Division of Endocrinology, Diabetes & Metabolism The Ohio State University College of Medicine Columbus OH USA.
The Ohio State University College of Nursing Columbus OH USA.
J Am Heart Assoc. 2023 Sep 19;12(18):e029254. doi: 10.1161/JAHA.122.029254. Epub 2023 Sep 13.
Background The American Heart Association's Life's Essential 8 (LE8) are 8 risk factors for cardiovascular disease, with poor attainment across all racial, ethnic, and socioeconomic groups. Attainment is lowest among Americans of low socioeconomic status (SES). Evidence suggests the association of SES with LE8 may vary by race and ethnicity. Methods and Results The association of 4 SES categories (education, income-to-poverty line ratio, employment, insurance) with LE8 was computed in age-adjusted linear regression models, with an interaction term for race and ethnicity, using National Health and Nutrition Examination Survey data, years 2011 to 2018. The sample (n=13 529) had a median age of 48 years (51% female) with weighting to be representative of the US population. The magnitude of positive association of college education (relative to ≤high school) with LE8 was greater among non-Hispanic White Americans (NHWA) compared with non-Hispanic Black Americans, Hispanic Americans, and non-Hispanic Asian Americans (all interactions <0.001). NHWA had a greater magnitude of positive association of income-to-poverty line ratio with LE8, compared with non-Hispanic Black Americans, Hispanic Americans, and non-Hispanic Asian Americans (all interactions <0.001). NHWA with Medicaid compared with private insurance had a greater magnitude of negative association with LE8 compared with non-Hispanic Black Americans, non-Hispanic Asian Americans, or Hispanic Americans (all interactions <0.01). NHWA unemployed due to disability or health condition (compared with employed) had a greater magnitude of negative association with LE8 than non-Hispanic Black Americans, non-Hispanic Asian Americans, or Hispanic Americans (all interactions <0.05). Conclusions The magnitude of association of SES with LE8 is greatest among NHWA. More research is needed on SES's role in LE8 attainment in minority group populations.
美国心脏协会的“生命基础 8 项”（LE8）是 8 项心血管疾病风险因素，所有种族、族裔和社会经济群体的达标率都很低。社会经济地位较低的美国人达标率最低。有证据表明，社会经济地位与 LE8 的关联可能因种族和族裔而异。
在年龄调整线性回归模型中，计算了 4 个社会经济地位类别（教育、收入与贫困线之比、就业、保险）与 LE8 的关联，并使用 2011 年至 2018 年全国健康和营养调查数据，为种族和族裔设置了交互项。样本（n=13529）的中位数年龄为 48 岁（51%为女性），经加权处理后具有代表性。与高中以下教育（相对于高中以下教育）相比，大学教育与 LE8 呈正相关的程度在非西班牙裔白种美国人（NHWA）中大于非西班牙裔黑种美国人、西班牙裔美国人和非西班牙裔亚裔美国人（所有交互作用均<0.001）。与非西班牙裔黑种美国人、西班牙裔美国人和非西班牙裔亚裔美国人相比，NHWA 的收入与贫困线之比与 LE8 呈正相关的程度更大（所有交互作用均<0.001）。与私人保险相比，NHWA 拥有医疗补助的人比非西班牙裔黑种美国人、非西班牙裔亚裔美国人和西班牙裔美国人的 LE8 呈负相关的程度更大（所有交互作用均<0.01）。与就业相比，NHWA 因残疾或健康状况而失业与 LE8 呈负相关的程度大于非西班牙裔黑种美国人、非西班牙裔亚裔美国人和西班牙裔美国人（所有交互作用均<0.05）。
社会经济地位与 LE8 之间的关联程度在 NHWA 中最大。需要进一步研究 SES 在少数民族群体 LE8 达标率中的作用。
