Trends and Key Factors Associated With Racial and Ethnic Differences in Life's Essential 8 Scores

Significant racial and ethnic differences exist in Life's Essential 8 (LE8), but the trends in these differences over time are not well understood. Additionally, the key components of LE8 associated with these differences are unclear.

To evaluate trends in racial and ethnic differences in LE8 over a 10-year period and to identify the primary factors associated with the LE8 differences.

Serial population-based cross-sectional study of the National Health and Nutrition Examination Survey from 2011 to 2020 that included adults aged 20 to 79 years. The analysis was performed between March and October 2024.

Self-reported race and ethnicity.

Trends in racial and ethnic differences in LE8 and primary factors associated with the differences.

The median (IQR) age of the 16 104 participants was 46 (32-59) years; 8262 (51.1%) were women; 1974 (5.2%) were Asian, 3918 (10.9%) were Black, 4144 (15.7%) were Latino/Hispanic, and 6068 (68.2%) were White. From 2011 to 2020, Asian adults had the highest LE8 score (71.2; 95% CI, 70.3-72.0), followed by White (67.7; 95% CI, 66.9-68.6) and Latino/Hispanic (65.9; 95% CI, 61.3-62.7) adults, and Black adults (62.0) had the lowest LE8 score. These racial and ethnic differences in LE8 overall score did not significantly change from 2011 to 2020. However, the differences in several individual components of LE8 changed significantly. For example, the Latino/Hispanic vs White difference in sleep health score significantly increased, from -1.25 to -4.38, with a descriptive difference-of-differences of -3.12 (95% CI, -5.83 to -0.42; P = .02). In 2017 to 2020, all but blood lipids and nicotine exposure were negatively associated factors (z scores <0) for the Black vs White difference; nicotine exposure was the key positive (z score = 1.01), while physical activity was the key negative (z score = -1.01) factor associated with the Latino/Hispanic vs White difference; nicotine exposure (z score = 2.59) and diet (z score = 2.12) were the primary positive factors associated with Asian vs White difference.

In this cross-sectional study, racial and ethnic differences in overall LE8 scores compared with White adults remained largely unchanged from 2011 to 2020. These differences were associated with varying components across different racial and ethnic groups, emphasizing the need for targeted, group-specific interventions.