Trends and Key Contributors of Racial and Ethnic Disparities in Life’s Essential 8: NHANES 2011-2020
Authors: Yang Huanhuan , Huang Chenxi , Sawano Mitsuaki , Herrin Jeph , Faridi Kamil F. , Li Zhihui , Spatz Erica , Krumholz Harlan M. , Lu Yuan 
Published: November 2024

ABSTRACTSIMPORTANCESignificant racial and ethnic differences exist in Life’s Essential 8 (LE8), but the trends in these disparities over time are not well understood. Additionally, the key components of LE8 to these differences are unclear.OBJECTIVETo evaluate trends in racial and ethnic disparities in LE8 over a 10-year period and to identify the primary contributors among the eight LE8 components to these disparities.DESIGN, SETTING, AND PARTICIPANTSSerial population based cross-sectional study of the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2020, that included 16,104 adults aged 20-79 years.EXPOSURESelf-reported race and ethnicity.MAIN OUTCOME AND MEASURESTrends in racial and ethnic differences in LE8, and primary contributors to the disparity.RESULTSThe mean age of the participants was 46.2 (SE: 0.33) years; 51.1% were women; 68.2%, 10.9%, 15.7%, and 5.2% were White, Black, Latino/Hispanic, and Asian adults. From 2011-2020, Asian adults had the highest LE8 score (71.2), followed by White (67.7) and Latino/Hispanic (65.9) adults, and Black adults (62.0) had the lowest LE8 score. These racial/ethnic differences in LE8 overall score did not significantly change from 2011 to 2020 (all p value > 0.05). However, the differences in several individual components of LE8 changed significantly. For example, the Latino/Hispanic-White difference in sleep health score significantly enlarged, from −1.25 to −4.38, with a difference-in-difference of −3.12 (95% CI: −5.83, −0.42; p = 0.020). In 2017-2020, all but blood lipids and nicotine exposure were negative contributors (Z-scores < 0) for the Black-White difference; nicotine exposure was the key positive (Z-score =1.01), while physical activity was the key negative (Z-score = −1.01) contributor for the Latino/Hispanic-White difference; nicotine exposure (Z-score = 2.59) and diet (Z-score = 2.12) were the primary positive contributors for Asian-White difference.CONCLUSIONS AND RELEVANCERacial and ethnic disparities in overall LE8 scores compared to White adults remained largely unchanged from 2011 to 2020. These disparities were driven by varying components across different racial and ethnic groups, emphasizing the need for targeted, group-specific interventions.Key PointsQuestionWhat are the trends in racial and ethnic disparities in Life’s Essential 8 (LE8) metrics and what are the primary contributors to it over the past decade?FindingsRacial and ethnic disparities in overall LE8 remained stable, though some component gaps widened or narrowed. Black-White disparities were driven by factors beyond blood lipids and nicotine exposure, with physical activity as the primary negative contributor to Latino/Hispanic-White disparities, and diet and nicotine exposure as key positive contributors to Asian-White disparities.MeaningThese findings highlight the need for tailored interventions, providing insights to meet each racial and ethnic group’s unique needs.