Relationship between race, income-level, and Cardiovascular Disease

Aim: To study the prevalence of cardiovascular disease (CVD) and associated risk factors among different races/ethnicities across different income groups.

Methods: This retrospective analysis included data from the National Health and Nutrition Examination Survey from 2005-2018. Adults >20 years who identified as non-Hispanic (NH) White, NH Black, or Hispanic were included. Family income-to-poverty ratio (PIR) was calculated by dividing family income by poverty guidelines specific to the survey year and divided into four quartiles. Weighted logistic regression was performed to estimate adjusted odds ratios to determine association of race/ethnicity and CVD in each PIR quartile. Models were adjusted for age, sex, race, health insurance, marital status, citizenship status, education level, and PIR.

Results: We included 31,884 adults that corresponded to ∼191.3 million weighted, nationally representative participants. Of these, 8,009, 7,967, 7,944, and 7,964 participants belonged to 1^st, 2^nd, 3^rd, and 4^th quartiles, respectively. The prevalence of diabetes mellitus (DM), hypertension, coronary artery disease (CAD), congestive heart failure (CHF), and stroke decreased with each successive PIR quartile. NH Black participants had higher prevalence odds of DM, hypertension, obesity, CHF, and stroke compared to NH White participants. The difference in prevalence odds between NH White adults and NH Black adults was greater for obesity (p-interaction=0.002), DM (p-interaction=0.027), and stroke (p-interaction=0.053) in the 4^th PIR quartile (highest income) compared to the 1^st PIR quartile (lowest income).

Conclusion: Racial and ethnic disparities in the risk of CVD persists across income levels, with a greater difference in prevalence of select CVD and risk factors between NH Black and NH White participants in the highest income quartile compared to the lowest income quartile.