Racial and Ethnic Health Disparities and Cardiovascular Disease Risk in the USA

We examined the relationship between race/ethnicity and cardiovascular disease (CVD) risk factors (i.e., clinically-measured triglycerides, total cholesterol, and hypertension) among 40+ adults in the United States of America (USA), with socioeconomic status (SES) and health behaviors as potential mediators or moderators.  We hypothesized SES, as a “fundamental cause,” and health behaviors, which are shaped by SES over the life course, would reduce the racial/ethnic effect related to CVD risk factors, comparing Mexican-Americans and non-Hispanic Blacks to non-Hispanic Whites (Lantz, et al. 2010; Link & Phelan 1995; Phelan & Link 2015).  We tested our hypotheses with multivariate negative binomial and logistic regression models using the 2005-2008 cross-sectional waves of the nationally-representative National Health and Nutrition Examination Survey (NHANES; n=6,063), adjusting for age, sex, nativity, medications, and fasting for triglycerides or not.  SES included total household income adjusted for family size and highest grade of school completed or degree received.  Health behaviors included smoking status and the number of days per week participants drank alcohol in the last year.  We also tested for interactions between race/ethnicity and SES and race/ethnicity and health behaviors related to CVD risk.  Compared to non-Hispanic Whites, non-Hispanic Blacks have significantly lower triglyceride levels, lower total cholesterol, and higher hypertension.  Additionally, Mexican-Americans have significantly higher triglyceride levels, similar levels of cholesterol, and similar levels of hypertension compared to non-Hispanic Whites.  Adjustments for SES and health behaviors did little to explain existing racial/ethnic health disparities.  In conclusion, we found racial differences in SES and health behaviors did not generally account for racial/ethnic disparities in CVD risk (i.e. the argument for the non-equivalence of SES by race/ethnicity).  Persistent racial/ethnic health disparities in CVD risk for middle and older age groups were also somewhat inconsistent with increasing life expectancy trends among older adults in the USA (NRC & IOM 2013).