Income Disparities and Cardiovascular Risk Factors Among Adolescents

Socioeconomic disparities in cardiovascular health among adults have been documented, but disparities during adolescence are less understood. In this study, we examined secular trends in cardiovascular risk factors and disparities among US adolescents.

We analyzed NHANES data from 1999 to 2014, including 11 557 (4854 fasting) participants aged 12 to 19 years. To examine trends in cardiovascular risk factors, adolescents were stratified into 3 groups on the basis of family poverty-income ratio: low income (poverty-income ratio, <1.3), middle income (≥1.3 and <3.5), and high income (≥3.5).

From 1999 to 2014, the prevalence of obesity increased (16.3%-20.9%, P = .001) but only among low- and middle-income adolescents, with significant disparities in prevalence by income (21.6% vs 14.6% among low- versus high-income adolescents, respectively, in 2011-2014). In addition, there were significant and persistent disparities in the prevalence of smoking (20.7% vs 7.3% among low- versus high-income adolescents, respectively, in 2011-2014), low-quality diet (68.9% vs 55.4%), and physical inactivity (25.6% vs 17.0%). No significant disparities were observed in the prevalence of prediabetes and diabetes, hypertension, or hypercholesterolemia, although the prevalence of prediabetes and diabetes nearly doubled (11.9%-23.1%, P < .001) among all adolescents from 1999 to 2014. Overall, the prevalence of adolescents with 2 or more risk factors declined, but this decline was only significant for high-income adolescents (44.1%-29.1%, P = .02).

Recent improvements in cardiovascular health have not been equally shared by US adolescents of varying socioeconomic status.