Income Disparities and Cardiovascular Risk Factors Among Adolescents

Abstract

Background and objectives: Socioeconomic disparities in cardiovascular health among adults have been documented, but disparities during adolescence are less understood. In this study, we examined secular trends in cardiovascular risk factors and disparities among US adolescents.

Methods: We analyzed NHANES data from 1999 to 2014, including 11 557 (4854 fasting) participants aged 12 to 19 years. To examine trends in cardiovascular risk factors, adolescents were stratified into 3 groups on the basis of family poverty-income ratio: low income (poverty-income ratio, <1.3), middle income (≥1.3 and <3.5), and high income (≥3.5).

Results: From 1999 to 2014, the prevalence of obesity increased (16.3%-20.9%, P = .001) but only among low- and middle-income adolescents, with significant disparities in prevalence by income (21.6% vs 14.6% among low- versus high-income adolescents, respectively, in 2011-2014). In addition, there were significant and persistent disparities in the prevalence of smoking (20.7% vs 7.3% among low- versus high-income adolescents, respectively, in 2011-2014), low-quality diet (68.9% vs 55.4%), and physical inactivity (25.6% vs 17.0%). No significant disparities were observed in the prevalence of prediabetes and diabetes, hypertension, or hypercholesterolemia, although the prevalence of prediabetes and diabetes nearly doubled (11.9%-23.1%, P < .001) among all adolescents from 1999 to 2014. Overall, the prevalence of adolescents with 2 or more risk factors declined, but this decline was only significant for high-income adolescents (44.1%-29.1%, P = .02).

Conclusions: Recent improvements in cardiovascular health have not been equally shared by US adolescents of varying socioeconomic status.

Figure 1:

Adjusted prevalence and trends of CVD risk factors and number of estimated adolescents by PIR among adolescents aged 12 to 19 years, NHANES 1999–2014. Adolescents having a BMI percentile ⩾95th percentile were classified as having obesity. Smoking status was classified as “current smoker” on the basis of self-reported smoking data or sex- and race-specific serum cotinine level. HEI-2010 scores ⩽50 were classified as low-quality diets. Physical inactivity was classified as no physical activity or <10 minutes of physical activity in a typical week in NHANES 2007 – 2014. Hypertension was classified according to 2017 AAP guidelines. Adolescents with a self reported diagnosis of diabetes, HbA1c ⩾6.5%, or FPG ⩾126 mg/dL were classified as having diabetes. Those without a self-reported diagnosis of diabetes but who had an HbA1c level of 5.7% to 6.4% or an FPG level of 100 to 125 mg/dL were classified as having prediabetes. Diabetes and prediabetes were combined into 1 category (prediabetes and diabetes). Adolescents were classified as having hypercholesterolemia if levels of LDL-C were ⩾130 mg/dL or TC were ⩾200 mg/dL.

Figure 1:

Adjusted prevalence and trends of CVD risk factors and number of estimated adolescents by PIR among adolescents aged 12 to 19 years, NHANES 1999–2014. Adolescents having a BMI percentile ⩾95th percentile were classified as having obesity. Smoking status was classified as “current smoker” on the basis of self-reported smoking data or sex- and race-specific serum cotinine level. HEI-2010 scores ⩽50 were classified as low-quality diets. Physical inactivity was classified as no physical activity or <10 minutes of physical activity in a typical week in NHANES 2007 – 2014. Hypertension was classified according to 2017 AAP guidelines. Adolescents with a self reported diagnosis of diabetes, HbA1c ⩾6.5%, or FPG ⩾126 mg/dL were classified as having diabetes. Those without a self-reported diagnosis of diabetes but who had an HbA1c level of 5.7% to 6.4% or an FPG level of 100 to 125 mg/dL were classified as having prediabetes. Diabetes and prediabetes were combined into 1 category (prediabetes and diabetes). Adolescents were classified as having hypercholesterolemia if levels of LDL-C were ⩾130 mg/dL or TC were ⩾200 mg/dL.

Figure 1:

Adjusted prevalence and trends of CVD risk factors and number of estimated adolescents by PIR among adolescents aged 12 to 19 years, NHANES 1999–2014. Adolescents having a BMI percentile ⩾95th percentile were classified as having obesity. Smoking status was classified as “current smoker” on the basis of self-reported smoking data or sex- and race-specific serum cotinine level. HEI-2010 scores ⩽50 were classified as low-quality diets. Physical inactivity was classified as no physical activity or <10 minutes of physical activity in a typical week in NHANES 2007 – 2014. Hypertension was classified according to 2017 AAP guidelines. Adolescents with a self reported diagnosis of diabetes, HbA1c ⩾6.5%, or FPG ⩾126 mg/dL were classified as having diabetes. Those without a self-reported diagnosis of diabetes but who had an HbA1c level of 5.7% to 6.4% or an FPG level of 100 to 125 mg/dL were classified as having prediabetes. Diabetes and prediabetes were combined into 1 category (prediabetes and diabetes). Adolescents were classified as having hypercholesterolemia if levels of LDL-C were ⩾130 mg/dL or TC were ⩾200 mg/dL.

Figure 1:

Adjusted prevalence and trends of CVD risk factors and number of estimated adolescents by PIR among adolescents aged 12 to 19 years, NHANES 1999–2014. Adolescents having a BMI percentile ⩾95th percentile were classified as having obesity. Smoking status was classified as “current smoker” on the basis of self-reported smoking data or sex- and race-specific serum cotinine level. HEI-2010 scores ⩽50 were classified as low-quality diets. Physical inactivity was classified as no physical activity or <10 minutes of physical activity in a typical week in NHANES 2007 – 2014. Hypertension was classified according to 2017 AAP guidelines. Adolescents with a self reported diagnosis of diabetes, HbA1c ⩾6.5%, or FPG ⩾126 mg/dL were classified as having diabetes. Those without a self-reported diagnosis of diabetes but who had an HbA1c level of 5.7% to 6.4% or an FPG level of 100 to 125 mg/dL were classified as having prediabetes. Diabetes and prediabetes were combined into 1 category (prediabetes and diabetes). Adolescents were classified as having hypercholesterolemia if levels of LDL-C were ⩾130 mg/dL or TC were ⩾200 mg/dL.

Figure 1:

Adjusted prevalence and trends of CVD risk factors and number of estimated adolescents by PIR among adolescents aged 12 to 19 years, NHANES 1999–2014. Adolescents having a BMI percentile ⩾95th percentile were classified as having obesity. Smoking status was classified as “current smoker” on the basis of self-reported smoking data or sex- and race-specific serum cotinine level. HEI-2010 scores ⩽50 were classified as low-quality diets. Physical inactivity was classified as no physical activity or <10 minutes of physical activity in a typical week in NHANES 2007 – 2014. Hypertension was classified according to 2017 AAP guidelines. Adolescents with a self reported diagnosis of diabetes, HbA1c ⩾6.5%, or FPG ⩾126 mg/dL were classified as having diabetes. Those without a self-reported diagnosis of diabetes but who had an HbA1c level of 5.7% to 6.4% or an FPG level of 100 to 125 mg/dL were classified as having prediabetes. Diabetes and prediabetes were combined into 1 category (prediabetes and diabetes). Adolescents were classified as having hypercholesterolemia if levels of LDL-C were ⩾130 mg/dL or TC were ⩾200 mg/dL.

Figure 1:

Adjusted prevalence and trends of CVD risk factors and number of estimated adolescents by PIR among adolescents aged 12 to 19 years, NHANES 1999–2014. Adolescents having a BMI percentile ⩾95th percentile were classified as having obesity. Smoking status was classified as “current smoker” on the basis of self-reported smoking data or sex- and race-specific serum cotinine level. HEI-2010 scores ⩽50 were classified as low-quality diets. Physical inactivity was classified as no physical activity or <10 minutes of physical activity in a typical week in NHANES 2007 – 2014. Hypertension was classified according to 2017 AAP guidelines. Adolescents with a self reported diagnosis of diabetes, HbA1c ⩾6.5%, or FPG ⩾126 mg/dL were classified as having diabetes. Those without a self-reported diagnosis of diabetes but who had an HbA1c level of 5.7% to 6.4% or an FPG level of 100 to 125 mg/dL were classified as having prediabetes. Diabetes and prediabetes were combined into 1 category (prediabetes and diabetes). Adolescents were classified as having hypercholesterolemia if levels of LDL-C were ⩾130 mg/dL or TC were ⩾200 mg/dL.

Figure 1:

Adjusted prevalence and trends of CVD risk factors and number of estimated adolescents by PIR among adolescents aged 12 to 19 years, NHANES 1999–2014. Adolescents having a BMI percentile ⩾95th percentile were classified as having obesity. Smoking status was classified as “current smoker” on the basis of self-reported smoking data or sex- and race-specific serum cotinine level. HEI-2010 scores ⩽50 were classified as low-quality diets. Physical inactivity was classified as no physical activity or <10 minutes of physical activity in a typical week in NHANES 2007 – 2014. Hypertension was classified according to 2017 AAP guidelines. Adolescents with a self reported diagnosis of diabetes, HbA1c ⩾6.5%, or FPG ⩾126 mg/dL were classified as having diabetes. Those without a self-reported diagnosis of diabetes but who had an HbA1c level of 5.7% to 6.4% or an FPG level of 100 to 125 mg/dL were classified as having prediabetes. Diabetes and prediabetes were combined into 1 category (prediabetes and diabetes). Adolescents were classified as having hypercholesterolemia if levels of LDL-C were ⩾130 mg/dL or TC were ⩾200 mg/dL.