Date of Award
Spring 2026
Language
English
Embargo Period
4-3-2026
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
College/School/Department
Department of Environmental Health Sciences
Program
Environmental Health Sciences
First Advisor
David Carpenter
Committee Members
David Lawrence, David Spink, Lawrence Lessner, Temi Adeyeye
Keywords
Polychlorinated Biphenyls, Cardiovascular Diseases, Health Disparities, Structural Equation Modeling, Cardiometabolic Risk, Environmental Epidemiology.
Subject Categories
Environmental Public Health | Medicine and Health Sciences | Public Health
Abstract
Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in the United States and continues to disproportionately burden racial/ethnic minorities and socioeconomically disadvantaged populations. Traditional risk factors and behavioral explanations fail to fully account for these persistent disparities, motivating increased attention to intermediate biological pathways and environmental toxicant exposures through which structural inequities may become biologically embedded. This dissertation investigates how cardiometabolic biomarkers, diet quality, and exposure to persistent organic pollutants jointly contribute to cardiovascular disease risk in a nationally representative U.S. population.
Using data from the National Health and Nutrition Examination Survey (NHANES), three complementary studies were conducted. The first study quantified racial and ethnic differences in cardiometabolic biomarkers associated with cardiovascular risk and evaluated whether diet quality, systemic inflammation, and glycemic control mediate or suppress racial differences in lipid ratios. Results demonstrated that adjustment for these intermediates frequently revealed suppression effects, suggesting that conventional covariate adjustment may underestimate cardiovascular vulnerability in marginalized populations. The second study examined associations between serum polychlorinated biphenyl (PCB) concentrations and prevalent cardiovascular disease and assessed effect modification by socioeconomic status. Higher PCB burden was consistently associated with increased odds of cardiovascular disease, with evidence that socioeconomic position shapes absolute disease burden despite limited relative effect modification. The third study decomposed the association between PCB exposure and cardiovascular disease into direct and indirect components operating through metabolic pathways including systemic inflammation, adiposity, glycemic regulation, and lipid imbalance using survey-weighted structural equation modeling. Across all models and demographic subgroups, indirect effects were small or suppressive, while direct effects dominated, indicating that PCB-related cardiovascular risk operates largely through biological mechanisms not captured by conventional metabolic biomarkers.
Collectively, these findings demonstrate that cardiovascular disparities reflect the intersection of social patterning, environmental toxicant exposure, and biological dysregulation across the life course. Routine cardiometabolic markers and diet quality explain only a fraction of this risk, underscoring the need for pathway-aware epidemiologic modeling and environmental justice–informed prevention strategies. This work advances understanding of how structural and environmental inequities are biologically embodied and contributes to more mechanistically informed approaches to cardiovascular disease prevention and risk assessment.
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Recommended Citation
Oghaghare, Ese F., "Structural Inequities, Environmental Toxicants, and Cardiometabolic Pathways in Cardiovascular Disease: Evidence from a Nationally Representative U.S. Population" (2026). Electronic Theses & Dissertations (2024 - present). 373.
https://scholarsarchive.library.albany.edu/etd/373