Trends in Income Inequities in Cardiovascular Health Among US Adults, 1988-2018

Area of Science:

• Public Health
• Cardiovascular Epidemiology
• Health Equity Research

Background:

• Cardiovascular health has improved nationally over decades.
• Equitable distribution of these health gains remains unclear.
• This study investigates cardiovascular health trends across income levels.

Purpose of the Study:

• To analyze 30-year trends in cardiovascular health equity.
• To assess cardiovascular risk distribution across socioeconomic strata.
• To provide a comprehensive picture of cardiovascular income equity in the US.

Main Methods:

• Utilized data from the National Health and Nutrition Examination Survey (1988–2018).
• Stratified participants by poverty-to-income ratio (PIR) categories.
• Calculated mean 10-year predicted cardiovascular risk (PCE) and employed equity metrics like concentration and achievement indices.

Main Results:

• Mean 10-year PCE risk decreased from 7.8% to 6.4% (1988-2018).
• Improvements were concentrated in the highest income groups; the lowest income group (PIR <1) showed no significant change.
• Relative inequity in cardiovascular risk between the lowest and highest income groups increased from 6% to 70%.

Conclusions:

• Despite overall cardiovascular risk reduction, improvements were not equitably shared across income levels.
• Significant disparities in cardiovascular health persist and have widened over 30 years.
• The poor continue to bear a disproportionately higher burden of adverse cardiovascular health outcomes.