Socioeconomic inequalities in blood pressure: co-ordinated analysis of 147,775 participants from repeated birth cohort a
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RESEARCH ARTICLE
Open Access
Socioeconomic inequalities in blood pressure: co-ordinated analysis of 147,775 participants from repeated birth cohort and cross-sectional datasets, 1989 to 2016 David Bann1*, Meg Fluharty1, Rebecca Hardy2 and Shaun Scholes3
Abstract Background: High blood pressure (BP) is a key modifiable determinant of cardiovascular disease and a likely determinant of other adverse health outcomes. While socioeconomic inequalities in BP are well documented, it remains unclear (1) how these inequalities have changed across time, given improvements over time in the detection and treatment of high BP (hypertension); (2) whether BP inequalities are present below and above hypertension treatment thresholds; and (3) whether socioeconomic position (SEP) across life has cumulative effects on BP. We sought to address these gaps using evidence from two complementary sources: birth cohort and repeated cross-sectional datasets. Methods: We used three British birth cohort studies—born in 1946, 1958, and 1970—with BP measured at 43–46 years (in 1989, 2003, and 2016), and 21 repeated cross-sectional datasets—the Health Survey for England (HSE), with BP measured among adults aged ≥ 25 years (1994–2016). Adult education attainment was used as an indicator of SEP in both datasets; childhood father’s social class was used as an alternative indicator of (early life) SEP in cohorts. Adjusting for the expected average effects of antihypertensive medication use, we used linear regression to quantify SEP differences in mean systolic BP (SBP), and quantile regression to investigate whether inequalities differed across SBP distributions—below and above hypertension treatment thresholds. (Continued on next page)
* Correspondence: [email protected] 1 Centre for Longitudinal Studies, Social Research Institute, University College London, London, UK Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Bann et al. BMC Medicine
(2020) 18:338
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