The Intersectional Forces of Race/Ethnicity and Gender: A Three-Way Moderation Analysis of Cardiovascular Disease Diagnosis and Preventive Care Utilization Among Midlife Adults

Background and Purpose:
Despite strong clinical evidence supporting secondary prevention for cardiovascular disease (CVD), utilization of preventive services remains uneven across populations. Prior research has documented disparities by race/ethnicity and gender, but these factors are often examined independently, potentially obscuring how intersecting social positions shape health behaviors. Guided by intersectionality theory, this study examines whether race/ethnicity and gender jointly moderate the association between a CVD diagnosis and preventive care utilization among midlife adults in the United States.

Methods:
Data were drawn from four waves (2010–2016) of the National Longitudinal Survey of Youth 1979 (N = 6,222), representing U.S. adults in midlife. Logistic regression models were estimated to examine associations between CVD diagnosis and four preventive services: influenza vaccination, cholesterol screening, blood sugar testing, and electrocardiography (ECG). Moderation was tested using two-way (CVD × race/ethnicity; CVD × gender) and three-way interaction terms (CVD × race/ethnicity × gender), adjusting for socioeconomic characteristics and comorbid conditions.

Results:
A CVD diagnosis was associated with higher likelihood of utilization across all four preventive services. However, race/ethnicity and gender, when examined separately, were not associated with significant moderation effects. In contrast, three-way interaction models revealed distinct intersectional patterns. Among Hispanic women, a CVD diagnosis was associated with a lower likelihood of influenza vaccination and ECG utilization, contrasting with the generally positive association observed in other groups. These findings indicate that disparities emerge not from race/ethnicity or gender alone, but from their combined and interacting effects.

Conclusion and Implications:
Findings suggest that transnationally and structurally embedded inequities shape preventive care utilization in ways that are not captured by conventional additive models. Intersectional analysis reveals patterns that remain hidden when social categories are treated independently. For social work research and practice, these results underscore the need for culturally responsive and gender-sensitive interventions targeting populations experiencing overlapping vulnerabilities, particularly Hispanic women with CVD. Policy and practice efforts should move beyond generalized approaches and instead address the structural, cultural, and relational mechanisms underlying disparities in preventive care. More broadly, this study demonstrates the importance of incorporating intersectionality into quantitative health research to better inform equity-focused interventions.