Pattern of Changes in Behavioral Risk Factors and Development of Cardiovascular Disease: A Cross-National Study

Introduction:Americans have shown shorter life expectancy than people in other high income countries in the past decades. A cross‐national study showed that older Americans were less healthy than England people for a range of chronic diseases such as cardiovascular disease. The difference in chronic disease prevalence was little explained by a set of behavioral risk factors. The goal of this study aimed to examine the pattern of changes in behavioral risk factors within the US and England and to evaluate the impact of pattern of changes in individual behavioral risk factor on the difference in subsequent development of cardiovascular disease between the US and England.

Study Design and Method:To facilitate the cross‐national comparison, four waves of data (2006, 2008, 2010, and 2012) were obtained from the Harmonized Health and Retirement Study and Harmonized English Longitudinal Study of Ageing created by the Gateway to Global Aging Data. The outcome variable was the onset of cardiovascular disease (CVD) between 2010 and 2012. Pattern of changes in four behavioral risk factors (smoking, heavy drinking, physical inactivity, obesity) between 2006 and 2008 were measured to predict CVD onset between 2010 and 2012. Pattern of changes in each behavioral risk factor was identified as followings: (1) Keep Healthy Behavior: (e.g., reported not smoking at 2006 and 2008 wave) vs. Lose Healthy Behavior (e.g., reported not smoking at 2006 wave, but reported smoking at 2008 wave) and (2) Keep Risk Factor (e.g., reported smoking at 2006 and 2008 wave) vs. Lose Risk Behavior (e.g., reported smoking at 2006 wave, but reported not smoking at 2008 wave). Multivariate logistic regression was performed after controlling for baseline demographics, socioeconomic, and health factors. All analyses were adjusted for the effects of complex survey design to provide unbiased inference to the US and England populations.

Results: Americans were found to have higher rates of keeping non-heavy drinking behavior and being non-obese (keep healthy behavior) and to have lower rates of being obese (keep risk behavior) compared to England people. By adjusting for baseline covariates, Americans had higher likelihood of developing CVD (OR=1.30, 95% CI=1.14-1.47) than England people. After additionally adjusting for pattern of changes (keep healthy behavior vs. lose healthy behavior) in heavy drinking behavior and obesity, the OR increased to 1.35 (95% CI=1.17-1.55) and decreased to 1.22 (95% CI=1.05-1.42) respectively. In addition, the OR increased to 1.40 (95% CI=1.09-1.79) when additionally adjusting for pattern of changes in obesity (keep risk behavior vs. lose risk behavior).

Conclusion: Americans were more likely to develop cardiovascular disease compared to its counterpart England people. The magnitude of likelihood of developing CVD among Americans was changed after adjusting for pattern of change in obesity and heavy drinking behavior.