Cross-sectional relations of race and poverty status to cardiovascular risk factors in the Healthy Aging in Neighborhoods of Diversity across the Lifespan (HANDLS) study.

Shari R Waldstein,Allyssa J Allen,Mauli T Shah,Elias Al’Najjar,Jessica M Mcneely,Alan B Zonderman,Mollie R Sprung,Michele K Evans,Danielle L Beatty Moody

doi:10.1186/s12889-016-2945-9

Abstract

BackgroundExamine interactive relations of race and poverty status with cardiovascular disease (CVD) risk factors in a socioeconomically diverse sample of urban-dwelling African American (AA) and White adults.MethodsParticipants were 2,270 AAs and Whites (57 % AA; 57 % female; ages 30–64 years) who completed the first wave of the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. CVD risk factors assessed included body mass index (BMI), waist circumference (WC), total cholesterol (TC), high- and low-density lipoprotein cholesterol (HDL-C, LDL-C), triglycerides (TG), glycated hemoglobin (HbA1c), high-sensitivity C-reactive protein (CRP), and systolic, diastolic, and pulse pressure (SBP, DBP, PP). Interactive and independent relations of race, poverty status, and sex were examined for each outcome via ordinary least squares regression adjusted for age, education, literacy, substance use, depressive symptoms, perceived health care barriers, medical co-morbidities, and medications.ResultsSignificant interactions of race and poverty status (p’s < .05) indicated that AAs living in poverty had lower BMI and WC and higher HDL-C than non-poverty AAs, whereas Whites living in poverty had higher BMI and WC and lower HDL-C than non-poverty Whites. Main effects of race revealed that AAs had higher levels of HbA1c, SBP, and PP, and Whites had higher levels of TC, LDL-C and TG (p’s < .05).ConclusionPoverty status moderated race differences for BMI, WC, and HDL-C, conveying increased risk among Whites living in poverty, but reduced risk in their AA counterparts. Race differences for six additional risk factors withstood extensive statistical adjustments including SES indicators.

Highlights

Examine interactive relations of race and poverty status with cardiovascular disease (CVD) risk factors in a socioeconomically diverse sample of urban-dwelling African American (AA) and White adults
For HANDLS, approximately equal numbers of participants were recruited from separate clusters of contiguous census tracts – neighborhoods – containing sufficient numbers of residents to fill a factorial cross of sex, race, 5-year age groups, and poverty status
Non-poverty AAs had greater body mass index (BMI) and waist circumference (WC) than those living in poverty

Summary

Introduction

Examine interactive relations of race and poverty status with cardiovascular disease (CVD) risk factors in a socioeconomically diverse sample of urban-dwelling African American (AA) and White adults. Pronounced disparities associated with race and socioeconomic status (SES) are well documented with respect to cardiovascular disease (CVD) morbidity and mortality [1, 2]. It has long been emphasized that dual consideration must be given to race and SES within the context of health disparities research [2, 7]. Disaggregating their respective influences has proven a challenging (and perhaps impossible) task. Results of multiple investigations have shown associations of higher SES (e.g., education, income) with better CVD outcomes such as coronary heart disease, subclinical atherosclerosis, overweight and obesity, and various measures of inflammation in Whites but not Blacks [8,9,10]

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