Racial, ethnic and socioeconomic disparities in the clustering of cardiovascular disease risk factors

Objective: To evaluate racial and ethnic differences in the clustering of cardiovascular disease (CVD) risk factors in the United States and to determine whether these differences vary by socioeconomic status (SES). Methods: Data from the Third National Health and Nutrition Examination Survey (1988-1994), a cross-sectional survey of the US population, were used to examine these relationships among 486 non-Hispanic Blacks, 469 Mexican Americans, and 772 non-Hispanic Whites, aged 25 to 99 years. Risk factors included hypertension, abnormal cholesterol, diabetes mellitus, overweight, and cigarette smoking. Educational level was used as a proxy for SES. Results: Twenty percent of non-Hispanic Whites had zero CVD risk factors vs 18% of Mexican Americans and 13% of non-Hispanic Blacks. Non-Hispanic Blacks were twice as likely as the other groups to have 4 or 5 risk factors. Across all groups, the prevalence of having zero risk factors increased with education (from 6%-14% among those with <12 years to 22%-29% among those with >12 years). After adjustment for age and gender, among those with <12 years of education, Mexican Americans were 60% more likely and non-Hispanic Blacks were 30% less likely to have zero risk factors than non-Hispanic Whites. Among persons with >12 years of education, Mexican Americans and non-Hispanic Blacks were 50%-60% less likely to have zero risk factors than non-Hispanic Whites. Conclusions: Increased CVD risk factor clustering exists among Americans with low SES, particularly among non-Hispanic Blacks. Among persons with high SES, Mexican Americans and non-Hispanic Blacks have a higher risk of CVD than non-Hispanic Whites. These disparities may be reduced through policy changes that promote heart-healthy environments throughout society.