Ethnic and Socioeconomic Differences in Cardiovascular Disease Risk Factors
Published in JAMA, July 1998
Abstract overview:
This study identified differences in cardiovascular (or heart) disease risk factors among black, Mexican-American and white women and examined whether differences were related to socioeconomic status. The study used data on women from the Third National Health and Nutrition Examination Survey (NHANES III), a large national survey conducted between 1988 and 1994. When released, NHANES III was one of the most comprehensive national surveys to date and included 1762 black, 1481 Mexican-American, and 2023 white women who were 25-64 years old. The women from each ethnic group represented women at all levels of education and family incomes, allowing for more precision in analyses than in many samples.
The study compared six risk factors for heart disease among these women: cigarette smoking, excess weight, high cholesterol levels, high blood pressure, physical inactivity, and diabetes. A woman’s race/ethnicity was measured by her own self-report; education and family income were also reported by the women.
Primary Findings: 1) Regardless of age and education (or family income), black and Mexican-American women were much more likely to be overweight, be physically inactive, and to suffer from diabetes and high blood pressure than their white counterparts. 2) Education and income also played a major part in risk factor differences. Women with lower levels of education and incomes, regardless of their ethnic background, were more likely to have higher levels of risk factors than women with higher levels of education and income.
According to the survey, 8.4% of Mexican-American women and 7.4% of black women reported that they had non-insulin dependent diabetes while 4.3% of white women reported the disease. Similarly, there were large differences in diabetes by level of education; 8.7% of women who had completed less than 9 years of schooling had diabetes compared with 3.2% of women who had completed more than 12 years of schooling. Black women, on average, were almost 17 pounds heavier than white women of similar ages and educational levels.
Secondary findings of the study:
Black and Mexican-American women had steeper increases in blood pressure than white women across age groups, resulting in significantly greater ethnic differences for the older than the younger groups. Also, black and Mexican-American women had stable smoking rates across age groups, whereas white women ages 25-34 had high smoking rates and after age 35 had much lower smoking rates.
White women with low levels of education and low incomes also ran a high-risk of developing heart disease. Their high risk factors reveal an often overlooked high-risk group who compose a large percentage of poor women in the United States (68 percent of the poor women in the United States are white).
Implications and recommendations from the study:
In this study, both ethnicity and education/income had important links to disparities in heart disease risk factors. The findings suggest that some disparities may be rooted in social, cultural, economic, and medical factors. To this end, appropriate programs and policies are needed to reach all women. Free or low-cost screening programs for cholesterol, high blood pressure, and diabetes must be made available as well as smoke-free working environments, and safe and convenient places to exercise. Similarly, the neighborhoods in which women live should encourage and support healthy living. Health care professionals and community members should work to build partnerships with government and other decision makers so that all women have equal opportunities for maintaining and adopting healthy behaviors.
Proposed news articles and related information:
What are some examples of health campaigns and policies that have effectively reached women at high risk of heart disease, and how can communities replicate these campaigns or adapt them to fit their own populations of women?
What services and resources can communities provide to lessen the risk of heart disease in women? What can be done to reach young girls and adolescents?
