Race and Ethnicity Disparities in the Life’s Essential 8 Ever-Pregnant Adults in the United States: The National Health and Nutrition Examination Survey 2011-2020
Authors: Adeleye Khadijat , Tomiwa Tosin , Kwapong Yaa Adoma , Boakye Ellen , Adebowale Oluwalonimi , Owusu Brenda , Turkson-Ocran Ruth-Alma , Commodore-Mensah Yvonne , Ogungbe Oluwabunmi 
Published: August 2024

Background

Cardiometabolic conditions are among the leading causes of maternal mortality in the US. The American Heart Association (AHA)Life’s Essential 8TM(LE8) provides an actionable summary measure for assessing cardiovascular health.

Methods

We conducted a cross-sectional analysis of National Health and Nutrition Examination Survey (NHANES) data among ever-pregnant adults from 2011 through March 2020. The exposure of interest was race/ethnicity. Primary outcomes included LE8 scores (health outcome and lifestyle metrics). We fitted survey-weighted linear and multinomial logistic regression models, examining racial and ethnic disparities by LE8 scores and each metric separately, adjusting for confounders.

Results

Among 2,208 ever-pregnant adults, the mean age was 52.0 ± 19.64 years. Non- Hispanic (NH) Black adults had lower mean LE8 scores (57.20 95%CI: 55.96, 58.44) compared to NH White (62.85 95% CI: 61.39, 64.30), Mexican/Hispanic (62.26, 95%CI 60.86, 63.66), and NH Asian adults (65.83 95% CI: 63.47, 68.19). After adjusting for confounders, NH Black adults had significantly lower overall LE8 scores than NH White adults (β = -0.09, 95% CI: -0.12, -0.06), with lower scores for blood pressure (β = -0.25, 95% CI: -0.32, -0.18) and BMI (β = -0.21, 95% CI: -0.30, -0.11).

Mexican/Hispanic adults were less likely to be in the high LE8 score category (Quartile 3) compared to NH White adults (PRR: 1.32, 95% CI: 0.92 1.91) and had lower physical activity scores (β = -0.38, 95% CI: -0.55, -0.21). NH Asian adults had lower scores for physical activity (β = -0.76, 95% CI: -1.10, -0.4) but higher scores for BMI (β = 0.31, 95% CI: 0.23, 0.40).

Conclusion

NH Black, Hispanic ever-pregnant adults had a higher prevalence of adverse cardiometabolic outcomes. Focused interventions are needed to address these disparities and improve maternal cardiometabolic health, per AHA’s LE8 goals.

Clinical Perspective

What Is New?

The Life’s Essential 8 (LE8) score provides a comprehensive and actionable tool for assessing cardiovascular health in ever-pregnant adults, offering clinicians a standardized method to identify and stratify cardiovascular risk.

Significant racial and ethnic disparities exist in LE8 scores among ever- pregnant adults, with NH Black women consistently showing lower scores across various components, indicating a higher burden of cardiovascular risk factors.

Higher education levels and socioeconomic status are strongly associated with better LE8 scores, highlighting the importance of addressing social determinants of health in cardiovascular risk management.

What Are the Clinical Implications?

LE8 score can be used alongside existing risk assessment tools to better identify women at high risk for cardiometabolic complications during pregnancy. This allows for earlier intervention and potentially improved maternal health outcomes.

For women identified with lower LE8 scores, early intervention becomes crucial.

Preconception care programs can help optimize their cardiovascular health before pregnancy by promoting healthy diets, physical activity, and weight management.

The link between lower LE8 scores and lower socioeconomic status underscores the importance of addressing social determinants of health.