This Article  • Full text  • PDF  • 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 (239)  • Contact me when this article is cited  Related Content  • Related letter  • Similar articles in JAMA  Social Bookmarking   What's this?

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.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTER

Ethnic and Socioeconomic Factors as Determinants of Health Status
Sharon K. Davis and Marilyn A. Winkleby
JAMA. 1998;280(23):1989-1990.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Correlates of availability and accessibility of fruits and vegetables in homes of low-income Hispanic families
Dave et al.
Health Educ Res 2009;0:cyp044v1-cyp044.
ABSTRACT | FULL TEXT  

Longitudinal impact of physical activity on lipid profiles in middle-aged adults: the Atherosclerosis Risk in Communities Study
Monda et al.
J. Lipid Res. 2009;50:1685-1691.
ABSTRACT | FULL TEXT  

Persistent pathogens linking socioeconomic position and cardiovascular disease in the US
Simanek et al.
Int J Epidemiol 2009;38:775-787.
ABSTRACT | FULL TEXT  

Health Perceptions of Latinos With Intellectual Disabilities: The Results of a Qualitative Pilot Study
Jurkowski et al.
Health Promot Pract 2009;10:144-155.
ABSTRACT  

High frequency of adverse health behaviors in multiple sclerosis
Marrie et al.
Mult Scler 2009;15:105-113.
ABSTRACT  

Socioeconomic status and comorbidity as predictors of preoperative quality of life in cardiac surgery
Koch et al.
J. Thorac. Cardiovasc. Surg. 2008;136:665-672.
ABSTRACT | FULL TEXT  

Relational pathways between socioeconomic position and cardiovascular risk in a multiethnic urban sample: complexities and their implications for improving health in economically disadvantaged populations
Schulz et al.
J. Epidemiol. Community Health 2008;62:638-646.
ABSTRACT | FULL TEXT  

Distinct Component Profiles and High Risk Among African Americans With Metabolic Syndrome: The Jackson Heart Study
Taylor et al.
Diabetes Care 2008;31:1248-1253.
ABSTRACT | FULL TEXT  

Prevalence of chronic kidney disease stages 3-5 among acute medical admissions: another opportunity for screening
Annear et al.
QJM 2008;101:91-97.
ABSTRACT | FULL TEXT  

Comparing Diabetes Prevalence Between African Americans and Whites of Similar Socioeconomic Status
Signorello et al.
AJPH 2007;97:2260-2267.
ABSTRACT | FULL TEXT  

Socioeconomic Position, Race/Ethnicity, and Inflammation in the Multi-Ethnic Study of Atherosclerosis
Ranjit et al.
Circulation 2007;116:2383-2390.
ABSTRACT | FULL TEXT  

Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration
Vandenbroucke et al.
ANN INTERN MED 2007;147:W-163-W-194.
ABSTRACT | FULL TEXT  

Using concentration index to study changes in socio-economic inequality of overweight among US adolescents between 1971 and 2002
Zhang and Wang
Int J Epidemiol 2007;36:916-925.
ABSTRACT | FULL TEXT  

Hispanic Paradox in Biological Risk Profiles
Crimmins et al.
AJPH 2007;97:1305-1310.
ABSTRACT | FULL TEXT  

Socioeconomic Status and Obesity
McLaren
Epidemiol Rev 2007;0:mxm001v1.
ABSTRACT | FULL TEXT  

Socioeconomic Status, Race, and Body Mass Index: The Mediating Role of Physical Activity and Sedentary Behaviors during Adolescence
Hanson and Chen
J Pediatr Psychol 2007;32:250-259.
ABSTRACT | FULL TEXT  

Race/Ethnicity, Socioeconomic Status and the Health of Pregnant Women
Stewart et al.
J Health Psychol 2007;12:285-300.
ABSTRACT  

Cardiovascular Disease Risk Factor Knowledge in Young Adults and 10-year Change in Risk Factors: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Lynch et al.
Am J Epidemiol 2006;164:1171-1179.
ABSTRACT | FULL TEXT  

Socioeconomic Status and Trends in Disparities in 4 Major Risk Factors for Cardiovascular Disease Among US Adults, 1971-2002
Kanjilal et al.
Arch Intern Med 2006;166:2348-2355.
ABSTRACT | FULL TEXT  

Education and Diabetes in a Racially and Ethnically Diverse Population
Borrell et al.
AJPH 2006;96:1637-1642.
ABSTRACT | FULL TEXT  

Chronic Exposure to Everyday Discrimination and Coronary Artery Calcification in African-American Women: The SWAN Heart Study
Lewis et al.
Psychosom. Med. 2006;68:362-368.
ABSTRACT | FULL TEXT  

Relation of Cardiovascular Risk Factors in Women Approaching Menopause to Menstrual Cycle Characteristics and Reproductive Hormones in the Follicular and Luteal Phases
Matthews et al.
J. Clin. Endocrinol. Metab. 2006;91:1789-1795.
ABSTRACT | FULL TEXT  

Heart Disease and Stroke Statistics--2006 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Thom et al.
Circulation 2006;113:e85-e151.
FULL TEXT  

Impaired Vascular Reactivity in African-American Patients with Type 2 Diabetes Mellitus and Microalbuminuria or Proteinuria Despite Angiotensin-Converting Enzyme Inhibitor Therapy
Jawa et al.
J. Clin. Endocrinol. Metab. 2006;91:31-35.
ABSTRACT | FULL TEXT  

Determining Lifestyle Correlates of Body Mass Index using Multilevel Analyses: The Tromso Study, 1979-2001
Wilsgaard et al.
Am J Epidemiol 2005;162:1179-1188.
ABSTRACT | FULL TEXT  

Sex and Racial/Ethnic Disparities in Outcomes After Acute Myocardial Infarction: A Cohort Study Among Members of a Large Integrated Health Care Delivery System in Northern California
Iribarren et al.
Arch Intern Med 2005;165:2105-2113.
ABSTRACT | FULL TEXT  

Income Disparities in Body Mass Index and Obesity in the United States, 1971-2002
Chang and Lauderdale
Arch Intern Med 2005;165:2122-2128.
ABSTRACT | FULL TEXT  

Overweight and obesity trends from 1974 to 2003 in English children: what is the role of socioeconomic factors?
Stamatakis et al.
Arch. Dis. Child. 2005;90:999-1004.
ABSTRACT | FULL TEXT  

Social Status and Risky Health Behaviors: Results From the Health and Retirement Study
Wray et al.
Journals of Gerontology Series B: Psychological Sciences and Social Science 2005;60:S85-S92.
ABSTRACT | FULL TEXT  

Blood Pressure and Cognitive Function in an African-American and a Caucasian-American Sample: The Maine-Syracuse Study
Robbins et al.
Psychosom. Med. 2005;67:707-714.
ABSTRACT | FULL TEXT  

Is the Association between Socioeconomic Position and Coronary Heart Disease Stronger in Women than in Men?
Thurston et al.
Am J Epidemiol 2005;162:57-65.
ABSTRACT | FULL TEXT  

Association Between Breastfeeding and Likelihood of Myopia in Children
Chong et al.
JAMA 2005;293:3001-3002.
FULL TEXT  

Hispanic and Non-Hispanic White Elders from Massachusetts Have Different Patterns of Carotenoid Intake and Plasma Concentrations
Bermudez et al.
J. Nutr. 2005;135:1496-1502.
ABSTRACT | FULL TEXT  

Risk Factors for Cardiovascular Disease in Homeless Adults
Lee et al.
Circulation 2005;111:2629-2635.
ABSTRACT | FULL TEXT  

Educational inequalities in the metabolic syndrome and coronary heart disease among middle-aged men and women
Silventoinen et al.
Int J Epidemiol 2005;34:327-334.
ABSTRACT | FULL TEXT  

Discovering the Full Spectrum of Cardiovascular Disease: Minority Health Summit 2003: Report of the Outcomes Writing Group
Benjamin et al.
Circulation 2005;111:e124-e133.
FULL TEXT  

Race, Education, and Weight Change in a Biracial Sample of Women at Midlife
Lewis et al.
Arch Intern Med 2005;165:545-551.
ABSTRACT | FULL TEXT  

Looking Upstream
Cypress
Diabetes Spectr. 2004;17:249-253.
FULL TEXT  

Postprandial Ghrelin Is Elevated in Black Compared with White Women
Brownley et al.
J. Clin. Endocrinol. Metab. 2004;89:4457-4463.
ABSTRACT | FULL TEXT  

Perspective on Selected Issues in Cardiovascular Disease Research With a Focus on Black Americans
Albert et al.
Circulation 2004;110:e7-e12.
FULL TEXT  

Psychosocial Correlates and Outcomes of Physical Activity Among Latinos: A Review
Marquez et al.
Hispanic Journal of Behavioral Sciences 2004;26:195-229.
ABSTRACT  

Diet, Physical Activity, and Sedentary Behaviors as Risk Factors for Overweight in Adolescence
Patrick et al.
Arch Pediatr Adolesc Med 2004;158:385-390.
ABSTRACT | FULL TEXT  

Predictors of Postmenopausal Body Mass Index and Waist Hip Ratio in the Oklahoma Postmenopausal Health Disparities Study
Gavaler and Rosenblum
J. Am. Coll. Nutr. 2003;22:269-276.
ABSTRACT | FULL TEXT  

Influence of individual and neighbourhood socioeconomic status on mortality among black, Mexican-American, and white women and men in the United States
Winkleby and Cubbin
J. Epidemiol. Community Health 2003;57:444-452.
ABSTRACT | FULL TEXT  

Non-HDL Cholesterol as a Predictor of Cardiovascular Disease in Type 2 Diabetes: The Strong Heart Study
Lu et al.
Diabetes Care 2003;26:16-23.
ABSTRACT | FULL TEXT  

Non-HDL Cholesterol: Into the Spotlight
Hsia
Diabetes Care 2003;26:240-242.
FULL TEXT  

Depressive Symptoms, Unemployment, and Loss of Income: The CARDIA Study
Whooley et al.
Arch Intern Med 2002;162:2614-2620.
ABSTRACT | FULL TEXT  

A Reexamination of Smoking Before, During, and After Pregnancy
Kahn et al.
AJPH 2002;92:1801-1808.
ABSTRACT | FULL TEXT  

A Physiological Basis for Disparities in Diabetes and Heart Disease Risk among Racial and Ethnic Groups
Ludwig et al.
J. Nutr. 2002;132:2492-2493.
FULL TEXT  

Task Force #1--magnitude of the prevention problem: opportunities and challenges
Benjamin et al.
J Am Coll Cardiol 2002;40:588-603.
FULL TEXT  

Serum Insulin, Obesity, and the Incidence of Type 2 Diabetes in Black and White Adults: The Atherosclerosis Risk in Communities Study: 1987-1998
Carnethon et al.
Diabetes Care 2002;25:1358-1364.
ABSTRACT | FULL TEXT  

Cholesterol Predicts Stroke Mortality in the Women's Pooling Project
Horenstein et al.
Stroke 2002;33:1863-1868.
ABSTRACT | FULL TEXT  

Neighborhood Context and Youth Cardiovascular Health Behaviors
Lee and Cubbin
AJPH 2002;92:428-436.
ABSTRACT | FULL TEXT  

Educational Attainment and Coronary and Aortic Calcification in Postmenopausal Women
Gallo et al.
Psychosom. Med. 2001;63:925-935.
ABSTRACT | FULL TEXT  

Cigarette Smoking Behavior Among US Latino Men and Women From Different Countries of Origin
Perez-Stable et al.
AJPH 2001;91:1424-1430.
ABSTRACT | FULL TEXT  

Overweight and Sympathetic Overactivity in Black Americans
Abate et al.
Hypertension 2001;38:379-383.
ABSTRACT | FULL TEXT  

Commentary: Considerations for Use of Racial/Ethnic Classification in Etiologic Research
Kaufman and Cooper
Am J Epidemiol 2001;154:291-298.
ABSTRACT | FULL TEXT  

Acculturation and Leisure-Time Physical Inactivity in Mexican American Adults: Results From NHANES III, 1988-1994
Crespo et al.
AJPH 2001;91:1254-1257.
ABSTRACT | FULL TEXT  

Total and regional body composition across age in healthy Hispanic and white women of similar socioeconomic status
Casas et al.
Am. J. Clin. Nutr. 2001;73:13-18.
ABSTRACT | FULL TEXT  

Race, Ethnicity, and Geography: Disparities in Heart Disease in Women of Color
Graham-Garcia et al.
J Transcult Nurs 2001;12:56-67.
ABSTRACT  

Differences in Energy, Nutrient, and Food Intakes in a US Sample of Mexican-American Women and Men: Findings from the Third National Health and Nutrition Examination Survey, 1988-1994
Dixon et al.
Am J Epidemiol 2000;152:548-557.
ABSTRACT | FULL TEXT  

Identifying Patients for Weight-Loss Treatment: An Empirical Evaluation of the NHLBI Obesity Education Initiative Expert Panel Treatment Recommendations
Kiernan and Winkleby
Arch Intern Med 2000;160:2169-2176.
ABSTRACT | FULL TEXT  

Country of birth, acculturation status and abdominal obesity in a national sample of Mexican-American women and men
Sundquist and Winkleby
Int J Epidemiol 2000;29:470-477.
ABSTRACT | FULL TEXT  

Impact of Evidence-Based "Clinical Judgment" on the Number of American Adults Requiring Lipid-Lowering Therapy Based on Updated NHANES III Data
Jacobson et al.
Arch Intern Med 2000;160:1361-1369.
ABSTRACT | FULL TEXT  

Disparities in Health Indicators for Latinas in California
Baezconde-Garbanati et al.
Hispanic Journal of Behavioral Sciences 1999;21:302-329.
ABSTRACT  

Understanding ethnic differences in energy balance: can we get there from here?1
Kumanyika
Am. J. Clin. Nutr. 1999;70:1-2.
FULL TEXT  

Ethnic Variation in Cardiovascular Disease Risk Factors Among Children and Young Adults: Findings From the Third National Health and Nutrition Examination Survey, 1988-1994
Winkleby et al.
JAMA 1999;281:1006-1013.
ABSTRACT | FULL TEXT  

Ethnic and Socioeconomic Factors as Determinants of Health Status
Davis and Winkleby
JAMA 1998;280:1989-1990.
FULL TEXT