The Gradient of Cardiovascular Health in Childhood: A Comparative Study of Portugal and South Africa

Abstract This study aims to explore the association between cardiovascular health (CVH) and socioeconomic circumstances (SEC) in children from Generation XXI (G21) (Portugal) and ExAMIN Youth Study (South Africa). CVH was assessed using the Life's Essential 8 CVH framework, including cholesterol, body mass index (BMI), blood pressure (BP), glucose, physical activity, diet, sleep, and tobacco exposure. SEC was categorized into low, intermediate, and high. In G21, all SEC indicators presented a graded association with CVH in children, with lower parental education, less advantaged occupation and lower income being associated with worse CVH indicators. For instance, children from mothers with lower educational levels presented higher BP (48m: AORlow=1.90, 95%CI:1.27-2.85, AORintermediate=1.74, 95%CI:1.14-2.65; 84m: AORlow = 1.36, 95%CI:0.92-2.02, AORintermediate=1.26, 95%CI:0.83-1.91; 120m: AORlow = 2.18, 95%CI:1.43-3.35, AORintermediate=1.81, 95%CI:1.15-2.85; 156m: AORlow=1.62, 95%CI:1.08-2.42, AORintermediate=1.23, 95%CI:0.79-1.91). The same trend was observed for lower paternal occupation and higher BP, lower income and higher BMI and more disadvantaged SEC and parents who smoke. In ExAMIN Youth children of parents with lower educational levels showed higher BP (AORlow=1.21, 95%CI:0.34-4.28; AORintermediate=1.17, 95%CI:0.64-2.14). Children from lower-income households also presented higher BP (AORlow=2.18, 95%CI:0.96-4.93; AORintermediate=1.79, 95%CI:0.76-4.21). Lower parental education was associated higher BMI (AORlow=3.26, 95%CI:0.47-22.40; AORintermediate=1.60, 95%CI:0.67-3.83). Also, lower-income households were associated with higher BMI (AORlow=2.56, 95%CI:0.81-8.13; AORintermediate=1.96, 95%CI:0.65-5.92). Socioeconomic disadvantage is consistently associated with poorer CVH in children. Findings highlight the need for early, equity-focused public health interventions, addressing social disparities for reducing burden of CV disease and fostering healthy aging worldwide. Key messages • Children from socioeconomically disadvantaged backgrounds consistently have poorer cardiovascular health, with lower parental education, income, and occupation linked to worse health outcomes. • Findings from Portugal and South Africa highlight the global need to address social determinants early to reduce cardiovascular risk and promote health equity.