic black adults compared with non-Hispanic white adults in the National Health and Nutrition Examination Surveys (NHANES). ) between 2011 and 2018.
The sample consisted of non-institutionalized adults aged ≥20 years who participated in the Mobile Examination Center (MEC) examinations. The composite CVH score ranges from 0 to 14 and is calculated as the sum of points in the seven categories, with a higher score indicating better CVH.
Individual-level factors associated with CVH and CVD were additionally measured, including educational attainment, food insecurity, health insurance, depression, and place of birth of the participant. The Kitagawa-Blinder-Oaxaca (KBO) decomposition was used to statistically quantify the magnitude of differences in mean CVH between racial and ethnic groups related to “explained differences” (observed factors) and “unexplained differences” (unobserved factors) that lead to to differential magnitudes of association of individual-level factors with CVH within each racial and ethnic group.
Of the 16,172 NHANES participants representing 255 million US adults, there were 7,969 men, of whom 24% were Hispanic, 12% were non-Hispanic Asian, 23% were non-Hispanic black, and 41% were non-Hispanic white. There were 8,203 women, of whom 25% were Hispanic, 12% non-Hispanic Asian, 23% non-Hispanic black, and 40% non-Hispanic white.
Among male participants, the mean CVH score ranged from 7.45 in Hispanic adults, 7.48 in non-Hispanic black adults, 7.58 in non-Hispanic white adults, and 8.71 in non-Hispanic Asian adults.
Among female participants, the mean CVH score was 8.03 in Hispanic adults, 9.34 in non-Hispanic Asian adults, 7.43 in non-Hispanic black adults, and 8.00 in non-Hispanic white adults.
In the KBO decomposition, it was noted that education explained the largest component of the CVH difference among men. The data show that if the distribution of education were similar to non-Hispanic white adults, the CVH score would be 0.36 points higher in Hispanic adults, 0.24 lower in non-Hispanic Asian adults, and 0.23 points higher in non-Hispanic black adults; P <.05).
Furthermore, the findings suggest that education explains the largest component of the CVH difference in non-Hispanic black women. If non-Hispanic black women had the same distribution of educational attainment as non-Hispanic women, the average CVH score would be significantly higher by 0.17 points (P < 0.05).
An individual’s place of birth (U.S.-born vs. born outside the U.S.) explained the largest component of the difference in CVH among Hispanic and non-Hispanic Asian women, according to researchers. If the distribution of place of birth were similar to non-Hispanic white women, the CVH score would be 0.36 points lower and 0.49 points lower, respectively (P <.05).
The contribution of individual-level factors to the unexplained component of differences in mean CVH was minimal.
“Our findings are intended to inform potential interventions and policies at the community and population level to address disparities and disparities in CVH,” Shah said. “Future studies with longitudinal data allowing for statistical mediation analyzes will complement our findings on the role of social and psychosocial factors in racial and ethnic disparities in CVH.”
The study, “Social and Psychosocial Determinants of Racial and Ethnic Disparities in Cardiovascular Health in the United States Population,” is published in Circulation.