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Objective <p>To quantify socioeconomic inequalities among U.S. adults using NHANES 2021–2023 data, applying advanced inequality metrics to capture disparities in the post-pandemic period.</p> Methods <p>We analyzed adults from NHANES 2021–2023 with complete socioeconomic and health outcome data. Socioeconomic status (SES) was assessed using the Poverty Income Ratio (PIR; continuous) and education. Outcomes included obesity (BMI ≥ 30&#xa0;kg/m²), central obesity (waist circumference ≥ 102&#xa0;cm in men/≥88&#xa0;cm in women), hypertension (SBP ≥ 130 mmHg or DBP ≥ 80 mmHg), HDL cholesterol (men &lt; 40&#xa0;mg/dL; women &lt; 50&#xa0;mg/dL), and diabetes (HbA1c ≥ 6.5%). Inequalities were quantified using the Relative Index of Inequality (RII) based on ridit-transformed SES variables in survey-weighted Poisson regression models, and the Concentration Index (CI) by PIR.</p> Results <p>The analytic sample included 6,878 adults. Prevalence estimates were: central obesity 55.6%, obesity 39.8%, hypertension 37.3%, low HDL 23.7%, and diabetes 9.9%. Strong socioeconomic gradients were observed. PIR-based RII values indicated lower risks at higher SES: obesity 0.76, central obesity 0.82, hypertension 0.73, low HDL 0.52, and diabetes 0.33. Education-based RIIs revealed even steeper inequalities, especially for diabetes (0.30) and low HDL (0.44). All CI values were negative (e.g., diabetes − 0.154), confirming disproportionate concentration of adverse outcomes among disadvantaged groups.</p> Conclusion <p>Measured and laboratory-defined cardiometabolic abnormalities remain highly prevalent and strongly socially patterned in the post-pandemic U.S. Consistent pro-rich inequalities highlight the need for equity-oriented prevention and monitoring strategies, while underscoring the importance of interpreting laboratory-based outcomes in light of potential underestimation among higher-SES groups with well-controlled disease.</p>

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Socioeconomic inequalities in cardiometabolic health among United States adults using NHANES data

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月14日

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  • Serranur Bagci,
  • Furkan Ozel

摘要

Objective

To quantify socioeconomic inequalities among U.S. adults using NHANES 2021–2023 data, applying advanced inequality metrics to capture disparities in the post-pandemic period.

Methods

We analyzed adults from NHANES 2021–2023 with complete socioeconomic and health outcome data. Socioeconomic status (SES) was assessed using the Poverty Income Ratio (PIR; continuous) and education. Outcomes included obesity (BMI ≥ 30 kg/m²), central obesity (waist circumference ≥ 102 cm in men/≥88 cm in women), hypertension (SBP ≥ 130 mmHg or DBP ≥ 80 mmHg), HDL cholesterol (men < 40 mg/dL; women < 50 mg/dL), and diabetes (HbA1c ≥ 6.5%). Inequalities were quantified using the Relative Index of Inequality (RII) based on ridit-transformed SES variables in survey-weighted Poisson regression models, and the Concentration Index (CI) by PIR.

Results

The analytic sample included 6,878 adults. Prevalence estimates were: central obesity 55.6%, obesity 39.8%, hypertension 37.3%, low HDL 23.7%, and diabetes 9.9%. Strong socioeconomic gradients were observed. PIR-based RII values indicated lower risks at higher SES: obesity 0.76, central obesity 0.82, hypertension 0.73, low HDL 0.52, and diabetes 0.33. Education-based RIIs revealed even steeper inequalities, especially for diabetes (0.30) and low HDL (0.44). All CI values were negative (e.g., diabetes − 0.154), confirming disproportionate concentration of adverse outcomes among disadvantaged groups.

Conclusion

Measured and laboratory-defined cardiometabolic abnormalities remain highly prevalent and strongly socially patterned in the post-pandemic U.S. Consistent pro-rich inequalities highlight the need for equity-oriented prevention and monitoring strategies, while underscoring the importance of interpreting laboratory-based outcomes in light of potential underestimation among higher-SES groups with well-controlled disease.