Background: Given the health and cost burden of cardiovascular (CV) disease, we aimed to describe the trends in CV risk factors (CRF) in the US over the last twelve years, and quantify the disparities in healthcare by socioeconomic status (SES).
Methods: The 2002-2013 Medical Expenditure Panel Survey (MEPS), a nationally representative sample was the basis for our study. CRFs (hypertension, diabetes mellitus, hypercholesterolemia, smoking, lack of physical activity and obesity) were identified by ICD9CM codes and/or self-report. Individuals were stratified by income level (per the federal poverty level), and proportions and logistic regression models were used to study trends and relationships for each CRF in two-year intervals. All analyses took into consideration the survey’s complex design. Inclusion criteria: age ≥ 18, BMI ≥ 18.5 and a positive sampling weight.
Results: The study sample consisted of 250,371 MEPS participants (46 ± 14 years of age, 49% male), translating into 1.3 billion US adults. During the study period, the proportion of individuals with obesity increased overall, though moreso among people of low SES (Table). Trends in diabetes prevalence increased (from 9.6% to 12.8% in “Poor/Near Poor” and 5.6% to 8.3% in “High Income”, both p trend < 0.001) and hypertension (from 28.5% to 36.3% in “Poor/Near Poor” and 24.2% to 33.4% in “High Income”, both p trend < 0.001), though the greatest relative change was observed among the Middle/High Income SES group. Prevalence of inadequate physical activity increased in all SES categories, with the “Poor/Near Poor” group having the most drastic change (32.4% vs. 55.4%, p trend < 0.001), and a relative percent change of 71.1% increase in this category. Smoking declined across time in all SES categories, and hypercholesterolemia showed no significant changes. In pooled analysis, the odds of having a “Poor CRF Profile” (≥ 4 CRFs) for “Poor/Near Poor” SES were 36% higher when compared to “High Income” SES (OR 1.36, 95% CI [1.30, 1.44]) (Table).
Conclusion: Disparities in the prevalence of CRFs have increased over the past 12 years, and have worsened for some conditions, including obesity, diabetes, hypertension and physical inactivity. There is a need for healthcare initiatives and policies to target the groups most in need.