Income inequalities in cardiovascular health among children and adolescents, young adults, and middle-aged adults in Canada: A nationwide trend analysis, 2007-2019

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While socioeconomic inequalities in cardiovascular health are well-documented among older adults, evidence in younger populations is limited. This study assessed income inequalities in cardiovascular health among children and adolescents (6-17 years), young adults (18-39 years), and middle-aged adults (40-64 years) in Canada from 2007 to 2019. This serial cross-sectional study included 25,538 respondents from six biennial cycles of the nationally representative Canadian Health Measures Survey. Equivalized annual household income quartiles were used to measure socioeconomic position. Sub-optimal cardiovascular health was defined as the presence of obesity, hypertension, diabetes, or dyslipidemia, based on age-specific biomarker thresholds and medication use. Relative and absolute income inequalities in cardiovascular health were quantified using the relative index of inequality (RII) and slope index of inequality (SII), estimated using age group- and sex-stratified generalized linear models (RII>1 and SII>0 indicate pro-rich inequality). The prevalence of sub-optimal cardiovascular health decreased from 2007 to 2019 for children and adolescents (23.0%-17.1%, p trend <0.01), but remained stable for young (28.4%-27.0%, p trend =0.44) and middle-aged adults (55.4%-54.6%, p trend =0.88). Among children and adolescents, income inequalities in cardiovascular health increased over time (RIIs=1.39-3.60, p trend =0.01; SIIs=0.08-0.22, p trend =0.03), with trends more pronounced in males (RIIs=1.10-4.63, p trend <0.01; SIIs=0.02-0.29, p trend =0.01) than females (RIIs=1.85-2.47, p trend =0.27; SIIs=0.13-0.13, p trend =0.42). Income inequalities in cardiovascular health were present in young and middle-aged adults, with no significant temporal trends but divergent patterns by sex, decreasing in females and increasing in males. While cardiovascular health improved over time among children and adolescents in Canada from 2007 to 2019, persistent and widening income inequalities in cardiovascular health were evident during this period.

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