Abstract 08: Prevalence and Patterns of Cardiovascular Multimorbidity in Black and White Adults at Midlife: The Bogalusa Heart Study

Background: Multiple chronic conditions, primarily of cardiovascular origins, are a major cause of disability, death, and health care spending. Cardiovascular multimorbidity is also associated with multiplicative risk of morality and substantially lower life expectancy, which may exacerbate health disparities. However, its impact in a rural and low socioeconomic community with a high proportion of minorities is understudied. We aimed to describe multimorbidity prevalence and patterns by race, sex, and socioeconomic status in a middle-aged, community-based cohort. Methods: We examined 1,298 Black (35%) and White (65%) individuals (mean age 48.17 ± SD 5.27 years; 59% female) from the Bogalusa Heart Study, a rural, community-based, longitudinal cohort in Bogalusa, Louisiana, between 2013 and 2016. Eight chronic conditions (CCs) selected based on CMS (Centers for Medicare & Medicaid Services) guidance were defined using data from self-reported medical history, medication use, and physiological or laboratory measures. We defined multimorbidity as the coexistence of two or more of these conditions. The prevalence of cardiovascular multimorbidity and the most commonly occurring dyads and triads were assessed by race, sex, and socioeconomic factors using chi-square tests. Results: We found that 70% of the 1,298 participants had ≥2 CCs, while 31% had ≥3 CCs. The most prevalent conditions were dyslipidemia (87.9%, n=1,141), hypertension (66.6%, n=864), and diabetes (19.7%, n=255). The prevalence of multimorbidity was higher in Black than in White (76.8%, n=344 vs. 66.5%, n=565; p<0.01) participants and higher in men than in women (73.6%, n=393 vs. 67.5%, n=516; p<0.02). Hypertension and dyslipidemia made up the most prevalent dyad (33.0%, n=413), while hypertension, dyslipidemia, and diabetes made up the most prevalent triad (9.4%, n=116). Multimorbidity prevalence was significantly higher among participants with government issued insurance compared to private insurance (80.7%, n=267 vs. 64%, n=427; p<0.001), and more common among lower income compared to higher income (74.6%, n=390 vs 65.4%, n=397; p<0.01), respectively. Conclusion: Cardiovascular multimorbidity is highly prevalent in midlife among participants of the Bogalusa cohort compared to national and even state-wide levels. These findings have critical public health ramifications and support the need to better study multiple CCs in rural, underserved populations to create tailored interventions that are effective among adults in their most productive years of life despite geographic and income barriers.