Racial-ethnic inequality in cardiovascular health in the U.S.: Does it mirror socioeconomic inequality?

Abstract Purpose : To document gender-specific racial-ethnic disparities in cardiovascular (CV) conditions and risk factors net of socioeconomic status (SES) across the lifespan. Methods : Using pooled data from the 1999-2016 U.S. National Health and Nutrition Examination Survey, we document gender-specific proportions of non-Hispanic Whites, non-Hispanic Blacks, and Hispanics ages 12-69 years with various socioeconomic characteristics and CV conditions. We then further disaggregate into 10-year age groups and present unadjusted and SES-adjusted prevalence of each CV condition for each gender/racial-ethnic/age group. Results : Racial-ethnic differences in the prevalence of CV conditions are large for some conditions, emerge early in adulthood, and remain relatively constant though age 69. Only small proportions of the differences can be attributed to differences in SES across groups; attenuation after adjusting for income, education, and available measures of wealth ranged from 0-2.3 percentage points. Black-White differences in prevalence of CV conditions differ substantially and systematically by gender; White females have larger advantages or smaller disadvantages relative to Black females (depending on indicator) than White males do relative to Black males. Conclusions : Racial-ethnic disparities in CV conditions are rooted early in the life course, do not mirror socioeconomic disparities, and (for race) vary considerably by gender. Explanations likely involve early life experiences such as racial discrimination and entrenched inequality.