PONE-D-24-48343Racial and Ethnic Disparities in Longitudinal Trajectories of Cardiovascular Risk Factors in U.S. Middle-Aged and Older AdultsPLOS ONE

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Reviewers' comments:

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Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This is a carefully thought-out analyses and the authors were successfully able to draw new data that highlights covariates that mediate disparities of racial and ethnic minorities (in middle-aged and older adults) in relation to their risks for different CVD risk factors, placing them in different trajectory group membership. Most of key data was highlighted and the methods were clear. The study is of significance to the broader scientific community.

I only have small suggestions here. Tables 4 and 5 were mostly utilized to demonstrate the sociodemographic factors that would place Hispanic adults or non-Hispanic black adults in different group memberships. It seems health related factors were not really mentioned and discussed much in text, whether in results / discussion. It might be more suited for discussion. What is the relationship between the health-related factors and the sociodemographic factors (if any)? Or simply acknowledge that looking at Table 4 and Table 5, health-related factors can account for some CVD risks, 36% for Hispanic adults, and 25% for non-Hispanic black adult.

Along the lines of the previous paragraph, can the study comment on baselines health characteristics of non-Hispanic black or Hispanic minorities compared to non-Hispanic white adults? These does not have to necessarily be mentioned with regards to CVD risks, but it would be important as health-related factors are also important covariates to consider in such analyses, whether in context of this study or previous studies.

Reviewer #2: Please expand the introduction section to shed light on the ethnicity and racial background as a determinant for population health, why certain ethnic/ racial groups are considered a health disparities.

Define the rationale of the study

Identify the impact of the study at the population and clinical practice levels.

Because the SD in the age is pretty wide which indicates presence of outliers, please use the median instead.

Define "South" and explain why South had been a classification category.

Expand the discussion section to further correlated between findings of this study and previous studies that had assessed similar population.

Add a section for future recommendations.

Reviewer #3: Thank you for the opportunity to review this manuscript in which the authors elucidate racial and ethnic disparities in longitudinal trajectories of cardiovascular risk factors in middle-aged and older adults in the United States.

This is an exceptional manuscript. The study is well conceived, well executed, and well reported. I just have some minor comments for consideration for this or future work.

1. How might geographic location of participant residential address play a part, for example poor vs wealthy suburbs, and rurality? These play significant roles in access to health care and therefore health outcomes. I believe that the United States has an area deprivation index – I wonder if this might help address this aspect, or if there is a geographic classification for health?

2. Similarly, consideration of participant visa/residency status may shed further light on access to health care and therefore health outcome.

3. For several variables, data is based on participant self-report of physician diagnosis. This presumes access to health provider, health literacy, acceptability of diagnosis. Some discussion of the direction and magnitude of any influence on the results this might have is warranted in the Strengths & Limitations section.

4. Very minor, in the Abstract: missing ‘[to] exhibit high rates of smoking’, and Nativity would benefit from explanation – it is explained in the Introduction but it was a novel term to come across in the abstract.

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Reviewer #1: No

Reviewer #2: Yes: WEAM BANJAR

Reviewer #3: Yes: Dr Miranda Buhler

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Racial and ethnic disparities in longitudinal trajectories of cardiovascular risk factors in U.S. middle-aged and older adults

PONE-D-24-48343R1

Dear Dr. Dupre,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Petri Böckerman

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

I am happy with the revised version of the paper.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

Reviewer #3: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: (No Response)

Reviewer #3: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: All comments have been addressed and I suggest for the manuscript to be accepted for publication, the study is a unique study and is likely to be of broad interest.

Reviewer #2: Thank you for addressing reviewers concerns, please define restrictions applied on data sharing and highlight protection applied to vulnerable population

Reviewer #3: Thank you to the authors for their responses to the reviewer comments and for their appropriate amendments. I have no further comments to add.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

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Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: Yes: WEAM BANJAR

Reviewer #3: Yes: Miranda Buhler

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