Racial, ethnic and socioeconomic disparities in the clustering of cardiovascular disease risk factors.
OBJECTIVE
To evaluate racial and ethnic differences in the clustering of cardiovascular disease (CVD) risk factors in the United States and to determine whether these differences vary by socioeconomic status (SES).


METHODS
Data from the Third National Health and Nutrition Examination Survey (1988-1994), a cross-sectional survey of the US population, were used to examine these relationships among 486 non-Hispanic Blacks, 409 Mexican Americans, and 772 non-Hispanic Whites, aged 25 to 99 years. Risk factors included hypertension, abnormal cholesterol, diabetes mellitus, overweight, and cigarette smoking. Educational level was used as a proxy for SES.


RESULTS
Twenty percent of non-Hispanic Whites had zero CVD risk factors vs 18% of Mexican Americans and 13% of non-Hispanic Blacks. Non-Hispanic Blacks were twice as likely as the other groups to have 4 or 5 risk factors. Across all groups, the prevalence of having zero risk factors increased with education (from 6%-14% among those with <12 years to 22%-29% among those with >12 years). After adjustment for age and gender, among those with <12 years of education, Mexican Americans were 60% more likely and non-Hispanic Blacks were 30% less likely to have zero risk factors than non-Hispanic Whites. Among persons with >12 years of education, Mexican Americans and non-Hispanic Blacks were 50%-60% less likely to have zero risk factors than non-Hispanic Whites.


CONCLUSIONS
Increased CVD risk factor clustering exists among Americans with low SES, particularly among non-Hispanic Blacks. Among persons with high SES, Mexican Americans and non-Hispanic Blacks have a higher risk of CVD than non-Hispanic Whites. These disparities may be reduced through policy changes that promote heart-healthy environments throughout society.
Sharma
Sameer
S
University of Birmingham, Birmingham, England.
Malarcher
Ann M
AM
Giles
Wayne H
WH
Myers
Gary
G
D000328:Adult; D001741:Black or African American / Q000193:education / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000208:ethnology*; D016000:Cluster Analysis; D004522:Educational Status; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008297:Male; D017058:Mexican Americans / Q000193:education / Q000706:statistics & numerical data*; D008875:Middle Aged; D009749:Nutrition Surveys; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000193:education / Q000706:statistics & numerical data*