Trends in Cardiovascular Risk Factors in US Adults by Race and Ethnicity and Socioeconomic Status, 1999-2018
Authors' conclusion
In this serial cross-sectional survey study that estimated US trends in cardiovascular risk factors from 1999 through 2018, differences in cardiovascular risk factors persisted between Black and White participants; the difference may have been moderated by social determinants of health.
Study context
- Population
- US adults aged 20 years or older, NHANES 1999–2018
- Participants
- 50,571 adults
- Exposure
- Trends in CV risk factors by calendar year, race and ethnicity, and socioeconomic status
- Outcome
- Age- and sex-adjusted means or proportions of CV risk factors and estimated 10-year ASCVD risk
- Follow-up
- Each of 10 two-year cycles
Methodological detailsnationally representative, 10 two-year cycles
- Nationally representative
- 10 two-year cycles
Main finding
As reported in the abstract
Age- and sex-adjusted CV risk factors, 1999-2000 to 2017-2018
| Group | BMI | Hemoglobin A1c | Total cholesterol | Smoking prevalence | SBP | 10-year ASCVD risk |
|---|---|---|---|---|---|---|
| 1999-2000 | 28.0 (95% CI, 27.5-28.5) | 5.4% (95% CI, 5.3%-5.5%) | 203.3 mg/dL (95% CI, 200.9-205.8 mg/dL) | 24.8% (95% CI, 21.8%-27.7%) | 123.5 mm Hg (95% CI, 122.2-124.8 mm Hg) | 7.6% (95% CI, 6.9%-8.2%) |
| 2017-2018 | 29.8 (95% CI, 29.2-30.4) | 5.7% (95% CI, 5.6%-5.7%) | 188.5 mg/dL (95% CI, 185.2-191.9 mg/dL) | 18.1% (95% CI, 15.4%-20.8%) | 122.8 mm Hg (95% CI, 121.7-123.8 mm Hg) |
BMI
1999-200028.0 (95% CI, 27.5-28.5)
2017-201829.8 (95% CI, 29.2-30.4)
Hemoglobin A1c
1999-20005.4% (95% CI, 5.3%-5.5%)
2017-20185.7% (95% CI, 5.6%-5.7%)
Total cholesterol
1999-2000203.3 mg/dL (95% CI, 200.9-205.8 mg/dL)
2017-2018188.5 mg/dL (95% CI, 185.2-191.9 mg/dL)
Smoking prevalence
1999-200024.8% (95% CI, 21.8%-27.7%)
2017-201818.1% (95% CI, 15.4%-20.8%)
SBP
1999-2000123.5 mm Hg (95% CI, 122.2-124.8 mm Hg)
2017-2018122.8 mm Hg (95% CI, 121.7-123.8 mm Hg)
10-year ASCVD risk
1999-20007.6% (95% CI, 6.9%-8.2%)
2017-2018— not stated in the abstract
- BMI and hemoglobin A1c increased
- P < 0.001 for linear trends
- Total cholesterol and smoking decreased
- P < 0.001 for linear trends
- SBP decreased to 120.5 mm Hg (95% CI, 119.6-121.3 mm Hg) in 2009-2010, then increased
- P < 0.001 for nonlinear trend
Observational data: associations, not effects.
Further findings
| Outcome | Difference (95% CI) | |
|---|---|---|
| 10-year ASCVD risk, non-Hispanic Black vs non-Hispanic WhiteNon-Hispanic Blackvs Non-Hispanic White1999-2008 | 1.4% (1.0%–1.7%) | |
| 10-year ASCVD risk, non-Hispanic Black vs non-Hispanic WhiteNon-Hispanic Blackvs Non-Hispanic White2009-2018 | 2.0% (1.7%–2.4%) | |
| 10-year ASCVD risk, non-Hispanic Black vs non-Hispanic WhiteNon-Hispanic Blackvs Non-Hispanic White1999-2008, further adjusted for social determinants | −0.3% (−0.6% to 0.1%) | |
| 10-year ASCVD risk, non-Hispanic Black vs non-Hispanic WhiteNon-Hispanic Blackvs Non-Hispanic White2009-2018, further adjusted for social determinants | 0.7% (0.3%–1.0%) | |
| −10123Difference (linear scale) |
- 10-year ASCVD risk, non-Hispanic Black vs non-Hispanic White: further adjustment: education, income, home ownership, employment, health insurance, access to health care
CV risk factors, non-Hispanic Black vs non-Hispanic White
- BMI, SBP and hemoglobin A1c consistently higher, total cholesterol lower in Black participants
- all P < .001 for group differences
CV risk factors by education and income
- College or higher education or high family income: consistently lower CV risk factor levels
Original publication
Trends in Cardiovascular Risk Factors in US Adults by Race and Ethnicity and Socioeconomic Status, 1999-2018. JAMA. Published 5 October 2021. doi:10.
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