Biological indicators of cardiovascular health by foster care history in adults.

Abstract

Introduction: Childhood adversity contributes to adult cardiovascular health (CVH) disparities, but CVH in foster care alumni, experience unique compounded stressors like attachment disruption and environmental upheaval, is understudied. In this study, biological CVH indicators were described among US adults with and without a foster care placement history.

Methods: Cross-sectional data from 4,625 adults (representing 17,226,361 US adults) approaching and in early midlife (2016-18) from The National Longitudinal Study of Adolescent to Adult Health was used. Biological indicators of CVH included body mass index, blood lipids, blood glucose, and blood pressure, which were each scored on a standardized scale of 0-100, with higher scores indicating better CVH. An unweighted average of these standardized scores was also computed. Incorporating sampling weights nationally representative estimates of CVH by foster care history were generated in 2024-25.

Results: There were 113 participants who reported a foster care placement history (1.8% [weighted]), representing 313,604 adults. Foster care alumni had poorer overall CVH scores (Mean=61.8, 95% CI=56.6, 66.9) and blood pressure health scores (Mean=48.7 [indicates hypertension], 95% CI=39.8, 57.5) compared to those without a foster care history (CVH: Mean=70.2, 95% CI=69.1, 71.4; blood pressure: Mean=61.6, 95% CI=59.9, 63.2). Notably, common protective factors (e.g., female sex, higher income) did not mitigate CVH risk in the foster care group.

Conclusions: Childhood foster care placement is associated with poorer CVH, particularly hypertension, even in groups generally at lower risk. Research and clinical initiatives are needed to better understand and address CVH inequities and promote cardiovascular wellness in this population.