Clustering of Cardiovascular Disease Risk Factors and Health-Related Quality of Life among adults in Texas, 2013

Background: In 2013, 8% of adults in Texas reported having cardiovascular disease (CVD). Risk factors for CVD tend to cluster in general populations; 15% of Texas adults without CVD reported having ≥3 risk factors for CVD. The quality of health may be affected by these risk factors. However, limited research has investigated the role of CVD risk factor clustering on health-related quality of life (HRQOL). We assessed the association between CVD risk factor clustering and HRQOL among adults without a history of CVD in Texas.

Methods: Data from 2013 Texas Behavioral Risk Factor Surveillance System were analyzed. Three dichotomous dependent HRQOL variables were measured: general health (fair/poor), poor physical health (≥14 days/month) and frequent mental distress (FMD) (≥14 days poor mental health/month). Primary independent variable, clustering of CVD risk factors (value range 0-5, 4 categories: none, 1, 2 and ≥3 risk factors) was defined by self-reported: diabetes, hypertension, high cholesterol, obesity and current smoking. Chi-square was used to test differences in the number of CVD risk factors with HRQOL measures and covariates (age, gender, race-ethnicity, income, and education). Weighted data analysis was conducted using the SAS surveyfreq procedure to account for complex survey design. Multivariable logistic regression analyses were conducted to calculate adjusted prevalence ratios (aPR) and 95% Confidence Intervals (CI) between clustering of CVD risk factors and HRQOL measures.    

Results: Approximately 17% of adults reported fair/poor general health, 10% reported poor physical health and 8% reported FMD.  CVD risk factor clustering was significantly associated with increasing age, being non-Hispanic Black, < high school education, and lower household income. Presence of ≥3 CVD risk factors was associated with 9.7 times (aPR: 9.7, 95%CI: 6.4-14.7) increased odds of reporting fair/poor general health, 6.5 times increased odds (aPR: 6.5, 95%CI: 4.2-10.2) of reporting poor physical health and 6.7 times (aPR: 6.7, 95%CI: 4.4-10.4) increased odds of reporting FMD.

Conclusion: Clustering of CVD risk factors among adults without prior CVD in Texas was common and had a significant association with poor HRQOL. Public health interventions which target reducing multiple CVD risk factors via a coordinated approach might improve HRQOL among adults in Texas.