Ethnic and Socioeconomic Differences in Cardiovascular Disease Risk Factors: Findings for Women From the Third National Health and Nutrition Examination Survey, 1988-1994

• Published in: JAMA : the journal of the American Medical Association Vol. 280; no. 4; pp. 356 - 362
• Main Authors: Winkleby, Marilyn A, Kraemer, Helena C, Ahn, David K, Varady, Ann N
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 22-07-1998
• Subjects: Adult; African Americans; Biological and medical sciences; Cardiovascular disease; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - ethnology; European Continental Ancestry Group; Female; General aspects; Health risk assessment; Health Surveys; Humans; Linear Models; Matched-Pair Analysis; Medical sciences; Mexican Americans; Middle Aged; Minority Groups; Planification. Prevention (methods). Intervention. Evaluation; Public health. Hygiene; Public health. Hygiene-occupational medicine; Race; Risk Factors; Socioeconomic Factors; United States - epidemiology; United States; Human; Socioeconomic status; Diet; Surveillance; Risk factor; Cardiovascular disease; Female; Statistical study; Ethnic group
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.280.4.356

CONTEXT.— Cardiovascular disease (CVD) risk factors are higher among ethnic minority
women than among white women in the United States. However, because ethnic
minority women are disproportionately poor, socioeconomic status (SES) may
substantially explain these risk factor differences. OBJECTIVE.— To determine whether differences in CVD risk factors by ethnicity could
be attributed to differences in SES. DESIGN.— Third National Health and Nutrition Examination Survey conducted between
1988 and 1994. SETTING.— Eighty-nine mobile examination centers. PARTICIPANTS.— A total of 1762 black, 1481 Mexican American, and 2023 white women,
aged 25 to 64 years, who completed both the home questionnaire and medical
examination. MAIN OUTCOME MEASURES.— Ethnicity and years of education (SES) in relation to systolic blood
pressure, cigarette smoking, body mass index (BMI, a measure of weight in
kilograms divided by the square of height in meters), physical inactivity,
non–high-density lipoprotein cholesterol (non–HDL-C [the difference
between total cholesterol and HDL-C]), and non–insulin-dependent diabetes
mellitus. RESULTS.— As expected, most CVD risk factors were higher among ethnic minority
women than among white women. After adjusting for years of education, highly
significant differences in blood pressure, BMI, physical inactivity, and diabetes
remained for both black and Mexican American women compared with white women
(P<.001). In addition, women of lower SES from
each of the 3 ethnic groups had significantly higher prevalences of smoking
and physical inactivity and higher levels of BMI and non–HDL-C than
women of higher SES (P<.001). CONCLUSIONS.— These findings provide the greatest evidence to date of higher CVD risk
factors among black and Mexican American women than among white women of comparable
SES. The striking differences by both ethnicity and SES underscore the critical
need to improve screening, early detection, and treatment of CVD-related conditions
for black and Mexican American women, as well as for women of lower SES in
all ethnic groups.