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Journal of Urban Health

, Volume 95, Issue 6, pp 801–812 | Cite as

Gender and Race Disparities in Cardiovascular Disease Risk Factors among New York City Adults: New York City Health and Nutrition Examination Survey (NYC HANES) 2013–2014

  • Rania Kanchi
  • Sharon E. Perlman
  • Claudia Chernov
  • Winfred Wu
  • Bahman P. Tabaei
  • Chau Trinh-Shevrin
  • Nadia Islam
  • Azizi Seixas
  • Jesica Rodriguez-Lopez
  • Lorna E. Thorpe
Article

Abstract

While gender and racial/ethnic disparities in cardiovascular disease (CVD) risk factors have each been well characterized, few studies have comprehensively examined how patterns of major CVD risk factors vary and intersect across gender and major racial/ethnic groups, considered together. Using data from New York City Health and Nutrition Examination Survey 2013–2014—a population-based, cross-sectional survey of NYC residents ages 20 years and older—we measured prevalence of obesity, hypertension, hypercholesterolemia, smoking, and diabetes across gender and race/ethnicity groups for 1527 individuals. We used logistic regression with predicted marginal to estimate age-adjusted prevalence ratio by gender and race/ethnicity groups and assess for potential additive and multiplicative interaction. Overall, women had lower prevalence of CVD risk factors than men, with less hypertension (p = 0.040), lower triglycerides (p < 0.001), higher HDL (p < 0.001), and a greater likelihood of a heart healthy lifestyle, more likely not to smoke and to follow a healthy diet (p < 0.05). When further stratified by race/ethnicity, however, the female advantage was largely restricted to non-Latino white women. Non-Latino black women had significantly higher risk of being overweight or obese, having hypertension, and having diabetes than non-Latino white men or women, or than non-Latino black men (p < 0.05). Non-Latino black women also had higher total cholesterol compared to non-Latino black men (184.4 vs 170.5 mg/dL, p = 0.010). Despite efforts to improve cardiovascular health and narrow disparities, non-Latino black women continue to have a higher burden of CVD risk factors than other gender and racial/ethnic groups. This study highlights the importance of assessing for intersectionality between gender and race/ethnicity groups when examining CVD risk factors.

Keywords

Cardiovascular disease Race Gender Disparities NYC HANES Intersectionality 

Notes

Acknowledgments

Role of Funding Source: Support for NYCHANES 2013–2014 was provided by the de Beaumont Foundation with additional support from the Robert Wood Johnson Foundation, Robin Hood, the NYS Health Foundation, Quest Diagnostics, and the Doris Duke Charitable Foundation, NYC Health Department, Hunter College Office of the Provost, CUNY Vice Chancellors Office of Research, and CUNY School of Public Health Dean’s Office. The effort of NI, CTS, and LT was supported in part by grants U58DP005621 and U48DP005008 (Centers for Disease Control and Prevention), grant U54MD000538-15 (NIH National Institute on Minority Health and Health Disparities). NI and CTS were also partially supported through grant 1R01DK110048-01A1 (NIH National Institute of Diabetes and Digestive and Kidney Diseases), and grant UL1 TR001445 (National Center for Advancing Translational Sciences). The contents of this paper are solely the responsibility of the authors and do not represent the official views of the funders

Authors Contribution

All authors have equally contributed to the development of this manuscript by taking part in constructing the conception, analysis/interpretation, or writing of the manuscript. They also all reviewed and commented on the manuscript. The authors have full access to the data and are responsible for the integrity of the data and the analysis.

References

  1. 1.
    Kochanek KD, Xu J, Murphy SL, ̃o AMM, Kung H-C. Deaths: final data for 2009. Atlanta, GA: Center for Disease Control and Prevention; 2011.Google Scholar
  2. 2.
    Center for Disease Control and Prevention. CDC National Health Report: Leading Causes of Morbidity and Mortality and Associated Behavioral Risk and Protective Factors—United States, 2005–2013. Atlanta, GA: Center for Disease Control and Prevention; 2014.Google Scholar
  3. 3.
    Hu FB, Grodstein F, Hennekens CH, Colditz GA, Johnson M, Manson JAE, et al. Age at natural menopause and risk of cardiovascular disease. Arch Intern Med. 1999;159(10):1061–6.CrossRefGoogle Scholar
  4. 4.
    Towfighi A, Zheng L, Ovbiagele B. Weight of the obesity epidemic rising stroke rates among middle-aged women in the United States. Stroke. 2010;41:1371–5.CrossRefGoogle Scholar
  5. 5.
    Towfighi A, Zheng L, Ovbiagele B. Sex-specific trends in midlife coronary heart disease risk and prevalence. Arch Intern Med. 2009;169(19):1762–6.CrossRefGoogle Scholar
  6. 6.
    Ford ES, Capewell S. Coronary heart disease mortality among young adults in the U.S. from 1980 through 2002: concealed leveling of mortality rates. J Am Coll Cardiol. 2007;50(22):2128–32.CrossRefGoogle Scholar
  7. 7.
    Rosen SE, Henry S, Bond R, Pearte C, Mieres JH. Sex-specific disparities in risk factors for coronary heart disease. Curr Atheroscler Rep. 2015;17(8):49.Google Scholar
  8. 8.
    Huxley R, Barzi F, Woodward M. Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies. Br Med J. 2006;332(7533):73–78.CrossRefGoogle Scholar
  9. 9.
    Wenger NK. Women and coronary heart disease: a century after Herrick understudied, underdiagnosed, and undertreated. Circulation. 2012;126:604–11.CrossRefGoogle Scholar
  10. 10.
    Safford MM, Brown TM, Muntner PM, Durant RW, Glasser S, Halanych JH, et al. Association of race and sex with risk of incident acute coronary heart disease events. Journal of American Medial Association. 2012;308(17):1768–74.CrossRefGoogle Scholar
  11. 11.
    Romero CX, Romero TE, Shlay JC, Ogden LG, Dabelea D. Changing trends in the prevalence and disparities of obesity and other cardiovascular disease risk factors in three racial/ethnic groups of USA adults. Adv Prev Med. 2012;2012:8.CrossRefGoogle Scholar
  12. 12.
    Feinstein M, Ning H, Kang J, Bertoni A, Carnethon M, Lloyd-Jones DM. Racial differences in risks for first cardiovascular events and noncardiovascular death: the atherosclerosis risk in communities study, the cardiovascular health study, and the multi-ethnic study of atherosclerosis. Circulation. 2012;126(1):50–9.CrossRefGoogle Scholar
  13. 13.
    Swenson CJ, Trepka MJ, Rewers MJ, Scarbro S, Hiatt WR, Hamman RF. Cardiovascular disease mortality in Hispanics and non-Hispanic whites. Am J Epidemiol. 2002;156(10):919–28.CrossRefGoogle Scholar
  14. 14.
    Nichaman MZ, Garcia G. Obesity in Hispanic Americans. Diabetes Care. 1991;14(7):691–4.CrossRefGoogle Scholar
  15. 15.
    Lewey J, Choudhry NK. The current state of ethnic and racial disparities in cardiovascular care: lessons from the past and opportunities for the future. Current Cardiology Reports. 2014;16(10):530.CrossRefGoogle Scholar
  16. 16.
    Fried LP, Borhani NO, Enright P, Furberg CD, Gardin JM, Kronmal RA, et al. The cardiovascular health study: design and rationale. Ann Epidemiol. 1991;1(3):263–76.CrossRefGoogle Scholar
  17. 17.
    Virani SS, Brautbar A, Davis BC, et al. Associations between lipoprotein (a) levels and cardiovascular outcomes in black and white subjects the atherosclerosis risk in communities (ARIC) study. Circulation. 2011;125:241–9.CrossRefGoogle Scholar
  18. 18.
    Mercado CI, Yang Q, Ford ES, Gregg E, Valderrama AL. Gender- and race-specific metabolic score and cardiovascular disease mortality in adults: a structural equation modeling approach—United States, 1988–2006. Obesity. 2015;23(9):1911–9.CrossRefGoogle Scholar
  19. 19.
    Walsemann KM, Goosby BJ, Farr D. Life course SES and cardiovascular risk: heterogeneity across race/ethnicity and gender. Soc Sci Med. 2016;152:147–55.CrossRefGoogle Scholar
  20. 20.
    Thorpe LE, Gwynn RC, Mandel-Ricci J, Roberts S, Tsoi B, Berman L, et al. Study design and participation rates of the New York City health and nutrition examination survey, 2004. Prev Chronic Dis. 2006;3(3):A94.Google Scholar
  21. 21.
    Thorpe LE, Greene C, Freeman A, Snell E, Rodriguez-Lopez JS, Frankel M, et al. Rationale, design and respondent characteristics of the 2013–2014 New York City Health and Nutrition Examination Survey (NYC HANES 2013–2014). Preventive Medicine Reports. 2015;2:580–5.CrossRefGoogle Scholar
  22. 22.
    Burt VL, Whelton P, Roccella EJ, Brown C, Cutler JA, Higgins M, et al. Prevalence of hypertension in the US adult population. Results from the Third National Health and nutrition examination survey, 1988–1991. Hypertension. 1995;25(3):305–13.CrossRefGoogle Scholar
  23. 23.
    Expert Panel on Detection E, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Journal of American Medial Association. 2001;285(19):2486–97.CrossRefGoogle Scholar
  24. 24.
    American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2013;36(Supplement 1):S67–74.CrossRefGoogle Scholar
  25. 25.
    Miller RR, Sales AE, Kopjar B, Fihn SD, Bryson CL. Adherence to heart-healthy behaviors in a sample of the U.S. population. Preventing Chronic Disease. 2005;2(2):A18.Google Scholar
  26. 26.
    Bieler GS, Brown GG, Williams RL, Brogan DJ. Estimating model-adjusted risks, risk differences, and risk ratios from complex survey data. Am J Epidemiol. 2010;171(5):618–23.CrossRefGoogle Scholar
  27. 27.
    VanderWeele TJ, Knol MJ. A tutorial on interaction. Epidemiologic Methods. 2014;3(1):33–72.Google Scholar
  28. 28.
    Andersson T, Alfredsson L, Kallberg H, Zdravkovic S, Ahlbom A. Calculating measures of biological interaction. Eur J Epidemiol. 2005;20:575–9.CrossRefGoogle Scholar
  29. 29.
    American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2016 update. A Report From the American Heart Association. Circulation. 2015;133:e38–360.Google Scholar
  30. 30.
    Maas AHEM, Appelman YEA. Gender differences in coronary heart disease. Neth Hear J. 2010;18(12):598–602.CrossRefGoogle Scholar
  31. 31.
    Smilowitz NR, Gil A, Maduro J, Lobach IV, Chen Y, Reynolds HR. Adverse trends in ischemic heart disease mortality among young New Yorkers, particularly young Black women. PLOS One. 2016;11(2):e0149015.CrossRefGoogle Scholar
  32. 32.
    Profant J, Dimsdale JE. Race and diurnal blood pressure patterns. A review and meta-analysis. Hypertension. 1999;33(5):1099–104.CrossRefGoogle Scholar
  33. 33.
    Harshfield GA, Alpert BS, Willey ES, Somes GW, Murphy JK, Dupaul LM. Race and gender influence ambulatory blood pressure patterns of adolescents. Hypertension. 1989;14(6):598–603.CrossRefGoogle Scholar
  34. 34.
    Jackson CL, Szklo M, Yeh H-C, et al. Black-White disparities in overweight and obesity trends by educational attainment in the United States, 1997–2008. J Obes. 2013;2013:140743.CrossRefGoogle Scholar
  35. 35.
    Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and trends in diabetes among adults in the United States, 1988–2012. Journal of American Medial Association. 2015;314(10):1021–9.CrossRefGoogle Scholar
  36. 36.
    Crenshaw K. Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. University of Chicago Legal Forum. 1989;1989(1):139–67.Google Scholar
  37. 37.
    Habburg E, Erfurt JC, Hauenstein LS, Chape C, Schull WJ, Schork MA. Socio-ecological stress, suppressed hostility, skin color, and black-white male blood pressure: detroit. Psychosom Med. 1973;35(4):276–96.CrossRefGoogle Scholar
  38. 38.
    Harburg E, Erfljrt JC, Chap C, Hauenstein LS, Schull WJ, Schork MA. Socioecological stressor areas and Black-White blood pressure: detroit. Journal of Chronic Disease. 1973;26:595–611.CrossRefGoogle Scholar
  39. 39.
    Diez-Roux AV, Nieto FJ, Muntaner C, Tyroler HA, Comstock GW, Shahar E, et al. Neighborhood environments and coronary heart disease: a multilevel analysis. Am J Epidemiol. 1997;146(1):48–63.CrossRefGoogle Scholar
  40. 40.
    Krieger N, Sidney S. Racial discrimination and blood pressure: the CARDIA study of young black and white adults. Am J Public Health. 1996;86(10):1370–8.CrossRefGoogle Scholar
  41. 41.
    Colhoun HM, Hemingway H, Poulter NR. Socio-economic status and blood pressure: an overview analysis. J Hum Hypertens. 1998;12(2):91–110.CrossRefGoogle Scholar
  42. 42.
    Williams DR, Jackson PB. Social sources of racial disparities in health. Health Aff. 2005;24(2):325–34.CrossRefGoogle Scholar
  43. 43.
    Mobley LR, Root ED, Finkelstein EA, Khavjou O, Farris RP, Will JC. Environment, obesity, and cardiovascular disease risk in low-income women. Am J Prev Med. 2006;30(4):327–32.CrossRefGoogle Scholar
  44. 44.
    Shelton RC, Goldman RE, Emmons KM, Sorensen G, Allen JD. An investigation into the social context of low-income, urban Black and Latina women: implications for adherence to recommended health behaviors. Health Education Behavior. 2011;38(5):471–81.CrossRefGoogle Scholar

Copyright information

© The New York Academy of Medicine 2018

Authors and Affiliations

  • Rania Kanchi
    • 1
  • Sharon E. Perlman
    • 2
  • Claudia Chernov
    • 2
  • Winfred Wu
    • 2
  • Bahman P. Tabaei
    • 2
  • Chau Trinh-Shevrin
    • 1
  • Nadia Islam
    • 1
  • Azizi Seixas
    • 1
  • Jesica Rodriguez-Lopez
    • 3
  • Lorna E. Thorpe
    • 1
  1. 1.Department of Population HealthNYU School of MedicineNew YorkUSA
  2. 2.NYC Department of Health and Mental HygieneLong Island CityUSA
  3. 3.Universidad De La SalleBogotaColombia

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