Oluseye Ogunmoroti1,2, Ovie A Utuama3, Erin D Michos4, Javier Valero-Elizondo1, Victor Okunrintemi1, Ziyad Ben Taleb2, Raed Bahelah2, Sankalp Das5, Maribeth Rouseff5, Don Parris6, Arthur Agatston1,7, Theodore Feldman1,8, Emir Veledar1,9, Wasim Maziak2, Khurram Nasir1,2,4,8,10. 1. Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, Florida. 2. Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida. 3. Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida. 4. The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland. 5. Wellness Advantage Administration, Baptist Health South Florida, Miami, Florida. 6. Center for Research and Grants, Baptist Health South Florida, Miami, Florida. 7. South Beach Preventive Cardiology, Miami Beach, Florida. 8. Herbert Wertheim College of Medicine, Florida International University, Miami, Florida. 9. Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida. 10. Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, Florida.
Abstract
BACKGROUND: Despite the progress made to decrease risk factors for cardiovascular diseases, disparities still exist. We examined how education and ethnicity interact to determine disparities in cardiovascular health (CVH) as defined by the American Heart Association. HYPOTHESIS: Education modifies the effect of ethnicity on CVH. METHODS: Individual CVH metrics (smoking, physical activity, body mass index, diet, total cholesterol, blood pressure, and blood glucose) were defined as ideal, intermediate, or poor. Combined scores were categorized as inadequate, average, or optimal CVH. Education was categorized as postgraduate, college, some college, and high school or less; ethnicity was categorized as white, Hispanic, black, and other. Main and interactive associations between education, ethnicity, and the measures of CVH were calculated with multinomial logistic regression. RESULTS: Of 9056 study participants, 74% were women, and mean age was 43 (±12) years. Over half were Hispanic, and two-thirds had at least a college education. With postgraduate education category as the reference, participants with less than a college education were less likely to achieve ideal status for most of the individual CVH metrics, and also less likely to achieve 6 to 7 ideal metrics, and optimal CVH scores. In most of the educational categories, Hispanic participants had the highest proportion with optimal CVH scores and 6 to 7 ideal metrics, whereas black participants had the lowest proportion. However, there were no statistically significant interactions of education and ethnicity for ideal CVH measures. CONCLUSIONS: Higher educational attainment had variable associations with achieved levels of ideal CVH across race/ethnic groups. Interventions to improve CVH should be tailored to meet the needs of target communities.
BACKGROUND: Despite the progress made to decrease risk factors for cardiovascular diseases, disparities still exist. We examined how education and ethnicity interact to determine disparities in cardiovascular health (CVH) as defined by the American Heart Association. HYPOTHESIS: Education modifies the effect of ethnicity on CVH. METHODS: Individual CVH metrics (smoking, physical activity, body mass index, diet, total cholesterol, blood pressure, and blood glucose) were defined as ideal, intermediate, or poor. Combined scores were categorized as inadequate, average, or optimal CVH. Education was categorized as postgraduate, college, some college, and high school or less; ethnicity was categorized as white, Hispanic, black, and other. Main and interactive associations between education, ethnicity, and the measures of CVH were calculated with multinomial logistic regression. RESULTS: Of 9056 study participants, 74% were women, and mean age was 43 (±12) years. Over half were Hispanic, and two-thirds had at least a college education. With postgraduate education category as the reference, participants with less than a college education were less likely to achieve ideal status for most of the individual CVH metrics, and also less likely to achieve 6 to 7 ideal metrics, and optimal CVH scores. In most of the educational categories, Hispanic participants had the highest proportion with optimal CVH scores and 6 to 7 ideal metrics, whereas black participants had the lowest proportion. However, there were no statistically significant interactions of education and ethnicity for ideal CVH measures. CONCLUSIONS: Higher educational attainment had variable associations with achieved levels of ideal CVH across race/ethnic groups. Interventions to improve CVH should be tailored to meet the needs of target communities.
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