Abstract
BackgroundSocioeconomic status is a predictor not only of mortality, but also of cardiovascular risk and morbidity. An ongoing debate in the field of social inequalities and health focuses on two questions: 1) Is individual health status associated with individual income as well as with income inequality at the aggregate (e. g. regional) level? 2) If there is such an association, does it operate via a psychosocial pathway (e.g. stress) or via a "neo-materialistic" pathway (e.g. systematic under-investment in societal infrastructures)? For the first time in Germany, we here investigate the association between cardiovascular health status and income inequality at the area level, controlling for individual socio-economic status.MethodsIndividual-level explanatory variables (age, socio-economic status) and outcome data (body mass index, blood pressure, cholesterol level) as well as the regional-level variable (proportion of relative poverty) were taken from the baseline survey of the German Cardiovascular Prevention Study, a cross-sectional, community-based, multi-center intervention study, comprising six socio-economically diverse intervention regions, each with about 1800 participants aged 25–69 years. Multilevel modeling was used to examine the effects of individual and regional level variables.ResultsRegional effects are small compared to individual effects for all risk factors analyzed. Most of the total variance is explained at the individual level. Only for diastolic blood pressure in men and for cholesterol in both men and women is a statistically significant effect visible at the regional level.ConclusionOur analysis does not support the assumption that in Germany cardiovascular risk factors were to a large extent associated with income inequality at regional level.
Highlights
Socioeconomic status is a predictor of mortality, and of cardiovascular risk and morbidity
Our analysis does not support the assumption that in Germany cardiovascular risk factors were to a large extent associated with income inequality at regional level
[7,8].An ongoing debate in the field of inequality and health focuses on two as yet unproven extensions of this association, which can be phrased as research questions: 1. Is individual health status associated with individual income and () with income inequality at aggregate (e. g. regional) level? [9]
Summary
Socioeconomic status is a predictor of mortality, and of cardiovascular risk and morbidity. An ongoing debate in the field of social inequalities and health focuses on two questions: 1) Is individual health status associated with individual income as well as with income inequality at the aggregate 2. If there is an association between income inequality and health status, does it operate via a psychosocial pathway (stress due to perceptions of relative disadvantage and the psychological consequences of inequality) [9,10]; or via a „neo-materialistic" pathway (systematic under-investment across a wide range of societal infrastructures such as libraries, schools, hospitals)? In the Scottish Heart Health Study, a significant variance in mean levels of cardiovascular risk factors persisted at the district level [17]; this again shows that factors related to area/place do influence health status
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