1. In this cross-sectional study, low-income, middle-aged adults in the United States had increased rates of hypertension, diabetes, and cigarette use than their higher-income counterparts over the past two decades.
2. The prevalence of hypertension increased among low-income middle-aged adults, while that of diabetes and obesity increased among their higher-income counterparts during the same period.
Level of Evidence Rating: 2 (Good)
Summary of the study: Over the past decade, there has been a significant increase in cardiovascular mortality among middle-aged adults in the United States. Income inequalities have significantly worsened in the country, and concerns have grown that the deaths have disproportionately affected the lower-income subset of that age demographic. Yet few studies have examined income-based differences in the burden of cardiovascular risk factors over the past two decades. Therefore, this cross-sectional study aimed to examine national trends in the prevalence, treatment, and control of cardiovascular risk factors among low- and higher-income middle-aged adults (aged 40 to 64 years) from 1999 to March 2020 Overall, it showed that low-income, middle-aged adults showed higher rates of hypertension, diabetes and cigarette use than their higher-income counterparts over the past two decades. Furthermore, the prevalence of hypertension increased among low-income middle-aged adults, while that of diabetes and obesity increased among their higher-income counterparts during this period. The study was limited by smaller sample sizes and the National Health and Nutrition Examination Survey (NHANES) used to collect participant data, which did not assess all relevant social determinants of health and may have been susceptible to recall bias. and the answer.
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Thoroughly [cross-sectional study]: This serial cross-sectional study aimed to examine trends in the prevalence, treatment, and control of cardiovascular risk factors among low- and higher-income middle-aged adults in the United States from 1999 to March 2020. All participants aged 40- to 64-year-olds who completed NHANES, a series of nationally representative surveys conducted every two years by the Centers for Disease Control and Prevention, during this period were identified. Treatment of hypertension, diabetes, and hyperlipidemia was defined as self-reported use of antihypertensive, antidiabetic, and cholesterol-lowering medication, respectively. After a population analysis of a study that included 20,761 middle-aged adults, the prevalence of hypertension, diabetes and cigarette use was consistently higher among low-income adults between 1999 and March 2020. Low-income adults showed an increase of hypertension of 37.2% (95% confidence interval [CI], 33.5% to 40.9%) to 44.7% (CI, 39.8% to 49.5%), but there were no changes in diabetes or obesity during the study period. In contrast, higher-income adults showed no change in hypertension but an increase in diabetes from 7.8% (CI, 5.0% to 10.6%) to 14.9% (CI, 12.4 % to 17.3%) and obesity from 33.0% (CI, 26.7) % to 39.4%) to 44.0% (CI, 40.2% to 47.7%). Low-income adults also demonstrated higher but stable cigarette use (33.2% [CI, 28.4% to 38.0%] up to 33.9% [CI, 29.6% to 38.3%]) compared to their higher-income counterparts, whose cigarette use declined over the study period (18.6% [CI, 13.5% to 23.7%] up to 11.5% [CI, 8.7% to 14.3%]). In summary, this study demonstrates the increased prevalence of hypertension, diabetes, and cigarette use among low-income middle-aged adults over the past two decades.
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