Andrew D Williams1, Edmond Shenassa2, Natalie Slopen3, Lauren Rossen4. 1. Maternal and Child Health Program, Department of Family Science, University of Maryland College Park, College Park, Maryland. 2. Maternal and Child Health Program, Department of Family Science, University of Maryland College Park, College Park, Maryland; Department of Epidemiology and Biostatistics, University of Maryland, College Park, Maryland; Department of Epidemiology and Biostatistics, School of Public Health, Brown University, Providence, Rhode Island; Department of Epidemiology and Biostatistics, School of Medicine, University of Maryland Baltimore, Baltimore, Maryland. Electronic address: shenassa@umd.edu. 3. Department of Epidemiology and Biostatistics, University of Maryland, College Park, Maryland. 4. National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland.
Abstract
PURPOSE: To examine race/ethnicity-specific associations between area-level poverty and cardiometabolic dysfunction among U.S. adolescents. METHODS: Data were from 10,415 adolescents aged 12-19 in the National Health and Nutrition Examination Survey (1999-2012), linked with census tract data on area-level poverty (the percent population living in poverty, grouped into race/ethnicity-specific quartiles). Cardiometabolic dysfunction was parameterized by summing z-scores of six cardiometabolic biomarkers, grouped into quintiles. Hierarchical ordinal models estimated overall and race/ethnicity specific associations. Posthoc analysis explored associations between area-level poverty and family poverty-to-income ratio. RESULTS: Overall, compared to adolescents residing in areas with the lowest area-level poverty (i.e., first quartile), residents in third (OR 1.32, 95% CI 1.13, 1.53) and fourth (OR 1.27, 95% CI 1.08, 1.50) quartiles of area-level poverty experienced elevated odds of cardiometabolic dysfunction. Area-level poverty predicted cardiometabolic dysfunction between non-Hispanic white and Mexican American adolescents, but not between non-Hispanic black adolescents. CONCLUSIONS: We found race/ethnicity-specific associations between area-level poverty and cardiometabolic dysfunction among U.S. adolescents, highlighting the moderating effect of race-ethnicity. Among non-Hispanic black adolescents, neither higher area-level nor family-level socioeconomic status is associated with cardiometabolic health, in contrast to non-Hispanic white adolescents. Similar associations among non-Hispanic white and Mexican American groups aligns with evidence of the Hispanic Paradox. Future studies of effect of area-level determinants of cardiometabolic dysfunction may consider race/ethnicity-specific associations.
PURPOSE: To examine race/ethnicity-specific associations between area-level poverty and cardiometabolic dysfunction among U.S. adolescents. METHODS: Data were from 10,415 adolescents aged 12-19 in the National Health and Nutrition Examination Survey (1999-2012), linked with census tract data on area-level poverty (the percent population living in poverty, grouped into race/ethnicity-specific quartiles). Cardiometabolic dysfunction was parameterized by summing z-scores of six cardiometabolic biomarkers, grouped into quintiles. Hierarchical ordinal models estimated overall and race/ethnicity specific associations. Posthoc analysis explored associations between area-level poverty and family poverty-to-income ratio. RESULTS: Overall, compared to adolescents residing in areas with the lowest area-level poverty (i.e., first quartile), residents in third (OR 1.32, 95% CI 1.13, 1.53) and fourth (OR 1.27, 95% CI 1.08, 1.50) quartiles of area-level poverty experienced elevated odds of cardiometabolic dysfunction. Area-level poverty predicted cardiometabolic dysfunction between non-Hispanic white and Mexican American adolescents, but not between non-Hispanic black adolescents. CONCLUSIONS: We found race/ethnicity-specific associations between area-level poverty and cardiometabolic dysfunction among U.S. adolescents, highlighting the moderating effect of race-ethnicity. Among non-Hispanic black adolescents, neither higher area-level nor family-level socioeconomic status is associated with cardiometabolic health, in contrast to non-Hispanic white adolescents. Similar associations among non-Hispanic white and Mexican American groups aligns with evidence of the Hispanic Paradox. Future studies of effect of area-level determinants of cardiometabolic dysfunction may consider race/ethnicity-specific associations.
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