Race/ethnic comparisons of waist‐to‐height ratio for cardiometabolic screening: The study of women's health across the nation
Abstract Objective To compare the performance of waist‐to‐height ratio as a screening tool for cardiometabolic conditions – hypertension, prediabetes/diabetes, dyslipidemia, and subclinical inflammation – in 5 race/ethnic groups of mid‐life women. Methods Waist‐to‐height ratio and 4 cardiometabolic conditions were assessed in 3033 premenopausal midlife women (249 Hispanic, 226 Chinese, 262 Japanese, 1435 European‐American, and 861 African American). The areas under the receiver operating characteristic curve (AUROC) were compared across the five race/ethnic groups using waist‐to‐height ratio to determine the likelihood of the four cardiometabolic conditions. Results The performance of waist‐to‐height ratio to detect one or more cardiometabolic conditions was comparable among all race/ethnic groups (AUROC > 0.60, p = 0.252), and was good/fair (AUROC > 0.60) when hypertension, prediabetes/diabetes, dyslipidemia, or subclinical inflammation were analyzed separately. The performance of waist‐to‐height ratio of 0.50 was skewed towards higher specificity among groups with low prevalence of cardiometabolic conditions and lower median waist‐to‐height ratio, and towards higher sensitivity among groups with high prevalence of cardiometabolic conditions and higher median waist‐to‐height ratio. Conclusions Waist‐to‐height ratio can be used for community‐based screening of mid‐life women who may need secondary prevention for cardiometabolic conditions. A simple public health message: “Keep your waist to less than half of your height” applies to midlife women.
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