Circulation. 2022 Nov 5. doi: 10.1161/CIRCULATIONAHA.122.061991. Online ahead of print.
Background: Social and psychosocial factors are associated with cardiovascular health (CVH). Our objective was to examine the contributions of individual-level social and psychosocial factors to racial and ethnic differences in population CVH in the National Health and Nutrition Examination Surveys (NHANES) 2011-2018, to inform strategies to mitigate CVH inequities. Methods: In NHANES participants aged ≥20 years, Kitagawa-Blinder-Oaxaca decomposition estimated the statistical contribution of individual-level factors (education, income, food security, marital status, health insurance, place of birth, depression) to racial and ethnic differences in population mean CVH score (range 0-14, accounting for diet, smoking, physical activity, body mass index, blood pressure, cholesterol, blood glucose) among Hispanic, non-Hispanic Asian, or non-Hispanic Black adults compared with non-Hispanic White adults. Results: Among 16,172 participants (representing 255 million US adults), 24% were Hispanic, 12% non-Hispanic Asian, 23% non-Hispanic Black, and 41% non-Hispanic White. Among males, mean (standard error [SE]) CVH score was 7.45 (2.3) in Hispanic, 8.71 (2.2) in non-Hispanic Asian, 7.48 (2.4) in non-Hispanic Black, and 7.58 (2.3) in non-Hispanic White adults. In Kitagawa-Blinder-Oaxaca decomposition, education explained the largest component of CVH differences among males (if distribution of education were similar to Non-Hispanic White, CVH score would be 0.36 [0.04] points higher in Hispanic, 0.24 [0.04] points lower in Non-Hispanic Asian, and 0.23 [0.03] points higher in Non-Hispanic Black, p<0.05). Among females, mean (SE) CVH score was 8.03 (2.4) in Hispanic, 9.34 (2.1) in non-Hispanic Asian, 7.43 (2.3) in non-Hispanic Black, and 8.00 (2.5) in non-Hispanic White adults. Education explained the largest component of CVH difference in Non-Hispanic Black females (if distribution of education were similar to NH White, CVH score would be 0.17 [0.03] points higher in NH Black, p<0.05). Place of birth (US-born versus born outside the US) explained the largest component of CVH difference in Hispanic and Non-Hispanic Asian females (if distribution of place of birth were similar to Non-Hispanic White, CVH score would be 0.36 [0.07] points lower and 0.49 [0.16] points lower, respectively, p<0.05). Conclusions: Education and place of birth confer the largest statistical contributions to the racial and ethnic differences in mean CVH score among US adults.