Navigating Cardiovascular Health Disparities: The Role of Race and Classification

The association between race and cardiovascular health (CVH) is well-documented, but race is a complex social construct that can be measured in various ways. This study examined the relationship between multiple dimensions of race and CVH in US adults.

We conducted a cross-sectional study using data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS). The independent variables included observed race, racial self-classification, and reflected race. A divergent race variable was created to identify individuals whose preferred race differed from racial classification by others. The outcome was a CVH score (continuous and categorical) based on a modified version of the American Heart Association's Life's Essential 8 (5/8 metrics). Survey-weighted linear and ordered logistic regression models were used.

Individuals of Asian descent had the highest mean CVH scores across all racial dimensions (racial self-classification - 73.3, measured on a scale from 0 to 100), while individuals who identified as American Indian or Alaska Native (AIAN) or Black/African American (Black) had the lowest (AIAN:64.6, Black:64.6). Multivariable linear regression showed that being classified by others as Black, Native Hawaiian or Other Pacific Islander (NHPI), or AIAN was significantly associated with lower CVH scores compared to being classified as White [Black:β= -3.2 (95%CI: -3.61,-2.88)); AIAN: -2.9(-5.08,-0.85); NHPI: -4.2(-6.43,-1.99)]. Individuals with a divergent race had a lower mean CVH score compared to those without divergence. Individuals who identified as White but were classified as a minority by others had a significantly lower CVH score [-2.1(-3.56,-0.61)]. Logistic regression models revealed that being classified by others as Black was associated with a 26% and 64% lower odds of achieving an intermediate/ ideal CVH score, respectively. In contrast, those observed by others as Asian had higher odds of achieving an intermediate [AOR = 2.12 (95% CI: 1.39, 3.40)] or ideal [ 3.07 (1.92, 4.92)] CVH score compared to those classified as White.

Different dimensions of race have varying associations with CVH. Racial divergence, particularly identifying as White but being perceived as a minority, is linked to poorer CVH. These findings underscore the importance of considering the multifaceted nature of racial identity in evaluating CVH.