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Cardiovascular disease (CVD) is the leading cause of death among women in the US, which is experienced inequitably by race\/ethnicity\/nativity and socioeconomic status and is embedded within geographic contexts. The objective of the current study was to examine social inequities in pre-pregnancy risk factors for cardiovascular disease. We analyzed 16 years of geocoded natality data in Texas (N = 2,089,588 births between 2005 and 2020 to mothers aged 30\u201345 years) linked with census tract- and county-level data. Dependent variables included pre-pregnancy diabetes, hypertension, obesity, and smoking. Independent variables included individual-level race\/ethnicity\/nativity and educational attainment, tract-level poverty and racial\/ethnic concentrations, and county-level urban\/rural status, with controls for other sociodemographic characteristics and time trend. Two-level, random intercept hierarchical generalized logistic models were used to estimate associations and model fit. Significant social inequities at the individual-, tract-, and county-levels in each risk factor were found. For example, tract-level variables had substantial and significant association with the four CVD risk factors, ranging from 13% to 72% higher odds in adjusted models. For all four risk factors, the more rural the county of residence was, the higher the odds of having the risk factor (24% to 256% higher odds). Individual-level social inequalities by race\/ethnicity\/nativity (ORs ranging from 0.04 to 2.12) and education (ORs ranging from 1.25 to 5.20) were also observed. Enhancing our understanding of this important period of life may enable policy and interventions to better support women through this critical life stage.<\/jats:p>","DOI":"10.3390\/ijerph22030404","type":"journal-article","created":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T09:36:24Z","timestamp":1741599384000},"page":"404","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Social Inequities in Cardiovascular Disease Risk Factors at Multiple Levels Persist Among Mothers in Texas"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6023-4541","authenticated-orcid":false,"given":"Catherine","family":"Cubbin","sequence":"first","affiliation":[{"name":"Steve Hicks School of Social Work, The University of Texas at Austin, 405 W. 25th Street, Austin, TX 78705, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Quynh Nhu (Natasha) B.","family":"La Frinere-Sandoval","sequence":"additional","affiliation":[{"name":"Steve Hicks School of Social Work, The University of Texas at Austin, 405 W. 25th Street, Austin, TX 78705, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9574-6109","authenticated-orcid":false,"given":"Elizabeth M.","family":"Widen","sequence":"additional","affiliation":[{"name":"Department of Nutritional Sciences, College of Natural Sciences, The University of Texas at Austin, 200 W. 24th Street, Austin, TX 78712, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1037\/amp0000600","article-title":"Established adulthood: A new conception of ages 30 to 45","volume":"75","author":"Mehta","year":"2020","journal-title":"Am. Psychol."},{"key":"ref_2","unstructured":"(2022, October 14). Heart Disease Facts. Centers for Disease Control and Prevention, Available online: https:\/\/www.cdc.gov\/heartdisease\/facts.htm."},{"key":"ref_3","first-page":"293","article-title":"Emerging modifiable risk factors for cardiovascular disease in women: Obesity, physical activity, and sedentary behavior","volume":"40","author":"Barnes","year":"2013","journal-title":"Tex. Heart Inst. J."},{"key":"ref_4","first-page":"38","article-title":"Deaths: Leading Causes for 2021","volume":"73","author":"Curtin","year":"2024","journal-title":"Natl. Vital Stat. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1161\/CIRCULATIONAHA.118.037137","article-title":"Twenty Year Trends and Sex Differences in Young Adults Hospitalized with Acute Myocardial Infarction: The ARIC Community Surveillance Study","volume":"139","author":"Arora","year":"2019","journal-title":"Circulation"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3137","DOI":"10.1161\/01.CIR.102.25.3137","article-title":"Trends and Disparities in Coronary Heart Disease, Stroke, and Other Cardiovascular Diseases in the United States: Findings of the National Conference on Cardiovascular Disease Prevention","volume":"102","author":"Cooper","year":"2000","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1001\/jama.2019.9161","article-title":"Trends in Cardiometabolic Mortality in the United States, 1999\u20132017","volume":"322","author":"Shah","year":"2019","journal-title":"JAMA"},{"key":"ref_8","first-page":"143","article-title":"Racial and ethnic differences in cardiovascular disease risk factors: A systematic review","volume":"17","author":"Kurian","year":"2007","journal-title":"Ethn. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1768","DOI":"10.1001\/jama.2012.14306","article-title":"Association of Race and Sex with Risk of Incident Acute Coronary Heart Disease Events","volume":"308","author":"Safford","year":"2012","journal-title":"JAMA"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1161\/CIRCULATIONAHA.111.045120","article-title":"Associations Between Lipoprotein(a) Levels and Cardiovascular Outcomes in Black and White Subjects: The Atherosclerosis Risk in Communities (ARIC) Study","volume":"125","author":"Virani","year":"2012","journal-title":"Circulation"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.2105\/AJPH.2004.048165","article-title":"Race\/ethnicity, income, major risk factors, and cardiovascular disease mortality","volume":"95","author":"Thomas","year":"2005","journal-title":"Am. J. Public Health"},{"key":"ref_12","first-page":"106","article-title":"Widening Socioeconomic and Racial Disparities in Cardiovascular Disease Mortality in the United States, 1969\u20132013","volume":"3","author":"Singh","year":"2015","journal-title":"Int. J. MCH Aids."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1001\/jama.2009.2014","article-title":"Prevalence and Trends in Obesity Among US Adults, 1999\u20132008","volume":"303","author":"Flegal","year":"2010","journal-title":"JAMA"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1001\/jama.2012.39","article-title":"Prevalence of Obesity and Trends in the Distribution of Body Mass Index Among US Adults, 1999\u20132010","volume":"307","author":"Flegal","year":"2012","journal-title":"JAMA"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1161\/CIRCULATIONAHA.115.019904","article-title":"Modeling Future Cardiovascular Disease Mortality in the United States: National Trends and Racial and Ethnic Disparities","volume":"133","author":"Penalvo","year":"2016","journal-title":"Circulation"},{"key":"ref_16","unstructured":"(2022, October 14). Obesity is a Common, Serious, and Costly Disease. Centers for Disease Control and Prevention, Available online: https:\/\/www.cdc.gov\/obesity\/data\/adult.html."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1161\/CIR.0000000000001145","article-title":"Epidemiology of Diabetes and Atherosclerotic Cardiovascular Disease Among Asian American Adults: Implications, Management, and Future Directions: A Scientific Statement from the American Heart Association","volume":"148","author":"Kwan","year":"2023","journal-title":"Circulation"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Gordon, N.P., Lin, T.Y., Rau, J., and Lo, J.C. (2019). Aggregation of Asian-American subgroups masks meaningful differences in health and health risks among Asian ethnicities: An electronic health record based cohort study. BMC Public Health, 19.","DOI":"10.1186\/s12889-019-7683-3"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1177\/00333549211007519","article-title":"Cardiovascular Disease Risk Factors Among Immigrant and US-Born Adults in New York City","volume":"137","author":"Chernov","year":"2022","journal-title":"Public Health Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1080\/13557858.2014.946473","article-title":"Is health a right for all? An umbrella review of the barriers to health care access faced by migrants","volume":"20","year":"2015","journal-title":"Ethn. Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1353\/hpu.2013.0019","article-title":"Barriers to Health Care among Asian Immigrants in the United States: A Traditional Review","volume":"24","author":"Clough","year":"2013","journal-title":"J. Health Care Poor Underserved"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1007\/s10903-013-9898-1","article-title":"Barriers to Health Care Access Faced by Black Immigrants in the US: Theoretical Considerations and Recommendations","volume":"16","author":"Wafula","year":"2014","journal-title":"J. Immigr. Minor. Health"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1007\/s10903-011-9566-2","article-title":"Immigration Disparities in Cardiovascular Disease Risk Factor Awareness","volume":"14","author":"Langellier","year":"2012","journal-title":"J. Immigr. Minor. Health"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Alam, M.T., Echeverria, S.E., DuPont-Reyes, M.J., Vasquez, E., Murillo, R., Gonzalez, T., and Rodriguez, F. (2021). Educational Attainment and Prevalence of Cardiovascular Health (Life\u2019s Simple 7) in Asian Americans. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18041480"},{"key":"ref_25","first-page":"687","article-title":"Neighborhood context and cardiovascular disease risk factors: The contribution of material deprivation","volume":"11","author":"Cubbin","year":"2001","journal-title":"Ethn. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1161\/CIRCOUTCOMES.113.000698","article-title":"Association of neighborhood characteristics with cardiovascular health in the multi-ethnic study of atherosclerosis","volume":"7","author":"Unger","year":"2014","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1161\/CIRCULATIONAHA.114.013871","article-title":"Assessing neighborhood-level effects on disparities in cardiovascular diseases","volume":"131","author":"Correa","year":"2015","journal-title":"Circulation"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2219","DOI":"10.2105\/AJPH.2016.303471","article-title":"Neighborhood Disadvantage, Poor Social Conditions, and Cardiovascular Disease Incidence Among African American Adults in the Jackson Heart Study","volume":"106","author":"Barber","year":"2016","journal-title":"Am. J. Public Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e2336207","DOI":"10.1001\/jamanetworkopen.2023.36207","article-title":"Neighborhood Factors, Individual Stressors, and Cardiovascular Health Among Black and White Adults in the US: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study","volume":"6","author":"Hines","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1840","DOI":"10.1289\/EHP199","article-title":"Individual and Neighborhood Socioeconomic Status and the Association between Air Pollution and Cardiovascular Disease","volume":"124","author":"Chi","year":"2016","journal-title":"Environ. Health Perspect."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.healthplace.2017.05.010","article-title":"A marginal structural modeling strategy investigating short and long-term exposure to neighborhood poverty on BMI among U.S. black and white adults","volume":"46","author":"Do","year":"2017","journal-title":"Health Place"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"100529","DOI":"10.1016\/j.ssmph.2019.100529","article-title":"Associations between obesity and neighborhood socioeconomic status: Variations by gender and family income status","volume":"10","author":"Fan","year":"2020","journal-title":"SSM Popul. Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1016\/j.ssmph.2016.09.008","article-title":"Neighborhood racial composition and poverty in association with pre-pregnancy weight and gestational weight gain","volume":"2","author":"Mendez","year":"2016","journal-title":"SSM Popul. Health"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1007\/s10900-011-9377-3","article-title":"Neighborhood deprivation, supermarket availability, and BMI in low-income women: A multilevel analysis","volume":"36","author":"Ford","year":"2011","journal-title":"J. Community Health"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.healthplace.2017.04.010","article-title":"Long-term neighborhood poverty trajectories and obesity in a sample of california mothers","volume":"46","author":"Sheehan","year":"2017","journal-title":"Health Place"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Clark, C.R., Ommerborn, M.J., Hickson, D.A., Grooms, K.N., Sims, M., Taylor, H.A., and Albert, M.A. (2013). Neighborhood disadvantage, neighborhood safety and cardiometabolic risk factors in African Americans: Biosocial associations in the Jackson Heart study. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0063254"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"103033","DOI":"10.1016\/j.healthplace.2023.103033","article-title":"Longitudinal profiles of neighborhood socioeconomic vulnerability influence blood pressure changes across the female midlife period","volume":"82","author":"Schiff","year":"2023","journal-title":"Health Place"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1080\/15332640.2014.1002879","article-title":"Racial\/ethnic differences in associations between neighborhood socioeconomic status, distress, and smoking among U.S. adults","volume":"15","author":"Liu","year":"2016","journal-title":"J. Ethn. Subst. Abus."},{"key":"ref_39","unstructured":"(2022, October 13). Health Disparities in Rural Women. The American College of Obstetricians and Gynecologists. Available online: https:\/\/www.acog.org\/en\/clinical\/clinical-guidance\/committee-opinion\/articles\/2014\/02\/health-disparities-in-rural-women."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2611","DOI":"10.1016\/j.jacc.2020.09.601","article-title":"Pre-Pregnancy Hypertension Among Women in Rural and Urban Areas of the United States","volume":"76","author":"Cameron","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e615","DOI":"10.1161\/CIR.0000000000000753","article-title":"Call to Action: Rural Health: A Presidential Advisory from the American Heart Association and American Stroke Association","volume":"141","author":"Harrington","year":"2020","journal-title":"Circulation"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/S0277-9536(01)00214-3","article-title":"Place effects on health: How can we conceptualise, operationalise and measure them?","volume":"55","author":"Macintyre","year":"2002","journal-title":"Soc. Sci. Med."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Bronfenbrenner, U. (1979). The Ecology of Human Development, Harvard University Press.","DOI":"10.4159\/9780674028845"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1136\/jech.57.10.778","article-title":"Life course epidemiology","volume":"57","author":"Kuh","year":"2003","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1093\/ije\/30.4.668","article-title":"Theories for social epidemiology in the 21st century: An ecosocial perspective","volume":"30","author":"Krieger","year":"2001","journal-title":"Int. J. Epidemiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1111\/1471-0528.17587","article-title":"Rural-urban disparities in pregestational and gestational diabetes in pregnancy: Serial, cross-sectional analysis of over 12\u2009million pregnancies","volume":"131","author":"Venkatesh","year":"2024","journal-title":"BJOG"},{"key":"ref_47","unstructured":"Tennessee Department of Health (2025, February 24). Annual Summary Report 2020. Tennessee Pregnancy Assessment Monitoring System (PRAMS), Available online: https:\/\/www.tn.gov\/content\/dam\/tn\/health\/documents\/PRAMS-Summary-Report-2020.pdf."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1748-0361.2012.00421.x","article-title":"Maternal obesity and gestational weight gain in rural versus urban dwelling women in South Carolina","volume":"29","author":"Gallagher","year":"2013","journal-title":"J. Rural. Health"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1177\/1745691613506016","article-title":"Shedding Light on the Mechanisms Underlying Health Disparities Through Community Participatory Methods: The Stress Pathway","volume":"8","author":"Schafer","year":"2013","journal-title":"Perspect. Psychol. Sci."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"146502","DOI":"10.1155\/2014\/146502","article-title":"Understanding barriers and facilitators to healthy eating and active living in rural communities","volume":"2014","author":"Seguin","year":"2014","journal-title":"J. Nutr. Metab."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1196\/annals.1425.008","article-title":"Supporting the Mental Health of Mothers Raising Children in Poverty. How Do We Target Them for Intervention Studies?","volume":"1136","author":"Beeber","year":"2008","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Deater-Deckard, K., and Panneton, R. (2017). Ethnic Variation in Poverty and Parenting Stress. Parental Stress and Early Child Development, Springer International Publishing.","DOI":"10.1007\/978-3-319-55376-4"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Haghighat, N., Hu, M., Laurent, O., Chung, J., Nguyen, P., and Wu, J. (2016). Comparison of birth certificates and hospital-based birth data on pregnancy complications in Los Angeles and Orange County, California. BMC Pregnancy Childbirth, 16.","DOI":"10.1186\/s12884-016-0885-0"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1111\/ppe.12120","article-title":"Validity of birth certificate-derived maternal weight data","volume":"28","author":"Bodnar","year":"2014","journal-title":"Paediatr. Perinat. Epidemiol."},{"key":"ref_55","first-page":"48","article-title":"Local Governments in the United States: An Overview of Cities and Counties","volume":"6","author":"Kemp","year":"2011","journal-title":"Bus. Public. Adm. Stud."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/3\/404\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:50:07Z","timestamp":1760028607000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/3\/404"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,10]]},"references-count":55,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["ijerph22030404"],"URL":"https:\/\/doi.org\/10.3390\/ijerph22030404","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,10]]}}}