Kundrick John, Rollins Heather, Mullachery Pricila, Sharaf Asma, Schnake-Mahl Alina, Diez Roux Ana V, Bilal Usama
Department of Health Management and Policy, Drexel Dornsife School of Public Health, Philadelphia, PA, USA.
Drexel University College of Medicine, Philadelphia, PA, USA.
Prev Med Rep. 2024 Oct 19;47:102908. doi: 10.1016/j.pmedr.2024.102908. eCollection 2024 Nov.
The United States has a lower life expectancy and wider income inequality than its similarly developed counterparts, and disparities continue to widen. The objective of our study is to examine the heterogeneity of disparities by income in cardiovascular disease (CVD) risk factors among U.S. metropolitan areas.
Data was obtained from the Behavioral Risk Factor Surveillance System for 2012-2019. We used self-reported data for respondent characteristics and for CVD risk factors/prevalence, and on metropolitan-level demographic and socioeconomic characteristics. We computed the relative index of inequality (RII) for each outcome using a multilevel Poisson model, sequentially adjusted for age, sex, and race/ethnicity with a random slope for income. We also included interactions between income and the metropolitan-level variables.
Our sample included 1.4 million participants from 209 metropolitan areas. All CVD risk factors and CVD demonstrated income-related disparities. There were no clear regional patterns for risk factors, though seven of the top 10 large metropolitan areas with the widest disparities in CVD prevalence were in the South. Improved socioeconomic conditions were associated with wider disparities in the five risk factors, and contextual variables explained almost half of the variability in income disparities in smoking, sedentarism, and obesity, even after adjusting for age, sex, and race/ethnicity.
This study found that CVD risk factors and prevalence in U.S. metropolitan areas have heterogeneous income disparities, especially in advantaged metropolitan areas. Further studies with improved data collection may shed more light into potential drivers of income-based disparities in cardiovascular risk.
与其他类似发达的国家相比，美国的预期寿命较低，收入不平等现象更为严重，且这种差距仍在不断扩大。我们研究的目的是考察美国各大都市区心血管疾病（CVD）风险因素方面收入差距的异质性。
数据来源于2012 - 2019年行为风险因素监测系统。我们使用了关于受访者特征、CVD风险因素/患病率以及大都市区层面人口和社会经济特征的自我报告数据。我们使用多水平泊松模型计算每个结果的不平等相对指数（RII），依次对年龄、性别和种族/族裔进行调整，并对收入采用随机斜率。我们还纳入了收入与大都市区层面变量之间的交互作用。
我们的样本包括来自209个大都市区的140万参与者。所有CVD风险因素和CVD均显示出与收入相关的差距。风险因素没有明显的区域模式，尽管在CVD患病率差距最大的前10个大型大都市区中，有7个位于南部。社会经济状况的改善与五个风险因素中更大的差距相关，并且即使在对年龄、性别和种族/族裔进行调整后，背景变量仍解释了吸烟、久坐不动和肥胖收入差距中近一半的变异性。
本研究发现，美国大都市区的CVD风险因素和患病率存在异质性收入差距，尤其是在优势大都市区。进一步通过改进数据收集进行的研究可能会更清楚地揭示心血管风险中基于收入的差距的潜在驱动因素。
