Rates of obesity, high blood pressure and diabetes keep climbing in US
Cardiovascular risk factors such as obesity and high blood pressure are much more prevalent in some parts of the United States than others—and some of those gaps are only widening as time goes on.
That was the biggest takeaway from a new analysis published in The American Journal of Cardiology.[1] The study’s authors reviewed answers to the Behavioral Risk Factor Surveillance System (BRFSS) survey from 2011 to 2021 to track changes in various health inequities over time.
“Delays in preventive care and screening as well as economic loss, disruptions in insurance coverage and worsening social determinants of health (food insecurity, housing instability) have fallen more heavily on low-income, minority and rural communities since the pandemic,” wrote first author Rachel K. Gardner, MD, a researcher with Beth Israel Deaconess Medical Center and Brigham and Women’s Hospital, and colleagues. “In addition, the spillover effects of the pandemic have disproportionately impacted some U.S. states more than others. Together, these changes could have profound implications for cardiovascular health across the country. However, little is known about how inequities in the burden of cardiometabolic and lifestyle risk factors across U.S. states have changed, especially since the pandemic. Understanding these epidemiological changes in place-based inequities is critically important and could inform targeted public health and policy interventions at the state- and national-level to advance cardiovascular health.”
The BRFSS survey is the world’s largest continuous health survey of its kind, collecting data from more than 400,000 adult participants each year. Gardner et al. based their comparison on data from 506,467 adults who participated in the survey in 2011 as well as 438,693 who participated in 2021.
Overall, from 2011 to 2021, increases were seen in the age- and sex-adjusted prevalence of diabetes (10.9% to 12.4%), hypertension (32.4% to 33.7%) and obesity (27.5% vs. 33.1%). The age- and sex-adjusted prevalence of hyperlipidemia, on the other hand, decreased during that time from 38.5% to 35.5%.
State-based differences in these risk factors, meanwhile, widened considerably. The age- and sex-adjusted difference between the U.S. state with the highest and lowest prevalence of diabetes, for example, increased from 5.7% in 2011 to 7.8% in 2021. Similar patterns were seen for hypertension (14.2% to 17.2%) and obesity (14.3% to 15.7%).
The team’s research did uncover some encouraging news. The age- and sex-adjusted prevalence of binge alcohol drinking decreased from 18.3% to 15.4%, for example, and physical inactivity and cigarette smoking also became less common in that 10-year timeframe. On a related note, the age- and sex-adjusted difference between the U.S. state with the highest and lowest prevalence of binge alcohol drinking, physical inactivity and cigarette smoking were all lower in 2021 than in 2011.
“Our discovery that state-based inequities in the burden of cardiometabolic risk factors have widened is concerning and has important public health implications,” the authors wrote. “There are a few potential reasons for these findings.”
The first of those potential reasons is the fact that geographic inequality is on the rise when it comes to both income and education in the United States. In addition, the group added, the fact that some states have made it a priority to expand Medicaid coverage, while other states have not is sure to impact the prevalence of these different risk factors.
The COVID-19 pandemic is another potential explanation. The pandemic resulted in “enormous disruptions in healthcare,” the authors wrote, in addition to “worsening social detriments of health that disproportionately affected some communities and states more than others.”
“As the U.S. emerges from the pandemic, our findings highlight the urgent need for targeted strategies to reduce state-based inequities in cardiometabolic risk factors,” the group concluded.
Click here for the full study.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.