Abdalla Salma M, Rosenberg Samuel B, Maani Nason, Melendez Contreras Catalina, Yu Shui, Galea Sandro
Global Health Department, Boston University School of Public Health, Boston, MA, USA.
Epidemiology Department, Boston University School of Public Health, Boston, MA, USA.
Lancet Reg Health Am. 2025 Mar 6;44:101039. doi: 10.1016/j.lana.2025.101039. eCollection 2025 Apr.
Health metrics in the United States (US) have lagged behind other high-income countries in recent decades, and show persistent gaps between socio-demographic groups. Top 20% income earners and college graduates have also increasingly diverged from the reminder of the population in various dimensions over the past few decades. This study described population patterns in cardiovascular diseases (CVD) by income and education over a twenty-year period.
This analysis used nationally representative data from 10 cycles (1999-2018) of the National Health and Nutrition Examination Survey (NHANES). Participants were stratified by income and education into four groups: top 20% income earners, college graduates; top 20% income earners, non-college graduates; bottom 80% income earners, college graduates; and bottom 80% income earners, non-college graduates. For income, we created a binary variable (ratio > 5 cutoff) using NHANES income-to-poverty ratio variable to create a standardized measure of income. We calculated the age-standardized prevalence and odds ratios of four conditions: congestive heart failure (CHF), angina, heart attack, and stroke, for each income-education group.
49,704 participants reported data for both income and education. The age-standardized prevalence of CVD outcomes varied across the four groups. This was most significant when comparing the prevalence among the top 20% income, college graduate group to the bottom 80% income, non-college graduate group: CHF (0.5% vs. 3.0%), angina (1.4% vs. 2.8%), heart attack (1.7% vs. 3.9%), and stroke (1.1% vs. 3.4%). Compared to the top 20% income, college graduate group, the odds of all CVD conditions were significantly higher in the bottom 80% income groups (college graduates: odds ratios (ORs) 1.48-3.67; non-college graduates: ORs 2.36-6.52), as well as for CHF and heart attack in the top 20% income, non-college graduates (OR 3.11 [95% CI: 1.92, 5.06] and OR 1.92 [95% CI: 1.35, 2.73], respectively).
Health gaps extend beyond extremes, with risk clustering favoring top 20% income earners with college degrees while most Americans are left behind. Future research should include longitudinal studies that focus on the mechanisms through which both income and education intersect to shape CVD outcomes in the US.
The Rockefeller Foundation.
近几十年来，美国的健康指标落后于其他高收入国家，且社会人口群体之间存在持续差距。在过去几十年中，收入最高的20%人群和大学毕业生在各个方面也与其他人群的差距越来越大。本研究描述了二十年间心血管疾病（CVD）按收入和教育程度划分的人群模式。
本分析使用了来自国家健康和营养检查调查（NHANES）10个周期（1999 - 2018年）具有全国代表性的数据。参与者按收入和教育程度分为四组：收入最高的20%人群中的大学毕业生；收入最高的20%人群中的非大学毕业生；收入最低的80%人群中的大学毕业生；以及收入最低的80%人群中的非大学毕业生。对于收入，我们使用NHANES收入与贫困率变量创建了一个二元变量（比率>5为临界值），以创建收入的标准化衡量指标。我们计算了每个收入 - 教育组四种疾病的年龄标准化患病率和比值比：充血性心力衰竭（CHF）、心绞痛、心脏病发作和中风。
49,704名参与者报告了收入和教育数据。心血管疾病结果的年龄标准化患病率在四组中各不相同。当比较收入最高的20%的大学毕业生组与收入最低的80%的非大学毕业生组的患病率时，这种差异最为显著：CHF（0.5%对3.0%）、心绞痛（1.4%对2.8%）、心脏病发作（1.7%对3.9%）和中风（1.1%对3.4%）。与收入最高的20%的大学毕业生组相比，收入最低的80%的人群中所有心血管疾病的患病几率显著更高（大学毕业生：比值比（OR）为1.48 - 3.67；非大学毕业生：OR为2.36 - 6.52），收入最高的20%的非大学毕业生中CHF和心脏病发作的患病几率也更高（分别为OR 3.11 [95%置信区间：1.92, 5.06]和OR 1.92 [95%置信区间：1.35, 2.73]）。
健康差距不仅存在于极端情况中，风险聚集有利于收入最高的20%的大学学位持有者，而大多数美国人则被甩在后面。未来的研究应包括纵向研究，重点关注收入和教育相互作用影响美国心血管疾病结果的机制。
洛克菲勒基金会。
