Cardiovascular Risk Factor Prevalence and Control by Education Strata in Older Adults in 3 Countries

Area of Science:

• Public Health
• Epidemiology
• Health Services Research

Background:

• Cardiovascular disease (CVD) mortality has plateaued in the US, with increasing rates among less educated adults, unlike peer nations.
• Disparities in managing CVD risk factors may contribute to these differing outcomes.

Purpose of the Study:

• To compare the prevalence and management of cardiovascular disease risk factors (cholesterol, blood pressure, diabetes) in adults aged 50+ in the US, England, and South Korea.
• To analyze trends over time and by education strata.

Main Methods:

• Secondary analysis of a serial cross-sectional study using nationally representative data from 1998-2020.
• Involved 120,678 adults across the US, England, and South Korea.
• Measured risk factor prevalence, care cascade, and control rates.

Main Results:

• The US had higher shares of adults at risk for CVD factors compared to England and South Korea.
• Despite higher baseline risk, the US demonstrated comparable or better management and control of CVD risk factors.
• Risk was higher in adults without a college degree, but control rates were similar across education levels.

Conclusions:

• The US health system performs well in managing CVD risk factors, even with higher initial risk prevalence.
• Differences in risk factor treatment do not fully explain country or education-based disparities.
• Upstream factors influencing risk accumulation, rather than healthcare delivery, may be key to understanding widening CVD disparities.