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Investigating Individual- and Area-Level Socioeconomic Gradients of Pulse Pressure among Normotensive and Hypertensive Participants
Social Epidemiology and Evaluation Research Group, Sansom Institute for Health Research, School of Population Health, Division of Health Sciences, University of South Australia, Adelaide 5001, Australia
Research Centre of the Douglas Mental Health University Institute, Verdun, Quebec H4H 1R2, Canada
The Health Observatory, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia 5005, Australia
Population Research and Outcome Studies, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia 5005, Australia
Department of Medicine, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria 3065, Australia
* Author to whom correspondence should be addressed.
Received: 30 October 2012; in revised form: 21 January 2013 / Accepted: 28 January 2013 / Published: 4 February 2013
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.
Keywords: pulse pressure; socioeconomic status; residence characteristics; geographic information system; education; income; employment
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Matricciani, L.A.; Paquet, C.; Howard, N.J.; Adams, R.; Coffee, N.T.; Taylor, A.W.; Daniel, M. Investigating Individual- and Area-Level Socioeconomic Gradients of Pulse Pressure among Normotensive and Hypertensive Participants. Int. J. Environ. Res. Public Health 2013, 10, 571-589.
Matricciani LA, Paquet C, Howard NJ, Adams R, Coffee NT, Taylor AW, Daniel M. Investigating Individual- and Area-Level Socioeconomic Gradients of Pulse Pressure among Normotensive and Hypertensive Participants. International Journal of Environmental Research and Public Health. 2013; 10(2):571-589.
Matricciani, Lisa A.; Paquet, Catherine; Howard, Natasha J.; Adams, Robert; Coffee, Neil T.; Taylor, Anne W.; Daniel, Mark. 2013. "Investigating Individual- and Area-Level Socioeconomic Gradients of Pulse Pressure among Normotensive and Hypertensive Participants." Int. J. Environ. Res. Public Health 10, no. 2: 571-589.