Millennial Cardiovascular Health in Early Adulthood: Dimensions of Generational Inequity

Background/Purpose:

A growing research suggests younger generations may exhibit poorer health than previous generations when they were the same age (Blue Cross Blue Shield, 2019). In 2019, members of the Millennial generation accounted for 72.1 million people of the United States population, surpassing Baby Boomers as the largest adult population. Unlike their Generation X predecessors, Millennials have faced particular disadvantages related to the great recession, increasing student loan debt, and lower income and social mobility (Pew Research Center, 2019). The economic and social contexts in which millennials have come of age may have unique implications on their health and well-being upending the assumption that each generation sees improvement in their standard of living. This study uses Link and Phelan’s (1995; 2010) theory of fundamental causes in health inequities to explore differences in cardiovascular health and risk factors between adults born in 1965-1980 (Generation X) and adults born in 1981-1996 (Millennials), when they are the same age. Understanding generational health differences aids in predicting future long-term health and health care needs as cohorts age.

Methods: This study uses detailed health and biomarker information obtained from questionnaire, body measurement, and blood sample measures available in the continuous National Health and Nutrition Examination Survey (1999-2018) to compare the health of Millennials and Generation X during young adulthood (ages 20 to 35). Outcome measures include obesity, smoking behavior, hypertension, high cholesterol, high C-reactive protein (inflammation), diabetes and pre-diabetes, and poor self-rated health. We also include sociodemographic and economic covariates in the models. We first construct the generations and then use logistic regression models to estimate odds ratios and predicted probabilities of poor cardiovascular wellbeing for the two generations.

Results: The average age of respondents in each cohort was 27.5 years. Preliminary results show that Millennials are more likely to smoke (OR=1.52), be obese (OR=1.48), have diabetes or pre-diabetes (OR=2.01), and rate their health poorly (OR=1.42). We did not find any statistical differences between the generations for cholesterol, high C-reactive protein, or hypertension. These differences were found across income and race and ethnic groups.

Conclusions and Implications: Millennials appear to be disadvantaged not only socially and economically, but also in terms of their cardiovascular health. While Millennials are more likely to be insured than Generation X was at the same age, it is not enough to protect against the other social and economic hardships that impact cardiovascular health and wellness. These results will have a long range effect on the life course health for Millennials, but also are important to consider as obesity, diabetes, and other pre-existing conditions are worrisome predictors of Covid-19 complications for all ages, and Millennials disproportionately suffer from these risk factors compared to previous generations.