Abstract 12235: Contribution of Individual-Level Factors to Racial and Ethnic Differences in Cardiovascular Health in the United States Population

Abstract

Introduction: Individual-level factors across several domains underlie racial and ethnic differences in cardiovascular health (CVH). Quantifying the contributions of these determinants to racial and ethnic differences in CVH may inform targeted strategies to mitigate inequities. Methods: In data from NHANES 2011-2018, we calculated mean CVH score (range 0-14; defined by AHA’s Life’s Simple 7 metrics) among US adults ≥20 years. We applied Kitagawa-Blinder-Oaxaca decomposition to quantify the contributions of education, income, food security, marital status, health insurance, place of birth (US vs. foreign born), and depression to racial and ethnic differences in CVH. Results: Among 16,172 participants representing 255 million US adults, 41% were non-Hispanic (NH) White, 23% NH Black, 24% Hispanic, and 12% NH Asian. Among males, mean (SE) CVH score was 7.58 (2.3) in NH White, 7.48 (2.4) in NH Black, 7.45 (2.3) in Hispanic, and 8.71 (2.2) in NH Asian adults. Education explained the largest component of CVH differences in males (if education were similar to NH White, CVH score would be 0.23 [0.03] points higher in NH Black, 0.36 [0.04] points higher in Hispanic, and 0.24 [0.04] points lower in NH Asian, p<0.05; Figure A). Among females, mean (SE) CVH score was 8.00 (2.5) in NH White, 7.43 (2.3) in NH Black, 8.03 (2.4) in Hispanic, and 9.34 (2.1) in NH Asian adults. Education explained the largest component of CVH difference in NH Black females (if education were similar to NH White, CVH score would be 0.17 [0.03] points higher in NH Black, p<0.05; Figure B). Place of birth explained the largest component of CVH difference in Hispanic and NH Asian females (if place of birth were similar to NH White, CVH score would be 0.36 [0.07] points lower and 0.49 [0.16] points lower, respectively, p<0.05). Conclusion: Education and place of birth confer the largest contributions to the net difference in mean CVH score among racial and ethnic groups in the US.