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http://conacyt.repositorioinstitucional.mx/jspui/handle/1000/300| Socioeconomic inequalities in blood pressure: co-ordinated analysis of 147,775 participants from repeated birth cohort and cross-sectional datasets, 1989 to 2016 | |
| David Bann Shaun Scholes Rebecca Hardy Meg Fluharty | |
| Novel Coronavirus | |
| Acceso Abierto | |
| Atribución | |
| 10.1101/2019.12.19.19015313 | |
| Objective: To evaluate whether socioeconomic inequalities in blood pressure (BP) have changed from 1989 to 2016 - a period in which average BP levels declined and the detection and treatment of high BP increased. Design Repeated observational studies. Setting: 3 nationally representative British birth cohort studies - born in 1946, 1958, and 1970 - and 21 nationally representative cross-sectional studies (Health Survey for England 1994 to 2016, HSE). Participants: 147,775 participants with BP outcomes at age 42-46 years (cohorts) or 25 years and over (HSE). Main outcome measure: Absolute differences in systolic BP (SBP) by educational attainment (cohorts and HSE) and early life social class (cohorts). Results: In both datasets, lower education was associated with higher SBP, with similar absolute magnitudes of inequality across the studied period. Differences in SBP by education (Slope Index of Inequality) based on HSE data were 3.0mmHg (95% CI: 1.8, 4.2) in 1994 and 4.3mmHg (2.3, 6.3) in 2016. Findings were similar for diastolic BP (DBP) and survey-defined hypertension. Cohort data suggested that disadvantage in early and adult life had cumulative independent associations with BP: cohort-pooled differences in SBP were 4.9mmHg (3.7, 6.1) in a score combining early life social class and own education, yet were 3.4mmHg (2.4, 4.4) for education alone. In both datasets, inequalities were found across the SBP distribution - below and above hypertension thresholds - yet were larger at the upper tail; in HSE, median SBP differences were 2.8mmHg (1.7, 3.9) yet 5.6mmHg (4.9, 6.4) at the 90th quantile. Conclusion: Socioeconomic inequalities in BP have persisted from 1989 to 2016, despite improved detection and treatment of high BP. To achieve future reductions in BP inequalities, policies addressing the wider structural determinants of high BP levels are likely required - targeting detection and treatment alone is unlikely to be sufficient. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement DB is supported by the Economic and Social Research Council (grant number ES/M001660/1) and The Academy of Medical Sciences / Wellcome Trust (Springboard Health of the Public in 2040 award: HOP001/1025). The HSE is funded by NHS Digital; SS is funded to conduct the annual HSE. RH is Director of CLOSER which is funded by the Economic and Social Research Council (award reference: ES/K000357/1). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ### Author Declarations All relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript. Yes All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes 1946c data are available from: https://www.nshd.mrc.ac.uk/data/data-sharing/ 1946c, 1958c, 1970c and HSE data are available from the UK Data Archive: https://www.data-archive.ac.uk. <https://www.data-archive.ac.uk> <https://www.nshd.mrc.ac.uk/data/data-sharing/> | |
| Cold Spring Harbor Laboratory Press | |
| 2019 | |
| Preimpreso | |
| https://www.medrxiv.org/content/10.1101/2019.12.19.19015313v1 | |
| Inglés | |
| VIRUS RESPIRATORIOS | |
| Aparece en las colecciones: | Artículos científicos |
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