{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T10:00:19Z","timestamp":1791540019741,"version":"4.3.4"},"reference-count":50,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2024,5,1]],"date-time":"2024-05-01T00:00:00Z","timestamp":1714521600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Mean cardiovascular health has improved over the past several decades in the United States, but it is unclear whether the benefit is shared equitably. This study examined 30-year trends in cardiovascular health using a suite of income equity metrics to provide a comprehensive picture of cardiovascular income equity.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>The study evaluated data from the 1988\u20132018 National Health and Nutrition Examination Survey. Survey groupings were stratified by poverty-to-income ratio (PIR) category, and the mean predicted 10-year risk of a major cardiovascular event or death based on the pooled cohort equations (PCE) was calculated (10-year PCE risk). Equity metrics including the relative and absolute concentration indices and the achievement index\u2014metrics that assess both the prevalence and the distribution of a health measure across different socioeconomic categories\u2014were calculated.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              A total of 26 633 participants aged 40 to 75 years were included (mean age, 53.0\u201355.5 years; women, 51.9%\u201353.0%). From 1988\u20131994 to 2015\u20132018, the mean 10-year PCE risk improved from 7.8% to 6.4% (\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.05). The improvement was limited to the 2 highest income categories (10-year PCE risk for PIR 5: 7.7%\u20135.1%,\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.05; PIR 3\u20134.99: 7.6%\u20136.1%,\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.05). The 10-year PCE risk for the lowest income category (PIR &lt;1) did not significantly change (8.1%\u20138.7%). In 1988\u20131994, the 10-year PCE risk for PIR &lt;1 was 6% higher than PIR 5; by 2015\u20132018, this relative inequity increased to 70% (\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.05). When using metrics that account for all income categories, the achievement index improved (8.0%\u20137.1%,\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.05); however, the achievement index was consistently higher than the mean 10-year PCE risk, indicating the poor persistently had a greater share of adverse health.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>In this serial cross-sectional survey of US adults spanning 30 years, the population\u2019s mean 10-year PCE risk improved, but the improvement was not felt equally across the income spectrum.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.123.010111","type":"journal-article","created":{"date-parts":[[2024,4,3]],"date-time":"2024-04-03T09:01:03Z","timestamp":1712134863000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Trends in Income Inequities in Cardiovascular Health Among US Adults, 1988\u20132018"],"prefix":"10.1161","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8156-0808","authenticated-orcid":true,"given":"Nicholas K.","family":"Brownell","sequence":"first","affiliation":[{"name":"Division of Cardiology (N.K.B.), University of California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9787-3649","authenticated-orcid":true,"given":"Boback","family":"Ziaeian","sequence":"additional","affiliation":[{"name":"Division of Cardiology (B.Z.), University of California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9515-5050","authenticated-orcid":true,"given":"Nicholas J.","family":"Jackson","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Health Services Research (N.J.J.), University of California, Los Angeles."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7098-0513","authenticated-orcid":true,"given":"Adam K.","family":"Richards","sequence":"additional","affiliation":[{"name":"Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington (A.K.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","article-title":"Leading causes of death.","author":"Centers for Disease Control and Prevention","year":"2022","unstructured":"Centers for Disease Control and Prevention. 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