Introduction: Higher education and income can modify behavioral risk factors for lifetime cardiovascular disease (CVD) risk. The aim of this study was to observe ethnic differences in the CV health, as measured by inadequate cardiovascular health index (CVHI) category, among a cohort of females with high family income, education, and BMI. We also examined differences in perception about self-reported weight and attitudes toward weight loss and exercise.
Methods: Adult non-pregnant females aged 20 years or older from the 2011-2012 NHANES were included in the study. Participants were at least college educated, had a poverty to income ratio of 350% or above, and BMI (≥ 30). Weighted regression was adjusted for demographics, PHQ-9 score, perception about weight, if participant tried to lose weight last year, and history of CVD, angina, or heart attack.
Results: The sample represented 2,990,456 eligible females in the US. About 13.2% Hispanic perceived their weight to be about right as compared to 10% Black, and 3.3% White. About 89% Hispanics tried to lose weight in past year compared to 71% White and Black. Weighted regression showed that Hispanic (β: -2.47, 95% CI: -4.44, -0.50) and Black (β: -0.74, 95% CI: -1.93, 0.45) had low CVHI score as compared to White. Higher PHQ9 score (β: -0.12, p > 0.05) and those who did not try to lose weight (β: -1.55, p < 0.01) were associated with lower, and those with positive attitude towards their weight were associated with higher CVHI score (β: 0.38, p > 0.05). Our study suggests huge variations in these characteristics by country of birth and citizenship with corroborated ambiguity in definitions.
Conclusion: Previous research is inconclusive about existence of Hispanic paradox in cardiovascular health domain. Our study suggests that Hispanic ethnicity was a significant predictor of negative CVHI, when socioeconomic status (SES) was high among all obese females. There was higher prevalence of history of weight management and low CVHI score among Hispanic females; Hispanic females belonging to higher SES may be at a higher risk for CVD related adverse events. In our study, effect of education and income diminished and SES was not associated with participant’s willingness to lose weight despite being obese. Health disparities expressed as differences in CVHI exist despite high education and family income.