Household income and cardiovascular disease risks in U.S. children and young adults: analyses from NHANES 1999-2008

Abstract

Objective: To assess the cardiovascular risk profile of youths across socioeconomic groups in the U.S.

Research design and methods: Analysis of 1999-2008 National Health and Nutrition Examination Surveys (NHANES) including 16,085 nonpregnant 6- to 24-year-olds to estimate race/ethnicity-adjusted prevalence of obesity, central obesity, sedentary behaviors, tobacco exposure, elevated systolic blood pressure, glycated hemoglobin, non-HDL cholesterol (non-HDL-C), and high-sensitivity C-reactive protein according to age-group, sex, and poverty-income ratio (PIR) tertiles.

Results: Among boys aged 6-11 years, 19.9% in the lowest PIR tertile were obese and 30.0% were centrally obese compared with 13.2 and 21.6%, respectively, in the highest-income tertile households (P(obesity) < 0.05 and P(central obesity) < 0.01). Boys aged 12-17 years in lowest-income households were more likely than their wealthiest family peers to be obese (20.6 vs. 15.6%, P < 0.05), sedentary (14.8 vs. 9.3%, P < 0.05), and exposed to tobacco (19.0 vs. 6.5%, P < 0.01). Compared with girls aged 12-17 years in highest-income households, lowest-income household girls had higher prevalence of obesity (17.9 vs. 13.1%, P < 0.05), central obesity (41.5 vs. 29.2%, P < 0.01), sedentary behaviors (20.4 vs. 9.4%, P < 0.01), and tobacco exposure (14.1 vs. 5.9%, P < 0.01). Apart from higher prevalence of elevated non-HDL-C among low-income women aged 18-24 years (23.4 vs. 15.8%, P < 0.05), no other cardiovascular disease risk factor prevalence differences were observed between lowest- and highest-income background young adults.

Conclusions: Independent of race/ethnicity, 6- to 17-year-olds from low-income families have higher prevalence of obesity, central obesity, sedentary behavior, and tobacco exposure. Multifaceted cardiovascular health promotion policies are needed to reduce health disparities between income groups.

Figure 1

Predicted prevalence (%)† of multiple risk factors for U.S. male (A) and female (B) NHWs, NHBs, and MAs aged 8–24 years‡ by PIR tertile (T) and age-group. *P < 0.05 for difference between T1 and T3 in having at least three risk factors (out of: central obesity, systolic hypertension, elevated hs-CRP, high non–HDL-C, and tobacco exposure). †Multinomial logistic regression models of multiple risk factors controlling for PIR, race/ethnicity, age, and PIR × age interaction. Values are calculated as predicted percentages. Interaction of PIR and age was nonsignificant for males (P = 0.17) and females (P = 0.49). ‡Age limited to ≥8 years because sBP was not measured in 6- to 7-year-olds.