Abstract
Socioeconomic status is a strong predictor of cardiovascular disease. Pulse pressure, the difference between systolic and diastolic blood pressure, has been identified as an important predictor of cardiovascular risk even after accounting for absolute measures of blood pressure. However, little is known about the social determinants of pulse pressure. The aim of this study was to examine individual- and area-level socioeconomic gradients of pulse pressure in a sample of 2,789 Australian adults. Using data from the North West Adelaide Health Study we estimated the association between pulse pressure and three indices of socioeconomic status (education, income and employment status) at the area and individual level for hypertensive and normotensive participants, using Generalized Estimating Equations. In normotensive individuals, area-level education (estimate: −0.106; 95% CI: −0.172, −0.041) and individual-level income (estimate: −1.204; 95% CI: −2.357, −0.050) and employment status (estimate: −1.971; 95% CI: −2.894, −1.048) were significant predictors of pulse pressure, even after accounting for the use of medication and lifestyle behaviors. In hypertensive individuals, only individual-level measures of socioeconomic status were significant predictors of pulse pressure (education estimate: −2.618; 95% CI: −4.878, −0.357; income estimate: −1.683, 95% CI: −3.743, 0.377; employment estimate: −2.023; 95% CI: −3.721, −0.326). Further research is needed to better understand how individual- and area-level socioeconomic status influences pulse pressure in normotensive and hypertensive individuals.
Highlights
There is substantial evidence that cardiovascular disease (CVD) is strongly associated with socioeconomic status, expressed in terms of income, education and/or occupational status [1,2]
This study was conducted as a part of the Place and Metabolic Syndrome (PAMS) project which links and evaluates population-based health information in relation to local community characteristics hypothesized to be associated with markers of metabolic syndrome
Since we only examined the association between pulse pressure and employment status, we were unable to identify differences that may exist amongst different occupations
Summary
There is substantial evidence that cardiovascular disease (CVD) is strongly associated with socioeconomic status, expressed in terms of income, education and/or occupational status [1,2]. Both prospective [3,4] and cross-sectional [5,6,7,8] studies have shown that low socioeconomic status is associated with elevated cardiovascular risk in men and women, across different countries. Avendano and colleagues [19] in a longitudinal study of 10 European countries identified low individual-level socioeconomic status was associated with an increased risk of cardiovascular-related mortality. Cozier and colleagues [22], in a study of 36,099 women, reported a significant inverse association between hypertension and area-level income in analyses accounting for individual-level socioeconomic status
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