Psychological and socio-economic correlates of cardiovascular health among young adults in Puerto Rico

Abstract

Objective: We aimed to determine the relationship between socioeconomic and psychological factors and overall cardiovascular health (CVH), as defined by the American Heart Association's Life's Essential 8 (LE8), among young adults in Puerto Rico.

Methods: Participants were 2156 young adults, between the ages of 18-29 years, enrolled in the PR-OUTLOOK study. The analysis included survey, laboratory, and physical measurement data collected from September 2020 to November 2023. Assessed socioeconomic indicators included food insecurity, housing instability, economic insecurity, and subjective social standing. Evaluated psychological factors comprised symptoms of depression, anxiety, post-traumatic stress, and overall perceived stress. LE8 scores were calculated and classified as suboptimal (poor/intermediate range) vs. ideal CVH. Logistic regression models estimated associations between each socioeconomic and psychological measure and suboptimal CVH, and dominance analysis assessed the importance of each measure.

Results: Participants' mean age was 22.6 (SD = 3.1), 60.9 % were female, about one-third (34.2 %) had high school education or less, and over one-third had public or no health insurance (38.4 %). Participants reporting socioeconomic adversity (i.e., high food insecurity, housing instability and economic insecurity, and low subjective social standing) and elevated psychological symptoms (i.e., symptoms of anxiety, depression, post-traumatic stress, and overall perceived stress) had lower CVH scores. However, in the adjusted analysis, only lower subjective social standing (OR = 1.38, 95 % CI = 1.13-1.69) and elevated symptoms of anxiety (OR = 1.63, 95 % CI = 1.25-2.13) and depression (OR = 1.30, 95 % CI = 1.03-1.65) emerged as the primary contributors to suboptimal CVH (vs. ideal).

Conclusion: Efforts to preserve and enhance CVH among young Puerto Ricans on the island should target these factors.

Keywords: Cardiovascular health; Hispanic/Latino; Psychological; Puerto Rican; Socioeconomic; Young adults.

Central Illustration

Fig. 1

Adjusted means of CVH score according to socio-economic indicators,¹ PR-OUTLOOK 2020–2023 (n = 2156) ¹Socio-economic indicators: Food insecurity was assessed using the short form of the Household Food Security Scale (high defined as a score ≥2). Housing instability assessed by two questions: one assessing the experience of having no place to live and another about current concerns about the possibility of losing one's home or place to live temporarily in the future months (high defined as a score ≥1). Economic insecurity was assessed by an item that asks respondents to consider all income contributed to their household and rate the difficulty of making ends meet (high defined as a score ≥4). Subjective social standing as assessed by the MacArthur Scale of Subjective Social Standing (low defined as a score ≤5). ²Mean scores were adjusted for age, sex, marital status, educational level, and health insurance type.

Fig. 2

Adjusted means of CVH score according to psychological factors,¹ PR-OUTLOOK 2020–2023 (n = 2156) ¹Psychological factors: Depressive symptoms assessed by the Center for Epidemiological Studies Depression Scale-10 (high defined as a score ≥10). Anxiety symptoms assessed by the Spielberger Trait Anxiety Scale-10 (high defined as a score ≥ 27). Perceived stress assessed by the Cohen Perceived Stress Scale-4 (high defined as a score ≥6). Post-traumatic stress symptoms assessed by the Abbreviated Civilian Post-Traumatic Stress Disorder Checklist-2 (high defined as a score ≥4). ²Mean scores were adjusted for age, sex, marital status, educational level, health insurance type, and subjective social standing.