Cubbin Catherine, La Frinere-Sandoval Quynh Nhu Natasha B, Widen Elizabeth M
Steve Hicks School of Social Work, The University of Texas at Austin, 405 W. 25th Street, Austin, TX 78705, USA.
Department of Nutritional Sciences, College of Natural Sciences, The University of Texas at Austin, 200 W. 24th Street, Austin, TX 78712, USA.
Int J Environ Res Public Health. 2025 Mar 10;22(3):404. doi: 10.3390/ijerph22030404.
The life stage between the ages of 30-45 years for women is critical, given the competing demands of occupational advancement, intimate partner relationships, and childcare responsibilities. Cardiovascular disease (CVD) is the leading cause of death among women in the US, which is experienced inequitably by race/ethnicity/nativity and socioeconomic status and is embedded within geographic contexts. The objective of the current study was to examine social inequities in pre-pregnancy risk factors for cardiovascular disease. We analyzed 16 years of geocoded natality data in Texas (N = 2,089,588 births between 2005 and 2020 to mothers aged 30-45 years) linked with census tract- and county-level data. Dependent variables included pre-pregnancy diabetes, hypertension, obesity, and smoking. Independent variables included individual-level race/ethnicity/nativity and educational attainment, tract-level poverty and racial/ethnic concentrations, and county-level urban/rural status, with controls for other sociodemographic characteristics and time trend. Two-level, random intercept hierarchical generalized logistic models were used to estimate associations and model fit. Significant social inequities at the individual-, tract-, and county-levels in each risk factor were found. For example, tract-level variables had substantial and significant association with the four CVD risk factors, ranging from 13% to 72% higher odds in adjusted models. For all four risk factors, the more rural the county of residence was, the higher the odds of having the risk factor (24% to 256% higher odds). Individual-level social inequalities by race/ethnicity/nativity (ORs ranging from 0.04 to 2.12) and education (ORs ranging from 1.25 to 5.20) were also observed. Enhancing our understanding of this important period of life may enable policy and interventions to better support women through this critical life stage.
鉴于职业发展、亲密伴侣关系和育儿责任等相互竞争的需求，30至45岁的女性所处的人生阶段至关重要。心血管疾病（CVD）是美国女性的主要死因，在种族/族裔/出生地以及社会经济地位方面存在不平等现象，且与地理环境相关。本研究的目的是调查心血管疾病孕前风险因素中的社会不平等情况。我们分析了德克萨斯州16年的地理编码出生数据（2005年至2020年间，年龄在30至45岁的母亲生育了2,089,588名婴儿），并将其与普查区和县级数据相链接。因变量包括孕前糖尿病、高血压、肥胖和吸烟。自变量包括个体层面的种族/族裔/出生地和教育程度、普查区层面的贫困和种族/族裔集中情况，以及县级的城乡地位，并对其他社会人口特征和时间趋势进行了控制。使用两级随机截距分层广义逻辑模型来估计关联和模型拟合情况。在每个风险因素的个体、普查区和县级层面均发现了显著的社会不平等现象。例如，普查区层面的变量与四种心血管疾病风险因素存在实质性且显著的关联，在调整模型中，优势比高出13%至72%。对于所有四种风险因素，居住县越偏远，存在该风险因素的几率就越高（优势比高出24%至256%）。在种族/族裔/出生地（优势比范围为0.04至2.12）和教育程度（优势比范围为1.25至5.20）方面，也观察到了个体层面的社会不平等现象。加深我们对这一重要人生阶段的理解，可能会使政策和干预措施更好地在这个关键人生阶段为女性提供支持。
