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Sex and Age Differences in the Association Between Social Determinants of Health and Cardiovascular Health According to Household Income Among Mongolian Adults: Cross-Sectional Study

Authors
 Sun Young Shim  ;  Hyeonkyeong Lee 
Citation
 JMIR PUBLIC HEALTH AND SURVEILLANCE, Vol.9 : e44569-10, 2023-12 
Journal Title
 JMIR PUBLIC HEALTH AND SURVEILLANCE 
Issue Date
2023-12
MeSH
Age Factors ; Blood Pressure ; Cardiovascular Diseases* / epidemiology ; Cross-Sectional Studies ; Female ; Humans ; Male ; Risk Factors ; Sex Factors ; Social Determinants of Health ; United States ; Young Adult
Keywords
association ; cardiovascular ; cardiovascular disease ; cardiovascular health ; cross-sectional study ; education ; health insurance ; household income ; risk factors ; social determinants of health
Abstract
Abstract

Background: Although social determinants of health (SDH) are an underlying cause of poor cardiovascular health (CVH), there is insufficient evidence for the association between SDH and CVH, which varies by sex and age among Mongolian adults.



Objective: We aimed to explore whether education, household income, and health insurance were associated with CVH according to sex and age among Mongolian adults.



Methods: The final sample included data on 5691 participants (male: n=2521. 44.3% and female: n=3170, 55.7%) aged 18-69 years from the 2019 World Health Organization STEPwise approach to noncommunicable disease risk-factor surveillance. CVH was measured using a modified version of Life's Simple 7 with 4 health behaviors (cigarette smoking, BMI, physical activity, and a healthy diet) and 3 biological factors (blood pressure, fasting glucose, and total cholesterol blood levels) and classified into poor, intermediate, and ideal levels as recommended by the American Heart Association. Multinomial logistic regression analyses examined the associations between SDH and CVH by monthly equivalized household income after adjusting for age, sex, work status, area, history of myocardial infarction or stroke, use of aspirin, and use of statin. Subgroup analyses were conducted to examine the associations between SDH and CVH based on sex and age, considering monthly equivalized household income as a key variable.



Results: Using the ideal level of CVH as a reference, among those with the lowest household income, having less than 12 years of education, and not having health insurance were associated with poor CVH (education level: odds ratio [OR] 2.42, 95% CI 1.30-4.51; P=.006; health insurance: OR 2.17, 95% CI 1.13-4.18; P=.02). These associations were more profound among female individuals (education level: OR 2.99, 95% CI 1.35-6.63; P=.007; health insurance: OR 2.54, 95% CI 1.09-5.90; P=.03) and those aged 18-44 years (education level: OR 3.22, 95% CI 1.54-6.72; P=.002; health insurance: OR 2.03, 95% CI 0.98-4.18; P=.06).



Conclusions: Participants in the lowest household income group with lower educational levels and without health insurance were more likely to have poor CVH, and these results were more pronounced in female individuals and young adults. These findings suggest the need to develop strategies for CVH equity in Mongolian female individuals and young adults that consider income levels, education levels, and health insurance.
Files in This Item:
T202307433.pdf Download
DOI
10.2196/44569
Appears in Collections:
3. College of Nursing (간호대학) > Dept. of Nursing (간호학과) > 1. Journal Papers
Yonsei Authors
Lee, Hyeonkyeong(이현경) ORCID logo https://orcid.org/0000-0001-9558-7737
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/197762
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