Trends and Key Factors Associated With Racial and Ethnic Differences in Life's Essential 8 Scores

Abstract

Importance: Significant racial and ethnic differences exist in Life's Essential 8 (LE8), but the trends in these differences over time are not well understood. Additionally, the key components of LE8 associated with these differences are unclear.

Objectives: To evaluate trends in racial and ethnic differences in LE8 over a 10-year period and to identify the primary factors associated with the LE8 differences.

Design, setting, and participants: Serial population-based cross-sectional study of the National Health and Nutrition Examination Survey from 2011 to 2020 that included adults aged 20 to 79 years. The analysis was performed between March and October 2024.

Exposure: Self-reported race and ethnicity.

Main outcome and measures: Trends in racial and ethnic differences in LE8 and primary factors associated with the differences.

Results: The median (IQR) age of the 16 104 participants was 46 (32-59) years; 8262 (51.1%) were women; 1974 (5.2%) were Asian, 3918 (10.9%) were Black, 4144 (15.7%) were Latino/Hispanic, and 6068 (68.2%) were White. From 2011 to 2020, Asian adults had the highest LE8 score (71.2; 95% CI, 70.3-72.0), followed by White (67.7; 95% CI, 66.9-68.6) and Latino/Hispanic (65.9; 95% CI, 61.3-62.7) adults, and Black adults (62.0) had the lowest LE8 score. These racial and ethnic differences in LE8 overall score did not significantly change from 2011 to 2020. However, the differences in several individual components of LE8 changed significantly. For example, the Latino/Hispanic vs White difference in sleep health score significantly increased, from -1.25 to -4.38, with a descriptive difference-of-differences of -3.12 (95% CI, -5.83 to -0.42; P = .02). In 2017 to 2020, all but blood lipids and nicotine exposure were negatively associated factors (z scores <0) for the Black vs White difference; nicotine exposure was the key positive (z score = 1.01), while physical activity was the key negative (z score = -1.01) factor associated with the Latino/Hispanic vs White difference; nicotine exposure (z score = 2.59) and diet (z score = 2.12) were the primary positive factors associated with Asian vs White difference.

Conclusions and relevance: In this cross-sectional study, racial and ethnic differences in overall LE8 scores compared with White adults remained largely unchanged from 2011 to 2020. These differences were associated with varying components across different racial and ethnic groups, emphasizing the need for targeted, group-specific interventions.

Figure 1.. Distribution and Trends of Life’s Essential 8 (LE8) Score and Cardiovascular Health (CVH) Status

A, Survey weighted mean LE8 scores across race and ethnicity groups. B, Survey weighted percentage of low cardiovascular health (CVH; LE8 score <50), moderate CVH (LE8 score 50-79), and high CVH (LE8 score ≥80) with error bars indicating 95% CI. C, Trends of LE8 scores by race and ethnicity. D, Weighted percentage with error bars indicating 95% CI of participants with low CVH (LE8 score <50) by race and ethnicity.

Figure 2.. Relative Magnitude of Race and Ethnicity Difference in Each Life’s Essential 8 (LE8) Component

The difference in each component of LE8 score compared with White individuals was calculated by subtracting the LE8 values of White adults from those of Asian, Black, and Latino/Hispanic adults for both the 2011 to 2012 (A) and 2017 to 2020 (B) survey cycles. z Scores were obtained by standardizing the values of all components across all racial and ethnic groups.