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BACKGROUND: In 2013, 7% adults in Texas reported having cardiovascular disease (CVD). Known risk factors of CVD tend to cluster in populations; 18% of Texas adults reported having ≥3 risk factors. Limited research has investigated role of CVD risk factor clustering on health-related quality of life (HRQOL). Due to lack of prior investigation, we assessed the association between CVD risk factor clustering and HRQOL among adults with and without history of CVD in Texas, ≥18 years age, 2013.
METHODS: Data from 2013 Texas Behavioral Risk Factor Surveillance System were analyzed. Three dichotomous dependent self-reported HRQOL variables were measured: general health (fair/poor), physical distress (≥14 days/month) and frequent mental distress (FMD) (≥14 days/month). The 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 CVD risk factors: diabetes, hypertension, high cholesterol, obesity and current smoking. Chi-square tests were used to test differences in proportions of CVD risk factor clusters with HRQOL measures and demographic factors (age, gender, race-ethnicity, income, education and CVD status). Weighted multivariable logistic regression analyses were conducted to account for complex survey design, determine adjusted odds ratios (aOR) and 95% Confidence Intervals (CI) between CVD risk factors clustering and HRQOL measures.
RESULTS: Approximately 19% adults reported fair/poor general health, 12% reported physical distress and 9% reported FMD. Approximately 40% of adults had ≥2 CVD risk factors. CVD risk factor clustering was significantly associated with increasing age, being non-Hispanic Black, < high school education, lower household income and presence of CVD. Presence of ≥3 CVD risk factors was associated with 8.5 times (aOR: 8.5, 95%CI: 5.6-12.6) increased odds of reporting fair/poor general health, 5.6 times increased odds (aOR: 5.6, 95%CI: 3.7-8.5) of reporting physical distress and 5.7 times (aOR: 5.7, 95%CI: 3.7-8.9) increased odds of reporting FMD. Increasing number of CVD risk factors was significantly associated with increased likelihood of reporting poor health (P1 <0.0001 for linear trend and P2 <0.0001 for quadratic trend),physical distress (P1 <0.0001 for linear trend and P2 <0.0001 for quadratic trend ) and FMD (P1 <0.0001 for linear trend and P2 <0.0302 for quadratic trend )
CONCLUSIONS: Clustering of CVD risk factors among adults in Texas was common. CVD risk factor clustering has 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.