Introduction
Methods
Study design, setting, and population
Study variables
Statistical analysis
Results
Descriptive characteristics
Overall | Optimal | Average | Poor | p value | |
---|---|---|---|---|---|
Sample (N) | 195,901 | 46,701 | 114,961 | 34,239 | |
Weighted sample, (weighted %) | 183,726,611 (100.0) | 45,549,963 (24.8) | 108,375,333 (58.9) | 29,801,315(16.2) | |
Mean age (SD) | 40.4 (13.0) | 36.5 (12.4) | 39.9 (12.7) | 48.2 (11.6) | |
Age Categories | < 0.001 | ||||
18–44 | 113,320 (58.6) | 33,121 (70.1) | 69,298 (60.7) | 10,901 (33.2) | |
45–54 | 43,425 (22.8) | 8148 (18.6) | 25,072 (22.3) | 10,205 (31.2) | |
55–64 | 39,156 (18.6) | 5432 (11.4) | 20,591 (17) | 13,133 (35.6) | |
Sex, n (weighted %) | 0.845 | ||||
Men | 89,079 (49.1) | 21,799 (49.2) | 52,140 (49.1) | 15,140 (49) | |
Women | 106,822 (50.9) | 24,902 (50.8) | 62,821 (50.9) | 19,099 (51) | |
Race/Ethnicity, n (weighted %) | < 0.001 | ||||
Non-Hispanic White adults | 112,084 (70) | 29,630 (75.9) | 62,973 (68) | 19,481 (68.7) | |
Non-Hispanic Black adults | 31,222 (13.3) | 4808 (9.3) | 18,503 (13.7) | 7911 (18) | |
Hispanic adults | 38,552 (16.7) | 8068 (14.8) | 25,025 (18.4) | 5459 (13.3) | |
Education, n (weighted %) | < 0.001 | ||||
< High School | 28,732 (13.3) | 3237 (6.8) | 18,402 (14.4) | 7093 (19) | |
High School or GED | 49,468 (26.2) | 7463 (16.6) | 30,838 (28) | 11,167 (34.3) | |
Some College | 40,161 (20.8) | 9964 (21.8) | 23,329 (20.6) | 6868 (20) | |
> College | 76,729 (39.7) | 25,936 (54.8) | 41,841 (37) | 8952 (26.7) | |
Family income, n (weighted %) | < 0.01 | ||||
High-income | 60,948 (39.8) | 19,665 (51.9) | 33,477 (37.4) | 7806 (30.1) | |
Middle-income | 49,681 (29) | 11,275 (26) | 29,820 (30.1) | 8586 (29.9) | |
Low-income | 66,723 (31.2) | 11,794 (22.1) | 40,205 (32.6) | 14,724 (40) | |
Insurance status, n (weighted %) | < 0.001 | ||||
Insured | 145,435 (79.4) | 37,333 (85) | 82,358 (76.7) | 25,744 (80.3) | |
Uninsured | 41,819 (20.6) | 7472 (15) | 27,780 (23.3) | 6567 (19.7) | |
Region, n (weighted %) | < 0.001 | ||||
Northeast | 31,260 (17.3) | 7507 (17.5) | 18,673 (17.6) | 5080 (15.8) | |
Midwest | 42,408 (23.5) | 9904 (23) | 24,800 (23.4) | 7704 (24.5) | |
South | 71,899 (36.5) | 14,948 (32) | 42,427 (36.8) | 14,524 (42.3) | |
West | 50,334 (22.8) | 14,342 (27.5) | 29,061 (22.3) | 6931 (17.4) | |
Cardiovascular Risk Factors, n (weighted %) | < 0.001 | ||||
Diabetes mellitus | 13,812 (6.5) | - | 2844 (2.5) | 10,968 (31.2) | |
Hypertension | 45,990 (22.4) | - | 19,903 (17.2) | 26,087 (75.5) | |
High cholesterol | 15,476 (19.7) | - | 5973 (14.3) | 9503 (60.2) | |
Smoker | 42,284 (21.3) | - | 27,190 (24) | 15,094 (44.2) | |
Obesity | 60,789 (30.3) | - | 34,894 (30.3) | 25,895 (76.7) | |
Insufficient physical activity | 101,128 (50.7) | - | 71,673 (62.2) | 29,455 (86.3) | |
Comorbidities | < 0.001 | ||||
0 | 50,869 (66.8) | 14,364 (77.7) | 29,557 (69.4) | 6948 (45.3) | |
1 | 18,621 (23.8) | 3520 (18.8) | 9949 (23) | 5152 (32.5) | |
>=2 | 8085 (9.4) | 691 (3.4) | 3498 (7.6) | 3896 (22.2) |
AAMR
All-cause mortality (per 100,000 person-years) | CVD mortality (per 100,000 person-years) | |||||
---|---|---|---|---|---|---|
Optimal | Average | Poor | Optimal | Average | Poor | |
Mortality Rate | 177.0 (154.9–199.1) | 397.8 (378.5–417.2) | 838.7 (786.5–890.8) | 74.0 (57.5–90.6) | 197.7 (185.5–209.8) | 328.6 (303.5–353.7) |
Age Categories | ||||||
18–44 | 110.2 (90.2–130.1) | 206.1 (187.9–224.3) | 441.7 (368.6–514.9) | 3.1 (0.6–5.7) | 17.8 (12.9–22.8) | 51.4 (30.6–72.1) |
45–54 | 205.3 (157.4–253.1) | 520 (476.4–563.6) | 1066 (943.1–1190) | 27.3 (11.1–43.5) | 93 (70.6–115.5) | 194.1 (145.8–242.5) |
55–64 | 319.4 (237.2–401.6) | 857.8 (792.2–923.3) | 1800 (1658–1942) | 54.1 (21.4–86.8) | 153.5 (123–184) | 346.3 (280.9–411.7) |
Sex, n (weighted %) | ||||||
Men | 226.9 (190.2–263.6) | 480.3 (451–509.6) | 976.7 (897.1–1056) | 88.8 (64.3–113.3) | 219.1 (200.7–237.6) | 391.6 (350.5–432.8) |
Women | 131.1 (107.1–155.0) | 317.2 (291.9–342.5) | 708.6 (643.1–774) | 57 (35.4–78.6) | 178.8 (162.6–195) | 280.7 (251.1–310.3) |
Race/Ethnicity, n (weighted %) | ||||||
NH White adults | 139.3 (114.1–164.6) | 381.2 (356.2–406.2) | 858.1 (793.3–922.9) | 79.6 (59.5–99.8) | 227.8 (211–244.6) | 382.3 (346.8–417.9) |
NH Black adults | 217.9 (153.1–282.8) | 462.7 (417.2–508.3) | 828.7 (673.8–983.6) | 85.3 (22.2–148.5) | 161.6 (132.2–191.1) | 264.2 (240.2–288.1) |
Hispanic adults | 336.8 (271.8–401.2) | 519.7 (474.5–565.1) | 701.6 (650.1–752.9) | 48.6 (17.8–79.1) | 105.1 (68.2–143.0) | 180.8 (150.1–211.2) |
Education, n (weighted %) | ||||||
< High School | 397.7 (280.1–515.3) | 604.2 (545.5–662.8) | 1163 (1028–1299) | 160.6 (69–252.3) | 405.7 (359.9–451.5) | 615.7 (542.8–688.7) |
High School or GED | 249.6 (182.8–316.3) | 468.1 (424.7–511.6) | 911.2 (821.7–1001) | 95.6 (49.4–141.8) | 224.1 (198.5–249.6) | 321 (276.5–365.5) |
Some College | 148.2 (109.3–187.2) | 330.9 (289.8–372.1) | 635.2 (545.5–724.9) | 68.1 (35.3–100.9) | 139.7 (117.8–161.6) | 274 (221.3–326.6) |
> College | 153.8 (127.8–179.7) | 297.7 (270.2–325.1) | 612.9 (521.3–704.6) | 50.7 (32.0–69.4) | 129 (112.5–145.5) | 215.5 (180.2–250.8) |
Family income, n (weighted %) | ||||||
High-income | 145.8 (118.9–172.7) | 276 (248.8–303.1) | 530.1 (452.1–608.1) | 32.8 (16.1–49.5) | 112 (96.1–128) | 181.8 (142.2–221.4) |
Middle-income | 163.3 (115.2–211.5) | 395.5 (357–434.1) | 752.5 (653.3–851.8) | 57.9 (29.9–85.9) | 208.5 (180.3–236.7) | 314.5 (267.9–361.2) |
Low-income | 343.6 (258.4–428.8) | 551.5 (508.5–594.5) | 952.1 (867.2–1037) | 135.5 (79.4–191.6) | 244.9 (217.9–271.9) | 417.7 (370.5–464.8) |
Insurance status, n (weighted %) | ||||||
Insured | 155.3 (132.1–178.6) | 384.5 (362.5–406.6) | 856.2 (794.2–918.1) | 84.8 (64.2–105.3) | 227.6 (213.1–242.1) | 380.7 (350.3–411.2) |
Uninsured | 326.3 (253.2–399.5) | 412 (367.5–456.5) | 730.9 (623–838.8) | 39.7 (12.8–66.6) | 73.5 (53.5–93.4) | 129.5 (88.2–170.7) |
Region, n (weighted %) | ||||||
Northeast | 160.6 (98.76–222.5) | 370.7 (326.1–415.4) | 665.1 (543.2–787) | 103.6 (43.9–163.4) | 215.3 (189.9–240.7) | 288.5 (231.6–345.5) |
Midwest | 157.5 (113.2–201.8) | 368.8 (329.3–408.2) | 795.7 (696.6–894.9) | 68.8 (40.6–97.1) | 193.3 (164.1–222.5) | 363.3 (305.5–421.1) |
South | 181.4 (143.7–219.0) | 409.7 (374.8–444.7) | 921.6 (839.4–1004) | 62.6 (37.0–88.1) | 198.1 (177.5–218.8) | 351.1 (309.9–392.4) |
West | 197.9 (156.3–239.6) | 434 (394.4–473.7) | 841.1 (704.0–978.2) | 77.6 (44.6–110.6) | 187.8 (164–211.5) | 274.6 (225.7–323.4) |
Cardiovascular Risk Factors, n (weighted %) | ||||||
Diabetes mellitus | 872.2 (693.1–1051) | 1653 (1501–1805) | 511.2 (404.8–617.5) | 792.8 (709.3–876.2) | ||
Hypertension | 561.6 (509.4–613.7) | 1235 (1156–1315) | 390.6 (355.7–425.5) | 668.9 (617.7–720.1) | ||
High cholesterol | 335.1 (193.1–477.2) | 833.2 (692.2–974.2) | 179 (91.6–266.4) | 342 (270.7–413.3) | ||
Smoker | 588.4 (542.2–634.6) | 1007 (920.3–1094) | 158.1 (131–185.1) | 262.4 (224.7–300.1) | ||
Obesity | 331.1 (295.5–366.7) | 815.5 (752.1–878.9) | 134.9 (107.7–162.1) | 266 (239–293.1) | ||
Insufficient physical activity | 466.5 (438.7–494.3) | 918.8 (860.5–977.1) | 280.3 (260–300.6) | 427.1 (393.8–460.4) | ||
Comorbidities | ||||||
0 | 138.1 (82.42–193.8) | 222.0 (184.5–259.4) | 436.5 (289.5–583.6) | 40.7 (7.1–74.4) | 97.8 (70.0–125.5) | 110.2 (69.1–151.3) |
1 | 175.8 (68.8–282.7) | 525.1 (398.1–652.0) | 739.6 (540.7–938.5) | 25.8 (1.3–61.9) | 158.2 (114.6–201.8) | 286 (200.9–371.1) |
>=2 | 539.7 (519.7–558.7) | 1185 (1074.3–1295.0) | 1405 (1123.1–1687.0) | 64.3 (9.2–157.7) | 310.7 (208.2–413.1) | 510.1 (375–645.1) |
Multivariable regression
Association between cardiovascular risk factor (CRF) profile and all-cause mortality
All-Cause Mortality | Cardiovascular Disease Mortality | ||||
---|---|---|---|---|---|
Hazard Ratio (95% CI) | Hazard Ratio (95% CI) | ||||
CRF Profile | Model 1* | Model 2** | Model 1* | Model 2** | |
Optimal | Reference | Reference | Reference | Reference | |
Total Population | Average | 2.57 (2.26–2.92) | 1.89 (1.62–2.21) | 5.16 (4.08–6.53) | 2.86 (2.09–3.92) |
Poor | 7.68 (6.71–8.80) | 3.48 (2.96–4.10) | 13.43 (10.57–17.08) | 4.76 (3.44–6.60) | |
Age: 18–44 y | Average | 1.97 (1.62–2.38) | 1.49 (1.16–1.91) | 6.31 (2.56–15.59) | 3.99 (1.08–14.74) |
Poor | 4.84 (3.81–6.13) | 2.95 (2.20–3.95) | 24.58 (9.51–63.50) | 10.81 (2.67–43.69) | |
45–54 y | Average | 2.56 (2.01–3.25) | 2.17 (1.65–2.86) | 3.46 (1.84–6.51) | 2.96 (1.26–6.96) |
Poor | 5.43 (4.21–7.01) | 3.86 (2.88–5.19) | 7.58 (3.96–14.50) | 4.95 (2.12–11.54) | |
55–64 y | Average | 2.72 (2.07–3.58) | 2.35 (1.70–3.25) | 2.88 (1.50–5.54) | 2.64 (1.14–6.08) |
Poor | 5.89 (4.54–7.65) | 4.19 (3.06–5.73) | 6.74 (3.58–12.70) | 5.74 (2.54–12.93) | |
Sex: Men | Average | 2.51 (2.12–2.97) | 1.69 (1.38–2.07) | 4.09 (3.02–5.53) | 2.63 (1.78–3.89) |
Poor | 7.16 (6.01–8.53) | 3.17 (2.56–3.92) | 11.51 (8.47–15.63) | 4.56 (3.04–6.83) | |
Women | Average | 2.69 (2.19–3.29) | 2.27 (1.78–2.89) | 7.41 (5.06–10.84) | 3.29 (2.01–5.37) |
Poor | 8.61 (7.00–10.60) | 4.05 (3.15–5.22) | 17.83 (12.10–26.27) | 5.23 (3.18–8.60) | |
NH White adults | Average | 3.19 (2.64–3.85) | 2.19 (1.77–2.69) | 5.9 (4.51–7.72) | 3.1 (2.21–4.34) |
Poor | 10.15 (8.42–12.24) | 4.14 (3.36–5.10) | 13.85 (10.50–18.28) | 5.18 (3.65–7.34) | |
NH Black adults | Average | 2.62 (1.80–3.81) | 1.47 (0.97–2.24) | 4.54 (2.21–9.33) | 1.57 (0.70–3.54) |
Poor | 7.93 (5.45–11.54) | 2.44 (1.56–3.80) | 14.6 (7.25–29.39) | 2.34 (1.04–5.25) | |
Hispanic adults | Average | 1.64 (1.27–2.11) | 1.29 (0.96–1.72) | 3.85 (1.80–8.27) | 2.01 (0.74–5.46) |
Poor | 3.62 (2.66–4.93) | 2.11 (1.48–2.99) | 14.9 (6.87–32.32) | 4.04 (1.42–11.50) | |
<High school | Average | 2 (1.46–2.73) | 1.52 (1.03–2.26) | 5.16 (2.91–9.16) | 2.67 (1.36–5.28) |
Poor | 5.71 (4.15–7.86) | 2.77 (1.83–4.18) | 12.34 (6.89–22.07) | 4.09 (2.05–8.17) | |
High school or GED | Average | 2.18 (1.65–2.88) | 1.93 (1.41–2.64) | 3.76 (2.26–6.27) | 2.77 (1.47–5.20) |
Poor | 5.84 (4.42–7.72) | 3.48 (2.50–4.83) | 7.43 (4.48–12.33) | 4.32 (2.31–8.08) | |
Some college | Average | 2.95 (2.22–3.91) | 2.14 (1.52–3.00) | 4.29 (2.57–7.14) | 2.33 (1.26–4.32) |
Poor | 8.95 (6.61–12.12) | 3.45 (2.39–4.99) | 13.81 (8.34–22.87) | 4.45 (2.46–8.08) | |
> College | Average | 2.25 (1.86–2.71) | 1.78 (1.41–2.24) | 4.69 (3.19–6.91) | 2.93 (1.83–4.70) |
Poor | 6.65 (5.37–8.24) | 3.7 (2.88–4.76) | 12.38 (8.19–18.73) | 5.31 (3.19–8.83) | |
High income | Average | 2.18 (1.77–2.68) | 1.76 (1.40–2.22) | 6.22 (3.67–10.56) | 3.09 (1.77–5.41) |
Poor | 5.55 (4.42–6.99) | 3.46 (2.68–4.46) | 15.12 (8.73–26.19) | 5.11 (2.90–9.02) | |
Middle income | Average | 3.01 (2.21–4.10) | 2.26 (1.60–3.20) | 7.03 (4.30–11.50) | 3.79 (2.25–6.37) |
Poor | 8.57 (6.33–11.61) | 4.28 (3.04–6.03) | 17.03 (10.30–28.18) | 5.91 (3.46–10.09) | |
Low income | Average | 2.39 (1.83–3.12) | 1.73 (1.28–2.34) | 3.88 (2.54–5.95) | 1.87 (1.18–2.95) |
Poor | 7.3 (5.56–9.58) | 2.91 (2.12–3.99) | 11.33 (7.33–17.50) | 3.19 (1.99–5.11) | |
Insured | Average | 2.91 (2.48–3.40) | 2.04 (1.70–2.44) | 5.85 (4.53–7.54) | 2.89 (2.09–3.98) |
Poor | 9.24 (7.86–10.86) | 3.67 (3.03–4.45) | 14.57 (11.23–18.92) | 4.77 (3.41–6.67) | |
Uninsured | Average | 1.48 (1.15–1.90) | 1.41 (1.04–1.91) | 2.39 (1.13–5.05) | 2.67 (0.91–7.80) |
Poor | 3.63 (2.82–4.65) | 2.58 (1.86–3.57) | 6.81 (3.17–14.61) | 5.52 (1.81–16.86) |
All-Cause Mortality | Cardiovascular Disease Mortality | ||||
---|---|---|---|---|---|
Hazard Ratio (95% CI) | Hazard Ratio (95% CI) | ||||
CRF Profile | Model A* | Model B** | Model A* | Model B** | |
Optimal | Reference | Reference | Reference | Reference | |
Total Population | Average | 2.15 (1.81–2.57) | 1.21 (0.80–1.83) | 2.56 (1.58–4.14) | 2.53 (0.69–9.25) |
Poor | 3.91 (3.24–4.72) | 1.64 (1.05–2.55) | 6.51 (3.97–10.68) | 2.08 (0.56–7.751)40 |