Social Determinants of Cardiovascular Health in US Adolescents: National Health and Nutrition Examination Surveys 1999 to 2014

Abstract

Background Cardiovascular health (CVH) is suboptimal in US adolescents. Social determinants of health (SDOH) may affect CVH. We examined SDOH by race and ethnicity and assessed for associations between SDOH and CVH among US adolescents. Methods and Results We analyzed data from the National Health and Nutrition Examination Survey for 3590 participants aged 12 to 19 years from 1999 to 2014. SDOH variables were chosen and an SDOH score assigned (range, 0–7 points; higher=more favorable). CVH was classified according to American Heart Association criteria. We estimated population prevalence and used multivariable linear and polytomous logistic regression for associations between SDOH and CVH. SDOH varied by group, with the non‐Hispanic White group (n=1155) having a higher/better mean SDOH score compared with non‐Hispanic Black (n=1223) and Mexican American groups (n=1212). Associations between SDOH and CVH differed between racial and ethnic groups (interaction P <0.0001). For the non‐Hispanic White group, each additional favorable SDOH variable was associated with a CVH score higher/better by 0.3 points (β, 0.3, P <0.0001), 20% higher odds for moderate (versus low) CVH (odds ratio [OR], 1.2 [95% CI, 1.1–1.4]), and 80% higher odds for high/favorable (versus low) CVH (1.8 [1.5–2.1]). Associations between SDOH and CVH were more modest among the Mexican American group (β, 0.12, P =0.001; OR 1.1 [1.0–1.2] for moderate CVH; OR, 1.3 [1.1–1.6] for high CVH) and were not significant among the non‐Hispanic Black group (β, 0.07; P =0.464). Conclusions SDOH and CVH were more favorable for non‐Hispanic White adolescents compared with non‐Hispanic Black and Mexican American adolescents. SDOH were strongly associated with CVH among the non‐Hispanic White group. Racially and culturally sensitive public policy approaches may improve CVH in US adolescents.