Abstract
AimTo investigate the cross-sectional and longitudinal social gradient in use of blood pressure monitors, an innovative health technology. BackgroundThis is one of the first studies of social inequalities in the utilization of an end-user health technology in a universal health care context. The diffusion of innovation (DoI) and fundamental cause (FCT) theories predicts a widening of inequalities with the introduction of a new technology. Data and methodsTwo waves (N > 18,000) of the Nord-Trøndelag Health Study (HUNT), conducted in 1997 and 2008. Dependent variables were three self-reported indicators of blood pressure monitor use. Independent variables were educational attainment and income quartiles. Control variables were gender, age, and blood pressure. ResultsFor the blood pressure monitor variable from 1997, there was evidence of an educational gradient. No social inequalities were found for the 2008 monitor variable. When interacting socio-economic status with a survey wave dummy, results showed a social gradient from 1997 becoming smaller or non-significant in 2008. These results are supportive of the DoI and FCT, suggesting that the use of technology may initially generate health inequalities, which decrease as the technology is diffused across all social strata.
Highlights
Technological innovation within the health and medical field has been extensive over the last decades and has been proposed as a remedy to many of the central challenges facing modern health care, related to public health as well as biomedical or economic issues [1]
First looking at the control variables, we find that age had signifi cantly positive associations with having a 24-h blood pressure monitor in HUNT3 and having ever measured blood pressure at home in HUNT2 and HUNT3
Moving on to the explanatory SES variables, the analyses showed that in HUNT2, income quartile groups was not significantly associated with having a blood pressure monitor at home
Summary
Technological innovation within the health and medical field has been extensive over the last decades and has been proposed as a remedy to many of the central challenges facing modern health care, related to public health as well as biomedical or economic issues [1]. In much of the health inequalities litera ture, the diffusion of medical innovations has proved to have an initial inequality-generating function; when new technologies or information is introduced, it tends to be disproportionally utilized by the higher social strata (cf [5,6,7,8]) This is in line with a seminal theory in the field, the fundamental cause theory (FCT), which proposes that time- and context-dependent mechanisms will connect social positions with health outcomes [9]. Within this line of reasoning, social conditions are the fundamental causes of health inequality; if the unequal distribution of vital, flexible resources persist, so will inequalities in health outcomes These resources are associated with, but not reduced to, indicators of socio-economic status, and often mentioned in this literature are the resources of money, knowledge, power, prestige, and social connections. Housing conditions may be a less rele vant mechanism for health inequalities in industrialized countries in 2019 than in 1850; but if resources are still unevenly distributed, this mechanism will be replaced by another, e.g. the utilization of medical technology, and health inequalities will endure
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