Racial and ethnic disparities in childhood cardiovascular health: evidence of the role of social disadvantage from NHANES 2013–2018

BACKGROUND: The loss of cardiovascular health (CVH)-a strong predictor of future health-begins early in life and disproportionately affects racial/ethnic minorities. We sought to quantify the contribution of household disadvantage to racial/ethnic disparities in CVH among US youth. METHODS: We analyzed data from 6690 youth (60.3% non-Hispanic White [NHW], 14.9% non-Hispanic Black [NHB], and 24.8% Hispanic/Latinx) ages 2-18 years old from the 2013-2018 National Health and Nutrition Examination Surveys. CVH was measured using the American Heart Association's Life's Essential 8 guidelines to combine 8 factors (diet, physical activity, nicotine exposure, sleep, BMI, blood glucose, blood pressure, and blood lipids) into one score ranging from 0 to 100 (higher is better). The contributions of six household-level determinants of health: parental education, marital status, household income, household food insecurity, overcrowding, and home ownership, to differences in CVH by race/ethnicity and sex were quantified using Kitagawa-Blinder-Oaxaca decomposition tests. RESULTS: CVH scores were higher among NHW girls (mean [SD] 78.3 [10.6]) and boys (78.2 [10.8]) than their NHB and Hispanic/Latinx counterparts. No significant difference in CVH was observed between NHW and NHB boys. NHW girls had CVH scores 2.5-point higher than NHB girls (mean difference [MD] = 2.45; 95% CI: 0.91, 3.98). Cumulatively, all six household determinants explained 67% of girls' CVH gap. Disparities in household income alone accounted for 41% of this difference (b = 1.00; 95% CI: 0.10, 1.90). NHW boys and girls had 1.6- and 1.5-point higher CVH scores than their Hispanic/Latinx same-sex counterparts. The combined six household determinants explained over 75% of these differences. For Hispanic/Latinx boys, differences in household food insecurity explained 36% of their mean CVH difference (b = 0.59; 95% CI: 0.12, 1.06), while differences in household income accounted for 67% of the CVH gap for Hispanic/Latinx girls (b = 1.00; 95% CI: 0.14, 1.85). CONCLUSIONS: NHB and Hispanic/Latinx youth had lower CVH scores than their NHW counterparts, with differences in household income and food security accounting for most of their CVH gap. These findings suggest racial and ethnic disparities in CVH in youth and future CVD risk are one more negative consequence of childhood poverty.