Does education modify the effect of ethnicity in the expression of ideal cardiovascular health? The Baptist Health South Florida Employee Study

Abstract

Background: Despite the progress made to decrease risk factors for cardiovascular diseases, disparities still exist. We examined how education and ethnicity interact to determine disparities in cardiovascular health (CVH) as defined by the American Heart Association.

Hypothesis: Education modifies the effect of ethnicity on CVH.

Methods: Individual CVH metrics (smoking, physical activity, body mass index, diet, total cholesterol, blood pressure, and blood glucose) were defined as ideal, intermediate, or poor. Combined scores were categorized as inadequate, average, or optimal CVH. Education was categorized as postgraduate, college, some college, and high school or less; ethnicity was categorized as white, Hispanic, black, and other. Main and interactive associations between education, ethnicity, and the measures of CVH were calculated with multinomial logistic regression.

Results: Of 9056 study participants, 74% were women, and mean age was 43 (±12) years. Over half were Hispanic, and two-thirds had at least a college education. With postgraduate education category as the reference, participants with less than a college education were less likely to achieve ideal status for most of the individual CVH metrics, and also less likely to achieve 6 to 7 ideal metrics, and optimal CVH scores. In most of the educational categories, Hispanic participants had the highest proportion with optimal CVH scores and 6 to 7 ideal metrics, whereas black participants had the lowest proportion. However, there were no statistically significant interactions of education and ethnicity for ideal CVH measures.

Conclusions: Higher educational attainment had variable associations with achieved levels of ideal CVH across race/ethnic groups. Interventions to improve CVH should be tailored to meet the needs of target communities.

Keywords: Cardiovascular; Epidemiology; Ideal Cardiovascular Health Metrics; Life's Simple 7; Preventive Cardiology; Socioeconomic Aspects.

Figure 1

Distribution of the cardiovascular health score and the number of ideal metrics by education and ethnicity