Investigating health risk behavior disparities in the United States with finite mixture modeling

Abstract Health disparities are ongoing challenges in the United States, with one of the underlying factors being the variation in health risk behaviors across different socioeconomic and demographic communities. In this cross-sectional ecological study, utilizing data from 26,781 US zip codes provided by the Centers for Disease Control and Prevention (CDC), we conducted generalized linear model regressions to explore the associations between race, poverty, education, and urban/rural status in areas. Our analysis indicated that areas with a higher prevalence of Black population and higher poverty levels are associated with a more significant number of unique health risk behaviors. Conversely, other racial groups were associated with fewer unique health risk behaviors, although they may still engage in higher levels of specific behaviors. These insights underscore the need for tailored public health strategies to address the disparities in health risk behaviors across different sub-populations. Additionally, we employed Finite Mixture Modeling (FMM) to identify distinct sub-populations in the United States based on health risk behaviors, specifically binge drinking, smoking, sleep deprivation, and physical inactivity, which are essential risk factors for chronic diseases such as cancer, diabetes, and cardiovascular diseases. We identified four clusters and conducted an in-depth analysis of the demographics and socioeconomic characteristics of the identified clusters. Our findings reveal that one cluster, characterized by the worst health risk behaviors, exhibited the highest poverty rate, the least favorable health insurance profile, and the lowest frequencies of post-secondary education attainment compared to the other three clusters. This cluster, therefore, warrants targeted public health interventions.