School of Nursing, Emory University, Atlanta, Georgia.
Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia.
JAMA Netw Open. 2022 Feb 1;5(2):e220331. doi: 10.1001/jamanetworkopen.2022.0331.
Low socioeconomic status (SES) in the form of educational level and income has been linked to greater cardiovascular risk across cohorts; however, associations have been inconsistent for African American individuals. Net worth, a measure of overall assets, may be a more relevant metric, especially for African American women, because it captures longer-term financial stability and economic reserve.
To examine whether net worth is associated with increased ambulatory blood pressure (ABP), a marker of cardiovascular disease (CVD) risk, independent of educational level and income, in young to middle-aged African American women.
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional, community-based study conducted in the southeastern US was performed using 48-hour ambulatory BP monitoring. Participants included 384 African American women aged 30 to 46 years without clinical CVD recruited between December 16, 2016, and March 21, 2019; data analysis was performed from September 2020 to December 2021.
Self-reported net worth (total financial assets minus debts), self-reported educational level, and self-reported income.
Mean daytime and nighttime BP levels, assessed via 48-hour ABP monitoring and sustained hypertension (ABP daytime and clinic BP ≥130/80 mm Hg).
The 384 African American women in this study represented a range of SES backgrounds; mean (SD) age was 38.0 (4.3) years. Excluding 66 women who were not receiving antihypertensive medications, in linear regression models adjusted for age, marital status, educational level, family income, and family size, women reporting a negative net worth (debt) had higher levels of daytime (β = 6.7; SE = 1.5; P < .001) and nighttime (β = 6.4; SE = 1.4; P < .001) systolic BP, compared with women reporting a positive net worth. Similar associations were observed with sustained hypertension: women reporting a negative net worth had 150% higher odds (odds ratio, 2.5; 95% CI, 1.3-4.7) of sustained hypertension than those reporting a positive net worth. Associations remained significant after additional adjustments for smoking, body mass index, psychosocial stress due to debt, and depressive symptoms and were similar, although attenuated, when women receiving antihypertensive medications were included and treatment was controlled for in all analyses.
In this cross-sectional study, having a negative net worth (ie, debt) was associated with elevated BP in African American women, independent of traditional indicators of SES. This finding suggests that limited assets or a lack of economic reserve may be associated with poor CVD outcomes in this at-risk group.
以教育程度和收入形式表现的低社会经济地位（SES）与不同队列中的更大心血管风险相关；然而，对于非裔美国人个体，这种关联并不一致。净资产是一种衡量总体资产的指标，可能是一个更相关的指标，尤其是对于非裔美国女性，因为它反映了更长期的财务稳定性和经济储备。
检验在没有教育程度和收入的情况下，非裔美国年轻到中年女性的净资产是否与增加的动态血压（ABP）相关，ABP 是心血管疾病（CVD）风险的标志物。
设计、地点和参与者：这是一项在美国东南部进行的基于社区的横断面研究，使用了 48 小时动态血压监测。参与者包括 384 名年龄在 30 岁至 46 岁之间、无临床 CVD 的非裔美国女性，于 2016 年 12 月 16 日至 2019 年 3 月 21 日之间招募；数据分析于 2020 年 9 月至 2021 年 12 月进行。
自我报告的净资产（总金融资产减去债务）、自我报告的教育程度和自我报告的收入。
通过 48 小时动态血压监测评估的日间和夜间平均血压水平，以及持续性高血压（ABP 日间和诊所血压≥130/80mmHg）。
这项研究中的 384 名非裔美国女性代表了不同的 SES 背景；平均（SD）年龄为 38.0（4.3）岁。在排除 66 名未服用抗高血压药物的女性后，在调整年龄、婚姻状况、教育程度、家庭收入和家庭规模的线性回归模型中，报告负净资产（负债）的女性日间（β=6.7；SE=1.5；P<.001）和夜间（β=6.4；SE=1.4；P<.001）收缩压水平更高。与持续性高血压也有类似的关联：报告负净资产的女性比报告正净资产的女性发生持续性高血压的可能性高 150%（比值比，2.5；95%置信区间，1.3-4.7）。在进一步调整吸烟、体重指数、因债务导致的心理社会压力、抑郁症状后，这些关联仍然显著，而当包括服用抗高血压药物的女性并在所有分析中控制治疗时，关联仍然相似，尽管有所减弱。
在这项横断面研究中，非裔美国女性的净资产为负（即负债）与血压升高相关，而与传统的 SES 指标无关。这一发现表明，有限的资产或缺乏经济储备可能与该高危人群的不良 CVD 结局有关。
