Key result
Black women show a ~3-point lower CVH score than White women, largely driven by socioeconomic factors.
Why the study?
Cardiovascular health in Black adults, particularly Black women, has lagged behind White adults for decades and contributes to higher mortality rates, but the contribution of social and economic factors was unquantified.
Do social and economic factors account for racial disparities in cardiovascular health between Black and White adults?
Cross-Sectional (n=8,019)
Do social and economic factors account for racial disparities in cardiovascular health between Black and White adults?
Racial differences in social and economic factors, particularly income and education, account for a significant portion of the disparity in cardiovascular health between Black and White adults in the US.
Social factors linked to lower CVH in Black women; leaves open whether targeting them improves outcomes.
Background: Cardiovascular health (CVH) in Black adults, and particularly in Black women, has lagged behind White adults for decades and contributes to higher mortality rates for Black adults. We quantified the contribution of five social and economic factors to observed racial disparities in CVH by gender. Methods: We analyzed data from N = 8,019 adults aged ≥20 years free of cardiovascular disease assessed in the National Health and Nutrition Examination Survey, 2011-2018. Social and economic factors included self-reported education, income, employment, food security, and marital status. CVH was measured using eight behavioral and clinical indicators. We utilized Kitagawa-Blinder-Oaxaca decomposition to quantify gendered racial differences in CVH accounted for by these factors. Results: Black women (mean CVH = 79.3) had a lower age-adjusted CVH score compared to White women (mean CVH = 82.3) (mean difference [MD] = -3.01; 95% CI: -5.18, -0.84). Social and economic factors accounted for a 3.26-point disadvantage (95% CI: -4.12, -2.40) and a 0.25-point CVH score advantage due to factors not accounted for in the model. In women, income had the largest coefficient associated with CVH score (b = -1.48; 95% CI: -2.04, -0.92). Among men, social and economic factors accounted for a 2.27-point disadvantage (95% CI: -2.97, -1.56) with educational attainment being the largest coefficient associated with CVH score (b = -1.55; 95% CI: -2.03, -1.06). However, the disadvantage in men was offset by a 1.99 CVH score advantage that was not accounted for by factors in the model resulting in no racial difference in age-adjusted CVH score (MD = -0.28; 95% CI: -3.78, 3.22). Conclusions: Racial differences in social and economic factors may contribute a large portion to the observed disparity in CVH between U.S. Black and White women.
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Fields et al. (2023) conducted a cross-sectional in Cardiovascular health (n=8,019). Black race and social/economic factors vs. White race was evaluated on Age-adjusted Cardiovascular Health (CVH) score (MD -3.01, 95% CI -5.18 to -0.84). Black women had a 3.01-point lower age-adjusted cardiovascular health score compared to White women, with social and economic factors accounting for a 3.26-point disadvantage.
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