Low income associated with worse cardiovascular health in middle-aged adults

1. In this cross-sectional study, low-income middle-aged adults in the United States had increased rates of hypertension, diabetes, and cigarette use than their higher-income counterparts over the past two decades. 

2. The prevalence of hypertension increased in low-income middle-aged adults while that of diabetes and obesity increased in their higher-income counterparts during the same period.

Evidence Rating Level: 2 (Good)

Study Rundown: There have been significant increases in cardiovascular mortality among middle-aged adults in the United States over the past decade. Income inequalities have significantly worsened in the country and concerns that the deaths have disproportionately affected the lower-income subset of this age demographic have increased. Yet, few studies have explored income-based differences in the burden of cardiovascular risk factors over the past two decades. Hence, this cross-sectional study aimed to investigate national trends in the prevalence, treatment, and control of cardiovascular risk factors among low-income and higher-income middle-aged adults (aged 40 to 64 years) from 1999 to March 2020. Overall, it demonstrated that low-income middle-aged adults exhibited higher rates of hypertension, diabetes, and cigarette use than their higher-income counterparts over the past two decades. Moreover, the prevalence of hypertension increased in low-income middle-aged adults while that of diabetes and obesity increased in their higher-income counterparts during this period. The study was limited by smaller sample sizes and the National Health and Nutritional Examination Survey (NHANES) used to gather participant data, which did not assess for all relevant social determinants of health and may have been susceptible to recall and response biases.

Click to read the study in AIM

In-Depth [cross-sectional study]: This serial cross-sectional study aimed to investigate trends in the prevalence, treatment, and control of cardiovascular risk factors among low-income and higher-income middle-aged adults in the United States from 1999 to March 2020. All participants aged 40 to 64 years who completed the NHANES, a series of nationally representative surveys conducted every two years by the Centers of Disease Control and Prevention, during this period were identified. Treatment of hypertension, diabetes, and hyperlipidemia was defined as the self-reported use antihypertensive, antidiabetic, and cholesterol-lowering medication, respectively. Following the analysis of a study population which included 20,761 middle-aged adults, the prevalence of hypertension, diabetes, and cigarette use was consistently higher among low-income adults between 1999 and March 2020. Low-income adults exhibited an increase in hypertension from 37.2% (95% Confidence Interval [CI], 33.5% to 40.9%) to 44.7% (CI, 39.8% to 49.5%) but no changes in diabetes or obesity during the study period. Contrastingly, higher-income adults did not exhibit a change in hypertension but increases in diabetes from 7.8% (CI, 5.0% to 10.6%) to 14.9% (CI, 12.4% to 17.3%) and obesity from 33.0% (CI, 26.7% to 39.4%) to 44.0% (CI, 40.2% to 47.7%). Low-income adults also demonstrated higher but stable cigarette use (33.2% [CI, 28.4% to 38.0%] to 33.9% [CI, 29.6% to 38.3%]) compared to their higher-income counterparts, whose cigarette use decreased over the study period (18.6% [CI, 13.5% to 23.7%] to 11.5% [CI, 8.7% to 14.3%]). In summary, this study demonstrated the increased prevalence of hypertension, diabetes, and cigarette use among low-income middle-aged adults over the past two decades.

Image: PD

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