A study led by Northwestern Medicine investigators found that education and place of birth significantly contribute to overall racial and ethnic differences in cardiovascular health among U.S. adults, according to findings published in Circulation.
The findings could help inform public health strategies that aim to mitigate racial and ethnic disparities in cardiovascular health.
“These findings emphasize the importance of understanding the role of social factors in assessing each of our patient’s risk for heart diseases. We’re still learning the best ways to assess and address social determinants for our patients, but we should at least try to identify the social barriers our patients face that make it harder to achieve good health,” said Nilay Shah, ’14 MD, ’14 MPH, ’20 GME, assistant professor of Medicine in the Division of Cardiology, of Preventive Medicine in the Division of Epidemiology and lead author of the study.
Sadiya Khan, ’09 MD, ’14 MSc, ’10, ’12 GME, assistant professor of Medicine in the Division of Cardiology and of Preventive Medicine in the Division of Epidemiology, was senior author of the study.
While it’s well known that social and psychosocial factors like food insecurity, housing instability and limited healthcare access contribute to poor cardiovascular health among U.S. adults, the extent to which these factors contribute to racial and ethnic differences in cardiovascular health at the population level has remained in question.
“This is important because race and ethnicity are social identities, not biological categories, which means that differences in social determinants of health underlie the racial and ethnic differences in cardiovascular health,” Shah said.
Using statistical analysis to study nationally representative data from National Health and Nutrition Examination Surveys (NHANES) conducted between 2011-2018, the investigators aimed to identify the contribution of seven leading individual-level determinants — education, income, food security, marital status, health insurance, place of birth and depression — to racial and ethnic differences in cardiovascular health scores among U.S. adults.
The data included 16,172 participants representing approximately 255 million U.S. adults; 24 percent were Hispanic, 12 percent were Asian, 23 percent were Black, and 41 percent were white. Cardiovascular health scores, ranging from zero to 14, accounted for diet, smoking, physical activity, body mass index, blood pressure, cholesterol and blood glucose levels.
Statistical analysis revealed education as the largest contributor to cardiovascular health differences among Asian, Black and Hispanic participants compared with white adults. Education was also the largest contributor to differences in cardiovascular health among Black women compared with white women.
However, the investigators identified place of birth (U.S.-born versus born outside the U.S.) as the leading significant contributor to differences in cardiovascular health among Hispanic and Asian women compared with white women.
According to Shah, the next step will be to understand how these factors contribute to overall health outcomes, which may help inform treatment interventions and policy initiatives that reduce disparities.
“What is it about attaining a higher education that helps support better health? How does place of birth, and associated social factors like immigration and acculturation, influence a person’s health through their life? Answering these questions may help develop interventions for patients and policy for populations to help support heart health,” Shah said.
Co-authors include Lucia Petito, PhD, assistant professor of Preventive Medicine in the Division of Biostatistics, Hongyan Ning, MS, research assistant professor of Preventive Medicine in the Division of Biostatistics, Natalie Cameron, MD, ’21 GME, instructor of Medicine in the Division of General Internal Medicine, Kiarri Kershaw, PhD, MPH, associate professor of Preventive Medicine in the Division of Epidemiology, Namratha Kandula, MD, MPH, professor of Medicine in the Division of General Internal Medicine and of Preventive Medicine in the Division of Epidemiology, Mercedes Carnethon, PhD, vice chair and the Mary Harris Thompson Professor of Preventive Medicine, and Donald Lloyd-Jones, MD, ScM, chair and Eileen M. Foell Professor of Preventive Medicine.
This work was supported in part by National Heart, Lung, and Blood Institute grants K23HL157766, R01HL161514 and R01HL159250.