Doctoral Candidate (Epidemiology) University of Toronto Toronto, Ontario, Canada
Background: Socioeconomic disparities in cardiovascular health are well-established among older adults, but less is known about these patterns in younger age groups. This study examined income inequalities in cardiovascular health between 2007 and 2019 among children and adolescents (6-17 years), young adults (18-39 years), and middle-aged adults (40-64 years) in Canada.
METHODS AND RESULTS: A serial cross-sectional design was applied using data from 25,500 respondents across six biennial cycles of the nationally representative Canadian Health Measures Survey. Equivalized household income quartiles were used as a marker of socioeconomic position. Sub-optimal cardiovascular health was defined by the presence of obesity, hypertension, diabetes, or dyslipidemia, based on objectively measured age-specific biomarker thresholds or self-reported medication use. Relative and absolute income inequalities were quantified using the relative index of inequality (RII) and slope index of inequality (SII), derived from survey-weighted generalized linear models (RII >1 and SII >0 indicate pro-rich inequality). All analyses were stratified by age group and adjusted for age, sex, race/ethnicity, and immigration status to account for population-level demographic changes. Sex-specific analyses and interaction terms were used to evaluate temporal trends. Between 2007 and 2019, the prevalence of sub-optimal cardiovascular health declined among children and adolescents (22.9%-17.1%, p< 0.01), but remained stable for young (28.4%-27.0%, p=0.44) and middle-aged adults (55.4%-54.6%, p=0.88). Income inequalities increased over time for children and adolescents (RII=1.39-3.59, p=0.01; SII=0.07-0.22, p=0.03), whereas no significant trends were observed for young (RII=1.58-2.79, p=0.45; SII=0.13-0.29, p=0.45) or middle-aged adults (RII=1.48-1.61, p=0.79; SII=0.22-0.26, p=0.78) (Figure 1). Among children and adolescents, the largest increases were observed in males (RII=1.09-4.63, p< 0.01; SII=0.02-0.29, p=0.01), while no significant trends were found for females (RII=1.85-2.47, p=0.27; SII=0.13-0.13, p=0.42). Among young adults, income inequalities appeared to increase among males (RII=0.94–3.10, p=0.07; SII=-0.01-0.37, p=0.06) and decrease among females (RII=2.81-2.10, p=0.26; SII=0.26-0.17, p=0.18), although these trends were not statistically significant. Similar but less pronounced patterns were observed among middle-aged males (RII=1.11-1.65, p=0.38; SII=0.06-0.32, p=0.36) and females (RII=1.97-1.63, p=0.67; SII=0.35-0.23, p=0.64).
Conclusion: Income inequalities in cardiovascular health persisted among Canadians aged 6-64 years from 2007 to 2019. Although the prevalence of sub-optimal cardiovascular health declined among children and adolescents, inequalities widened, with the largest increases observed among males. Among young and middle-aged adults, prevalence remained stable, while inequality trends appeared to diverge by sex. These findings highlight the need for targeted prevention strategies and equity-oriented policies to address growing socioeconomic disparities in cardiovascular health.
