That is according to a study of cardiovascular health in 20,761 adults. The results were published in Annals of Internal Medicine.
A study team from Beth Israel Deaconess Medical Center and Harvard Medical School reported that declines in cardiovascular mortality have plateaued over the past 10 years in the U.S., at least partly because of an increase in deaths among middle-aged adults. “There is growing concern that these changes have been concentrated in middle-aged adults with low incomes, a population that is disproportionately affected by social determinants linked to poor cardiovascular health,” according to a journal press release. “However, little is known about how the burden of cardiovascular risk factors has changed among middle-aged adults by income level over the past 2 decades.”
The researchers sought to evaluate trends in the prevalence, treatment, and control of cardiovascular risk factors among low-income and higher income middle-aged adults and how social determinants contribute to recent associations between income and cardiovascular health. To do that, they used NHANES (National Health and Nutrition Examination Survey) data for 20,761 adults aged 40 to 64 years from 1999 to March 2020
Their focus was on age-standardized prevalence of hypertension, diabetes, hyperlipidemia, obesity, and cigarette use; treatment rates for hypertension, diabetes, and hyperlipidemia; and rates of blood pressure, glycemic, and cholesterol control.
The results indicated that the prevalence of hypertension, diabetes, and cigarette use was consistently higher among low-income adults between 1999 and March 2020. Low-income adults had an increase in hypertension over the study period (37.2% [95% CI, 33.5%-40.9%] to 44.7% [CI, 39.8%-49.5%]) but no changes in diabetes or obesity.
“In contrast, higher-income adults did not have a change in hypertension but had increases in diabetes (7.8% [CI, 5.0%-10.6%] to 14.9% [CI, 12.4%-17.3%]) and obesity (33.0% [CI, 26.7%-39.4%] to 44.0% [CI, 40.2%-47.7%]),” the researchers reported.
The research also found that cigarette use was high and stagnant among low-income adults (33.2% [CI, 28.4%-38.0%] to 33.9% [CI, 29.6%-38.3%]), even while decreasing among their higher income counterparts (18.6% [CI, 13.5%-23.7%] to 11.5% [CI, 8.7%-14.3%]).
While treatment and control rates for hypertension were unchanged in both groups (>80%), diabetes treatment rates improved only among the higher income group (58.4% [CI, 44.4%-72.5%] to 77.4% [CI, 67.6%-87.1%]).
“Income-based disparities in hypertension, diabetes, and cigarette use persisted in more recent years even after adjustment for insurance coverage, health care access, and food insecurity,” the authors advised.
“Over 2 decades in the United States, hypertension increased in low-income middle-aged adults, whereas diabetes and obesity increased in their higher-income counterparts,” the study concluded. “Income-based disparities in hypertension, diabetes, and smoking persisted even after adjustment for other social determinants of health.”
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