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Findings for Women From the Third National Health and Nutrition Examination Survey, 1988-1994

Marilyn A. Winkleby, PhD; Helena C. Kraemer, PhD; David K. Ahn, PhD; Ann N. Varady, MS

JAMA. 1998;280:356-362.

Context.— Cardiovascular disease (CVD) risk factors are higher among ethnic minority women than among white women in the United States. However, because ethnic minority women are disproportionately poor, socioeconomic status (SES) may substantially explain these risk factor differences.

Objective.— To determine whether differences in CVD risk factors by ethnicity could be attributed to differences in SES.

Design.— Third National Health and Nutrition Examination Survey conducted between 1988 and 1994.

Setting.— Eighty-nine mobile examination centers.

Participants.— A total of 1762 black, 1481 Mexican American, and 2023 white women, aged 25 to 64 years, who completed both the home questionnaire and medical examination.

Main Outcome Measures.— Ethnicity and years of education (SES) in relation to systolic blood pressure, cigarette smoking, body mass index (BMI, a measure of weight in kilograms divided by the square of height in meters), physical inactivity, non–high-density lipoprotein cholesterol (non–HDL-C [the difference between total cholesterol and HDL-C]), and non–insulin-dependent diabetes mellitus.

Results.— As expected, most CVD risk factors were higher among ethnic minority women than among white women. After adjusting for years of education, highly significant differences in blood pressure, BMI, physical inactivity, and diabetes remained for both black and Mexican American women compared with white women (P<.001). In addition, women of lower SES from each of the 3 ethnic groups had significantly higher prevalences of smoking and physical inactivity and higher levels of BMI and non–HDL-C than women of higher SES (P<.001).

Conclusions.— These findings provide the greatest evidence to date of higher CVD risk factors among black and Mexican American women than among white women of comparable SES. The striking differences by both ethnicity and SES underscore the critical need to improve screening, early detection, and treatment of CVD-related conditions for black and Mexican American women, as well as for women of lower SES in all ethnic groups.

From the Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, Palo Alto, Calif.

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