Trends in cardiovascular risk factor prevalence, treatment, and control among US adolescents aged 12 to 19 years, 2001 to March 2020.
Level 4 - case-series / case-control
Serial cross-sectional study using national survey data
PubMed 38872207 · doi:10.1186/s12916-024-03453-5
What was done
This serial cross-sectional study analyzed data from nine National Health and Nutrition Examination Survey (NHANES) cycles between January 2001 and March 2020. The sample included 15,155 US adolescents aged 12 to 19 years (representing approximately 32.4 million individuals). Investigators evaluated age-adjusted temporal trends in the prevalence, treatment, and control of key cardiovascular risk factors (including hypertension, elevated blood pressure, diabetes, prediabetes, hyperlipidemia, obesity, overweight, cigarette use, physical inactivity, and poor diet quality) using Joinpoint regression analysis across sociodemographic subgroups.
What was found
From 2001 to March 2020, significant increases occurred in the prevalence of prediabetes (from 12.5% [95% CI, 10.2%-14.9%] to 37.6% [95% CI, 29.1%-46.2%]), overweight (from 16.0% [95% CI, 14.1%-17.9%] to 20.3% [95% CI, 17.9%-22.7%]), and obesity (from 21.1% [95% CI, 19.3%-22.8%] to 24.8% [95% CI, 21.4%-28.2%]). Reductions were observed in cigarette use (18.0% [95% CI, 15.7%-20.3%] to 3.5% [95% CI, 2.0%-5.0%]), physical inactivity (83.0% [95% CI, 80.7%-85.3%] to 9.5% [95% CI, 4.2%-14.8%]), hyperlipidemia (34.2% [95% CI, 30.9%-37.5%] to 22.8% [95% CI, 18.7%-26.8%]), and hypertension (8.1% [95% CI, 6.9%-9.4%] to 5.5% [95% CI, 3.7%-7.3%]). Elevated blood pressure (10.4% to 11.0%), diabetes (0.7% to 1.2%), and poor diet quality (76.1% to 71.7%) showed no significant change. Hypertension treatment (9.6% to 6.0%) and diabetes treatment (51.0% to 26.5%) did not improve significantly, while blood pressure control was stable (75.7% to 73.5%) and glycemic control improved from 11.8% to 62.7%.
Why it matters
These findings delineate a 20-year divergence in adolescent cardiovascular health: substantial improvements in smoking, lipid profiles, and physical activity contrast with a tripling of prediabetes prevalence and worsening obesity rates.
Limits
The repeated cross-sectional design cannot evaluate individual-level trajectories or establish causality. Subgroup analyses for conditions with lower prevalence, such as diagnosed diabetes and hypertension treatment, had very wide confidence intervals due to small subgroup sample sizes. Lifestyle variables like diet and activity rely on survey reporting subject to recall bias.
Cited by
- contradicts According to the US census, over half of US citizens have a carbohydrate metabolism problem, pre-diabetes, or metabolic disease by age 18.