• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (105)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Sanjat Kanjilal, MPH; Edward W. Gregg, PhD; Yiling J. Cheng, MD, PhD; Ping Zhang, PhD; David E. Nelson, MD, MPH; George Mensah, MD; Gloria L. A. Beckles, MD, MSc

Arch Intern Med. 2006;166:2348-2355.

Background  It is unknown whether the previously recognized disparities in cardiovascular disease (CVD) risk factors related to annual income and educational level have diminished, persisted, or worsened in recent decades. The objective of this study was to examine 31-year trends in CVD risk factors by annual income and educational levels among US adults.

Methods  Four cross-sectional national surveys were used: National Health and Nutrition Examination Survey I (1971-1974), II (1976-1980), III (1988-1994), and 1999-2002. The main outcome measure was prevalence of high cholesterol (240 mg/dL [6.2 mmol/L]), high blood pressure (140/90 mm Hg), smoking, and diabetes mellitus.

Results  Between 1971 and 2002, the prevalence of all CVD risk factors, except diabetes, decreased in all income and education groups, but there has been little reduction in income- and education-related disparities in CVD risk factors and few improvements during the past 10 years. The prevalence of high blood pressure declined by about half in all income and education groups, ranging from 30.3% to 40.6% in 1971-1974 and 16.4% in 1999-2002, with the greatest reduction among those in the lowest income quartile and those with less than a high school education (18.0 and 15.9 percentage points, respectively). High cholesterol prevalence also declined in all groups and ranged from 28.8% to 32.4% in 1971-1974 and 15.3% to 22.0% in 1999-2002, with the largest decline (15.9 percentage points) among people with the highest incomes. Education- and income-related disparities in smoking widened considerably, because there were large declines in smoking prevalence among people with high incomes and education (from about 33% in 1971-1974 to about 14%-17% in 1999-2002) but only marginal reductions among those with low incomes and education (about 6–percentage point decline). Diabetes prevalence increased most among persons with low incomes and education.

Conclusions  Despite the general success in reducing CVD risk factors in the US population, not all segments of society are benefiting equally and improvements may have slowed. Education- and income-related disparities have worsened for smoking, and increases in diabetes prevalence have occurred primarily among persons with a lower socioeconomic status. Diabetes prevention and smoking prevention and cessation programs need to specifically target persons of lower income and education.

Author Affiliations: Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga.

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Tobacco Smoking and Bladder Cancer
Dowdy
JAMA 2011;306:2216-2217.
FULL TEXT  

Tobacco Smoking and Bladder Cancer--Reply
Freedman et al.
JAMA 2011;306:2217-2217.
FULL TEXT  

The Path to Quit: How Awareness of a Large-Scale Mass-Media Smoking Cessation Campaign Promotes Quit Attempts
Richardson et al.
Nicotine Tob Res 2011;13:1098-1105.
ABSTRACT | FULL TEXT  

Trends in adult cardiovascular disease risk factors and their socio-economic patterning in the Scottish population 1995-2008: cross-sectional surveys
Hotchkiss et al.
BMJ Open 2011;1:e000176-e000176.
ABSTRACT | FULL TEXT  

Trends in home smoking bans in the USA, 1995-2007: prevalence, discrepancies and disparities
Zhang et al.
Tobacco Control 2011;0:tc.2011.043802v1-tc.2011.043802.
ABSTRACT | FULL TEXT  

Effect of socioeconomic status on secondary prevention of stroke
Liu et al.
Int J Qual Health Care 2011;23:405-412.
ABSTRACT | FULL TEXT  

Education Predicts Incidence of Preclinical Mobility Disability in Initially High-Functioning Older Women. The Women's Health and Aging Study II
Gregory et al.
J Gerontol A Biol Sci Med Sci 2011;66A:577-581.
ABSTRACT | FULL TEXT  

En Balance Participants Decrease Dietary Fat and Cholesterol Intake as Part of a Culturally Sensitive Hispanic Diabetes Education Program
Salto et al.
The Diabetes Educator 2011;37:239-253.
ABSTRACT | FULL TEXT  

Household Responsibilities, Income, and Ambulatory Blood Pressure Among Working Men and Women
Thurston et al.
Psychosom. Med. 2011;73:200-205.
ABSTRACT | FULL TEXT  

A socio-biological explanation for social disparities in non-communicable chronic diseases: the product of history?
Schooling and Leung
J. Epidemiol. Community Health 2010;64:941-949.
ABSTRACT | FULL TEXT  

Does Black Ethnicity Influence the Development of Stent Thrombosis in the Drug-Eluting Stent Era?
Collins et al.
Circulation 2010;122:1085-1090.
ABSTRACT | FULL TEXT  

Effects of Prenatal Poverty on Infant Health: State Earned Income Tax Credits and Birth Weight.
Strully et al.
American Sociological Review 2010;75:534-562.
ABSTRACT | FULL TEXT  

Inequalities in cardiovascular disease mortality: the role of behavioural, physiological and social risk factors
Beauchamp et al.
J. Epidemiol. Community Health 2010;64:542-548.
ABSTRACT | FULL TEXT  

Gender, race, and education differences in abstinence rates among participants in two randomized smoking cessation trials
Piper et al.
Nicotine Tob Res 2010;12:647-657.
ABSTRACT | FULL TEXT  

Decreasing disparity in cholesterol screening in minority communities--findings from the Racial and Ethnic Approaches to Community Health 2010
Liao et al.
J. Epidemiol. Community Health 2010;64:292-299.
ABSTRACT | FULL TEXT  

Images of Illness: How Causal Claims and Racial Associations Influence Public Preferences toward Diabetes Research Spending
Gollust et al.
Journal of Health Politics, Policy and Law 2010;35:921-959.
ABSTRACT  

Coarse particles and mortality: evidence from a multi-city study in California
Malig and Ostro
Occup. Environ. Med. 2009;66:832-839.
ABSTRACT | FULL TEXT  

An unequal social distribution of peripheral arterial disease and the possible explanations: results from a population-based study
Kroger et al.
Vasc Med 2009;14:289-296.
ABSTRACT  

Epi + demos + cracy: Linking Political Systems and Priorities to the Magnitude of Health Inequities--Evidence, Gaps, and a Research Agenda
Beckfield and Krieger
Epidemiol Rev 2009;31:152-177.
ABSTRACT | FULL TEXT  

Would Achieving Healthy People 2010's Targets Reduce Both Population Levels and Social Disparities in Heart Disease?
Alvarado et al.
Circ Cardiovasc Qual Outcomes 2009;2:598-606.
ABSTRACT | FULL TEXT  

Worksite Wellness Programs for Cardiovascular Disease Prevention: A Policy Statement From the American Heart Association
Carnethon et al.
Circulation 2009;120:1725-1741.
FULL TEXT  

Educational inequalities in smoking cessation trends in Italy, 1982-2002
Federico et al.
Tobacco Control 2009;18:393-398.
ABSTRACT | FULL TEXT  

ACCF/AHA/ACP 2009 Competence and Training Statement: A Curriculum on Prevention of Cardiovascular Disease
American College of Cardiology Foundation et al.
J Am Coll Cardiol 2009;54:1336-1363.
FULL TEXT  

ACCF/AHA/ACP 2009 Competence and Training Statement: A Curriculum on Prevention of Cardiovascular Disease: A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Competence and Training (Writing Committee to Develop a Competence and Training Statement on Prevention of Cardiovascular Disease): Developed in Collaboration With the American Academy of Neurology; American Association of Cardiovascular and Pulmonary Rehabilitation; American College of Preventive Medicine; American College of Sports Medicine; American Diabetes Association; American Society of Hypertension; Association of Black Cardiologists; Centers for Disease Control and Prevention; National Heart, Lung, and Blood Institute; National Lipid Association; and Preventive Cardiovascular Nurses Association
WRITING COMMITTEE MEMBERS et al.
Circulation 2009;120:e100-e126.
FULL TEXT  

Fundamental Cause Theory, Technological Innovation, and Health Disparities: The Case of Cholesterol in the Era of Statins
Chang and Lauderdale
Journal of Health and Social Behavior 2009;50:245-260.
ABSTRACT  

Trends in risk factors for cardiovascular disease in Canada: temporal, socio-demographic and geographic factors
Lee et al.
CMAJ 2009;181:E55-E66.
ABSTRACT | FULL TEXT  

Coronary heart disease mortality among young adults in Scotland in relation to social inequalities: time trend study
O'Flaherty et al.
BMJ 2009;339:b2613-b2613.
ABSTRACT | FULL TEXT  

Hostility and Minimal Model of Glucose Kinetics in African American Women
Surwit et al.
Psychosom. Med. 2009;71:646-651.
ABSTRACT | FULL TEXT  

Socioeconomic status, blood pressure progression, and incident hypertension in a prospective cohort of female health professionals
Conen et al.
Eur Heart J 2009;30:1378-1384.
ABSTRACT | FULL TEXT  

Social inequality in adolescent daily smoking: Has it changed over time?
Rasmussen et al.
Scand J Public Health 2009;37:287-294.
ABSTRACT  

Differences in Control of Cardiovascular Disease and Diabetes by Race, Ethnicity, and Education: U.S. Trends From 1999 to 2006 and Effects of Medicare Coverage
McWilliams et al.
ANN INTERN MED 2009;150:505-515.
ABSTRACT | FULL TEXT  

Prevalence and Control of Diabetes and Impaired Fasting Glucose in New York City
Thorpe et al.
Diabetes Care 2009;32:57-62.
ABSTRACT | FULL TEXT  

Co-occurrence of risk factors for cardiovascular disease by social class: 1958 British birth cohort
Power et al.
J. Epidemiol. Community Health 2008;62:1030-1035.
ABSTRACT | FULL TEXT  

Go to the head of the class to avoid vascular dementia and skip diabetes and obesity
Knopman
Neurology 2008;71:1046-1047.
FULL TEXT  

Prevalence, Awareness, Treatment, and Predictors of Control of Hypertension in New York City
Angell et al.
Circ Cardiovasc Qual Outcomes 2008;1:46-53.
ABSTRACT | FULL TEXT  

Secular Trends in Mortality From Common Cancers in the United States by Educational Attainment, 1993-2001
Kinsey et al.
JNCI J Natl Cancer Inst 2008;100:1003-1012.
ABSTRACT | FULL TEXT  

A framework for tobacco control: lessons learnt from Veterans Health Administration
Sherman
BMJ 2008;336:1016-1019.
FULL TEXT  

The Year in Epidemiology, Health Services Research, and Outcomes Research
Krumholz and Masoudi
J Am Coll Cardiol 2007;50:2254-2262.
FULL TEXT  

High prevalence of patients with a high risk for obstructive sleep apnoea syndrome after kidney transplantation association with declining renal function
Molnar et al.
Nephrol Dial Transplant 2007;22:2686-2692.
ABSTRACT | FULL TEXT  

Economics of Health and Mortality Special Feature: Nature and causes of trends in male diabetes prevalence, undiagnosed diabetes, and the socioeconomic status health gradient
Smith
Proc. Natl. Acad. Sci. USA 2007;104:13225-13231.
ABSTRACT | FULL TEXT