Abdalla Salma M, Yu Shui, Galea Sandro
Boston University, School of Public Health, USA.
SSM Popul Health. 2021 Jan 30;13:100745. doi: 10.1016/j.ssmph.2021.100745. eCollection 2021 Mar.
Income inequality between the richest 20% and the poorest 80% in the United States has been increasing over the past two decades. Emerging evidence indicates widening disparities between the two groups in cardiovascular disease prevalence as well. However, the mechanisms behind this trend remains unclear. This analysis examines whether a similar trend exists in the levels of biomarkers and risk factors of cardiovascular disease in the United States.
We conducted a serial cross-sectional analysis of a nationally representative data from the National Health and Nutrition Examination Survey (NHANES) for participants age 20 or older between 1999 and 2018. We calculated trends in age-standardized means of body mass index (BMI), systolic blood pressure (SBP), and high-density lipoproteins (HDL) and the trend in prevalence of obesity, high SBP, and low HDL by income group.
This analysis included 49,764 participants. Age-standardized mean BMI increased every two years by an average of 0.15 kg/m 2 among the richest 20% and by an average of 0.21 kg/m 2 among the poorest 80%. Age-standardized mean SBP decreased every two years by an average of 0.13 mm Hg among the richest 20% and by an average of 0.10 mm Hg among the poorest 80%. Age-standardized mean HDL increased every two years by an average of 0.39 mg/dL among the richest 20% and by an average of 0.19 mg/dL among the poorest 80%. When adjusted for demographic factors and time, the richest 20% had lower mean BMI (OR = -0.67, 95% CI: -0.89, - 0.44), lower mean SBP (OR = -0.72, 95% CI: -1.24, -0.20), and higher mean HDL (OR = 3.04, 95% CI: 2.46, 3.62) compared to the poorest 80.
There are increasing disparities in cardiovascular disease biomarkers by income in the US. Between 1999 and 2018, improvement in biomarkers overwhelmingly occurred among the richest 20.
在过去二十年中，美国最富有的20%人群与最贫穷的80%人群之间的收入不平等一直在加剧。新出现的证据表明，这两组人群在心血管疾病患病率方面的差距也在扩大。然而，这一趋势背后的机制仍不清楚。本分析旨在研究美国心血管疾病生物标志物水平和危险因素中是否存在类似趋势。
我们对1999年至2018年间年龄在20岁及以上的全国健康和营养检查调查（NHANES）参与者的全国代表性数据进行了系列横断面分析。我们计算了体重指数（BMI）、收缩压（SBP）和高密度脂蛋白（HDL）的年龄标准化均值趋势，以及按收入组划分的肥胖、高SBP和低HDL患病率趋势。
本分析纳入了49764名参与者。在最富有的20%人群中，年龄标准化平均BMI每两年平均增加0.15kg/m²，在最贫穷的80%人群中平均增加0.21kg/m²。在最富有的20%人群中，年龄标准化平均SBP每两年平均下降0.13mmHg，在最贫穷的80%人群中平均下降0.10mmHg。在最富有的20%人群中，年龄标准化平均HDL每两年平均增加0.39mg/dL，在最贫穷的80%人群中平均增加0.19mg/dL。在调整了人口统计学因素和时间后，与最贫穷人群相比，最富有的20%人群的平均BMI较低（OR=-0.67，95%CI：-0.89，-0.44），平均SBP较低（OR=-0.72，95%CI：-1.24，-0.20），平均HDL较高（OR=3.04，95%CI：2.46，3.62）。
在美国，心血管疾病生物标志物在收入方面的差距正在加大。1999年至2018年间，生物标志物的改善主要发生在最富有的20%人群中。
