Gray, Darrell M.

Background Higher scores for the American Heart Association Life's Essential 8 (LE8) metrics, blood pressure, cholesterol, glucose, body mass index, physical activity, smoking, sleep, and diet, are associated with lower risk of chronic disease. Socioeconomic status (SES; employment, insurance, education, and income) is associated with LE8 scores, but there is limited understanding of potential differences by sex. This analysis quantifies the association of SES with LE8 for each sex, within Hispanic Americans, non‐Hispanic Asian Americans, non‐Hispanic Black Americans, and non‐Hispanic White Americans. Methods and Results Using cross‐sectional data from the National Health and Nutrition Examination Survey, years 2011 to 2018, LE8 scores were calculated (range, 0–100). Age‐adjusted linear regression quantified the association of SES with LE8 score. The interaction of sex with SES in the association with LE8 score was assessed in each racial and ethnic group. The US population representatively weighted sample (13 529 observations) was aged ≥20 years (median, 48 years). The association of education and income with LE8 scores was higher in women compared with men for non‐Hispanic Black Americans and non‐Hispanic White Americans ( P for all interactions <0.05). Among non‐Hispanic Asian Americans and Hispanic Americans, the association of SES with LE8 was not different between men and women, and women had greater LE8 scores than men at all SES levels (eg, high school or less, some college, and college degree or more). Conclusions The factors that explain the sex differences among non‐Hispanic Black Americans and non‐Hispanic White Americans, but not non‐Hispanic Asian Americans and Hispanic Americans, are critical areas for further research to advance cardiovascular health equity.

Background Socioeconomic status (SES) is associated with cardiovascular health (CVH). Potential differences by sex in this association remain incompletely understood in Black Americans, where SES disparities are posited to be partially responsible for cardiovascular inequities. The association of SES measures (income, education, occupation, and insurance) with CVH scores was examined in the Jackson Heart Study. Methods and Results American Heart Association CVH components (non–high‐density‐lipoprotein cholesterol, blood pressure, diet, tobacco use, physical activity, sleep, glycemia, and body mass index) were scored cross‐sectionally at baseline (scale: 0–100). Differences in CVH and 95% CIs (Estimate, 95% CI) were calculated using linear regression, adjusting for age, sex, and discrimination. Heterogeneity by sex was assessed. Participants had a mean age of 54.8 years (SD 12.6 years), and 65% were women. Lower income, education, occupation (non‐management/professional versus management/professional occupations), and insurance status (uninsured, Medicaid, Veterans Affairs, or Medicare versus private insurance) were associated with lower CVH scores (all P <0.01). There was heterogeneity by sex, with greater magnitude of associations of SES measures with CVH in women versus men. The lowest education level (<high school) versus highest (>high school) was associated with 8.8‐point lower (95% CI: −10.2 to −7.3) and 5.4‐point lower (95% CI: −7.2 to −3.6) CVH scores in women and men, respectively (interaction P =0.003). The lowest (<25 000) versus highest level of income (≥$75 000) was associated with a greater reduction in CVH scores in women than men (interaction P =0.1142). Conclusions Among Black Americans, measures of SES were associated with CVH, with a greater magnitude in women compared with men for education and income. Interventions aimed to address CVH through SES should consider the role of sex.

Abstract PURPOSE: To evaluate the prevalence of food insecurity among patients with cancer and to validate the Hunger Vital Sign (HVS) instrument compared to the standard-of-care USDA 18-item Household Food Security Scale (HFSS). The secondary objective was to assess disparities in food access based on race, zip code and insurance status.PATIENTS AND METHODS: Patients with cancer who were hospitalized at The Ohio State University James Comprehensive Cancer Center (OSU-CCC) were identified to participate by the Department of Social Work. Each patient completed the HVS and the 18-item HFSS. The prevalence of food insecurity was estimated and 95% Wilson score confidence intervals were calculated. The agreement between the prevalence of food insecurity as measured by the two different instruments were compared through the use of McNemar’s test. Disparities in food access based on race, zip code and insurance status were further assessed with Fisher exact tests. RESULTS: One hundred and twelve patients participated. We found that the HVS identified food insecurity in 14.3% (95% Confidence Interval (CI): 9.1, 21.7) of participants, whereas the 18-item HFSS identified 8.6% (95% CI: 4.8, 15.1) of participants. However, there was no significant difference between food insecurity as measured by the HVS and the 18-item HFSS (p = 0.289). There were also no significant differences in food insecurity based on race, insurance status or geographical location of patients.CONCLUSION: The HVS is an alternative to the 18-item HFSS as a valid tool to assess food security amongst hospitalized patients with cancer.