Race and Ethnicity Disparities in Life’s Essential 8 Among Ever‐Pregnant Adults in the United States: The National Health and Nutrition Examination Survey 2011 to 2020

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BACKGROUND: Cardiometabolic conditions are among the leading causes of maternal mortality in the United States. The American Heart Association's Life's Essential 8 provides an actionable summary measure for assessing cardiovascular health. METHODS: We conducted a cross-sectional analysis using data from the 2011 to March 2020 National Health and Nutrition Examination Survey on ever-pregnant adults. The exposure was race and ethnicity; outcomes included total Life's Essential 8 scores and individual metrics. We used survey-weighted linear and multinomial logistic regression, adjusting for confounders. RESULTS: Among 2208 ever-pregnant adults (mean age, 52.0±19.6 years), non-Hispanic (NH) Black adults had the lowest Life's Essential 8 scores (57.20 [95% CI, 55.96-58.44]), compared with NH White (62.85 [95% CI, 61.39-64.30]), Mexican and Hispanic (62.26 [95% CI, 60.86-63.66]), and NH Asian adults (65.83 [95% CI, 63.47-68.19]). After adjustment, NH Black adults had lower overall scores than NH White adults (β=-5.27 [95% CI, -6.81 to -3.74]), particularly for Life's Essential 8 components: blood pressure (β=-16.40 [95% CI, -20.17 to -12.63]) and body mass index (β=-9.36 [95% CI, -13.46 to -5.26]). Mexican and Hispanic adults had lower physical activity scores (β=-13.13 [95% CI, -19.41 to -6.86]) and were less likely to be in the high Life's Essential 8 quartile (relative risk ratio=1.32 [95% CI, 0.92-1.91]). NH Asian adults had lower physical activity (β=-20.29 [95% CI, -28.74 to -11.84]) but higher body mass index scores (β=22.98 [95% CI, 16.61-29.35]). CONCLUSIONS: Significant racial and ethnic disparities in cardiovascular health exist among ever-pregnant US adults, with NH Black women exhibiting the poorest profiles. Educational attainment was highly correlated with ideal cardiovascular health.

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