Sex-Specific Associations Between Area-Level Poverty and Cardiometabolic Dysfunction Among US Adolescents

Abstract

Objective: Cardiometabolic disease is the leading cause of mortality in the United States. Cardiometabolic function during adolescence predicts future cardiometabolic disease, yet few studies have examined early determinants of cardiometabolic function. Informed by evidence of sex differences in the prevalence and severity of cardiometabolic disorders and evidence of sexual dimorphism in the stress response, we examined sex differences in the association between living in poverty and cardiometabolic function during adolescence, a precursor of later cardiometabolic disorders. Methods: We linked data from 10 415 adolescents aged 12-19 in the National Health and Nutrition Examination Survey (1999-2012) with US Census–tract data on area-level poverty (percentage of the population living in poverty, grouped into quartiles). We parameterized cardiometabolic dysfunction by summing the z scores of 6 cardiometabolic biomarkers, grouped into quintiles. Hierarchical ordinal models estimated associations. Results: Compared with residents in low-poverty areas, residents in high-poverty areas had elevated odds of cardiometabolic dysfunction (highest quartile of poverty odds ratio [OR] = 1.27; 95% confidence interval [CI], 1.08-1.50). This association was more pronounced among boys than girls (highest quartile of poverty for boys: OR = 1.36; 95% CI, 1.10-1.70; highest quartile of poverty for girls: OR = 1.17; 95% CI, 0.94-1.47). Conclusion: Our study supports the existence of sex-specific associations. These results highlight the potential for community-based programs, such as housing assistance, to improve population health.

Nutritional problems in childhood and adolescence: a narrative review of identified disparities

“…Poor body image puts young individuals at risk for engaging in disordered eating and such unhealthy attempts at weight control tend to promote greater weight gain over time (16)(17)(18)(19) . In order to design effective and equitable solutions to these health problems it is important to identify disparities in their burden among the population and contributing nutritional disparities (20)(21)(22)(23)(24)(25) .…”

Elevated Dietary Inflammation Among Supplemental Nutrition Assistance Program Recipients Provides Targets for Precision Public Health Intervention

“…35 Furthermore, emerging evidence indicates that severe COVID-19 involves inflammatory disruptions, 36 and low-income minority communities are experiencing greater burdens of both inflammation-associated chronic disease and COVID-19. 15,16,37 Study findings indicate that people receiving SNAP may be at Note: Boldface indicates statistical significance (p<0.05).One participant had a reported total daily energy intake of 24,000 kcal (>20 IQRs above the median). This participant remained in the analytic data set, but the 1 year of data were excluded from the mixed models.…”

“…In addition, each of the nutrient deficiencies identified in this study, including vitamin D, which was insufficient among the full study population, is independently linked to the prevention of inflammation-driven chronic disease and the support of immune responses to viral infections. 35,38−46 Thus, chronic disease and COVID-19 disparities seen in lowincome minority communities 15,16,37 may both be driven, in part, by modifiable nutritional deficiencies. This offers further support for leveraging SNAP policy to boost nutritional defense mechanisms.…”

A Population-Based Study of 33 Causes of Death amongst America’s Five Ethnic Populations 2015. In Pursuit of Social Justice

“…In examining current patterns of mortality we can make broad assumptions when we compare White American rates with the others, but especially Black and Indian/Alaskan Americans, who have long been known to have less favourable socioeconomic circumstances and poorer health outcomes ( Williams and Shenassa, 2020). Taking all the thirty-three categories into consideration, Black and Indian/Alaskan Americans, had the highest mortality rates in twenty-four of the thirtythree categories and second highest in twenty-one mortalities.…”