Income Disparities and Cardiovascular Risk Factors among Adolescents
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Income Disparities and Cardiovascular Risk Factors among Adolescents

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      Background and Objective: Socioeconomic disparities in cardiovascular health among adults have been documented, but disparities during adolescence are less understood. This study examined secular trends in 7 cardiovascular risk factors and disparities among US adolescents. Methods: We analyzed National Health and Nutrition Examination Survey data from 1999-2014, including 11,557 (4,854 fasting) participants aged 12-19 years. To examine trends in cardiovascular risk factors, adolescents were stratified into 3 groups based on family income to poverty ratio (PIR): low income (PIR, <1.3), middle income (≥1.3 and <3.5), and high income (≥3.5). Results: From 1999-2014, the prevalence of obesity increased (16.5% to 21.0%, p=0.001), but only among low and middle income adolescents, with significant disparities in prevalence by income (21.7% vs 14.6% among low vs high income adolescents, respectively, in 2011-2014). In addition, there were significant and persistent disparities in the prevalence of smoking (20.8% vs 7.4% among low vs high income adolescents, respectively, in 2011-2014), low quality diet (67.8% vs 49.0%), and physical inactivity (25.6% vs 17.0%). No significant disparities were observed in the prevalence of prediabetes/diabetes, hypertension, or hypercholesterolemia, although the prevalence of prediabetes/diabetes increased among low-income adolescents (21.4% to 28.0%, p=0.01). Overall, the prevalence of adolescents with two or more risk factors declined (48.3% to 37.1%, p<0.001), but this decline was only significant for high and middle income adolescents. Conclusions: Recent improvements in cardiovascular health have not been equally shared by US adolescents of varying socioeconomic status.
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