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. 2022 Jul 12;80(2):138-151.
doi: 10.1016/j.jacc.2022.04.046.

Trends and Disparities in Cardiometabolic Health Among U.S. Adults, 1999-2018

Meghan O'Hearn  1 , Brianna N Lauren  2 , John B Wong  3 , David D Kim  4 , Dariush Mozaffarian  5
Affiliations

Trends and Disparities in Cardiometabolic Health Among U.S. Adults, 1999-2018

Meghan O'Hearn et al. J Am Coll Cardiol. .

Abstract

Background: Few studies have assessed U.S. cardiometabolic health trends-optimal levels of multiple risk factors and absence of clinical cardiovascular disease (CVD)-or its impact on health disparities.

Objectives: The purpose of this study was to investigate U.S. trends in optimal cardiometabolic health from 1999 to 2018.

Methods: We assessed proportions of adults with optimal cardiometabolic health, based on adiposity, blood glucose, blood lipids, blood pressure, and clinical CVD; and optimal, intermediate, and poor levels of each component among 55,081 U.S. adults in the National Health and Nutrition Examination Survey.

Results: In 2017-2018, only 6.8% (95% CI: 5.4%-8.1%) of U.S. adults had optimal cardiometabolic health, declining from 1999-2000 (P trend = 0.02). Among components of cardiometabolic health, the largest declines were for adiposity (optimal levels: 33.8%-24.0%; poor levels: 47.7%-61.9%) and glucose (optimal levels: 59.4%-36.9%; poor levels: 8.6%-13.7%) (P trend <0.001 for each). Optimal levels of blood lipids increased from 29.9%-37.0%, whereas poor decreased from 28.3%-14.7% (P trend <0.001). Trends over time for blood pressure and CVD were smaller. Disparities by age, sex, education, and race/ethnicity were evident in all years, and generally worsened over time. By 2017-2018, prevalence of optimal cardiometabolic health was lower among Americans with lower (5.0% [95% CI: 2.8%-7.2%]) vs higher education (10.3% [95% CI: 7.6%-13.0%]); and among Mexican American (3.2% [95% CI: 1.4%-4.9%]) vs non-Hispanic White (8.4% [95% CI: 6.3%-10.4%]) adults.

Conclusions: Between 1999 and 2000 and 2017 and 2018, U.S. cardiometabolic health has been poor and worsening, with only 6.8% of adults having optimal cardiometabolic health, and disparities by age, sex, education, and race/ethnicity. These novel findings inform the need for nationwide clinical and public health interventions to improve cardiometabolic health and health equity.

Keywords: cardiometabolic health; diabetes; health disparities; metabolic syndrome; obesity.

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Conflict of interest statement

Funding Support and Author Disclosures This research was supported by the National Institutes of Health and the National Heart, Lung, and Blood Institute, Bethesda, Maryland (grant 2R01HL115189-06A1 to Dr Mozaffarian). The funding agency did not contribute to the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. All authors have received research funding from the National Institutes of Health. Dr Mozaffarian has received additional research funding from the Gates Foundation, the Rockefeller Foundation, and Vail Institute for Global Research; is on the scientific advisory board for Beren Therapeutics, Calibrate, DayTwo (ended 6/20), Elysium Health, Filtricine, Foodome, HumanCo, January Inc., Perfect Day, Season, and Tiny Organics; all outside the submitted work. Dr Wong has membership in the U.S. Preventive Services Task Force, outside the submitted work. Ms Lauren has received personal fees from Abt Associates and the Centers for Disease Control and Prevention, both outside the submitted work.

Figures

FIGURE 1
FIGURE 1. Mean Counts of Cardiometabolic Components by Race/Ethnicity, 1999 to 2018
Survey-weighted national means (line) and 95% CIs (error bars) for U.S. adults are shown for counts of (A) optimal and (B) poor levels for 5 cardiometabolic components: adiposity, blood glucose, blood lipids, blood pressure, and prior CVD (see Table 1 for definitions). Mean counts were adjusted for NHANES survey weights and age-standardized to the 2017–2018 survey cycle age proportions. U.S. adults identifying as Asian or other (including multiracial) were removed from the figure because of large uncertainty in estimates (see Supplemental Tables 2 to 4 for optimal, intermediate, and poor counts by all race/ethnicity categories). The findings show differences in counts of optimal, intermediate, and poor cardiometabolic components by race/ethnicity. Mexican American adults had lower counts of optimal components compared with non-Hispanic White and other race/ethnicity adults, whereas Mexican American and non-Hispanic Black adults had higher counts of poor components than non-Hispanic White, other Hispanic, and other race/ethnicity adults in 2017–2018. CVD = cardiovascular disease; NHANES = National Health and Nutrition Examination Survey.
FIGURE 2
FIGURE 2. Mean Counts of Cardiometabolic Components by Education and Income, 1999 to 2018
Survey-weighted national mean (line) and 95% CIs (error bars) for U.S. adults are shown for counts of optimal and poor levels for 5 cardiometabolic components: adiposity, blood glucose, blood lipids, blood pressure, and prior CVD (see Table 1 for definitions) by (A) education level and (B) income: poverty ratio. Mean counts were adjusted for NHANES survey weights and age-standardized to the 2017–2018 survey cycle age proportions. The findings show U.S. adults with lower educational attainment were more likely to have lower counts of optimal levels and higher counts of poor levels, with declining disparities by education level between 1999 and 2018. Abbreviations as in Figure 1.
FIGURE 3
FIGURE 3. Trends in 5 Major Cardiometabolic Components Among U.S. Adults, 1999 to 2018
Survey-weighted national proportions (lines) and 95% CIs (error bars) are shown for optimal, intermediate, and poor levels for each cardiometabolic component: adiposity, blood glucose, blood lipids, blood pressure, and prior CVD (see Table 1 for definitions). Prevalence estimates were adjusted for NHANES survey weights to represent the national U.S. population of noninstitutionalized adults. The findings show worsening levels (eg, higher prevalence of poor levels along with lower prevalence of optimal levels) of adiposity and glucose, and to a lesser extent blood pressure, among U.S. adults from 1999 to 2018. Prevalence of CVD remained fairly stable, whereas optimal and intermediate levels of blood lipids improved. Abbreviations as in Figure 1.
CENTRAL ILLUSTRATION
CENTRAL ILLUSTRATION. Prevalence of Optimal Cardiometabolic Health Among U.S. Adults, 1999 to 2018
Survey-weighted national proportion (line) and 95% CIs (error bars) are shown (A) overall and by age, (B) race/ethnicity, (C) education level, and (D) income level. Optimal cardiometabolic health was defined as optimal levels for adiposity, blood glucose, blood lipids, blood pressure, and prior CVD (Table 1). Prevalence estimates were adjusted for NHANES survey weights and age-standardized to the 2017–2018 survey cycle age proportions for subgroup analyses. For race/ethnicity, adults identifying as Asian/other were removed from the figure because of large uncertainty in estimates. The findings show declining cardiometabolic health among U.S. adults between 1999 and 2018, with optimal cardiometabolic health generally less common at older vs younger ages, in lower vs higher educated adults, in lower vs higher income adults, and in Mexican American and non-Hispanic Black adults vs adults of other races. AA = Associate of Arts; CVD = cardiovascular disease; NHANES = National Health and Nutrition Examination Survey.
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