scholarly journals Socioeconomic inequalities in blood pressure: co-ordinated analysis of 147,775 participants from repeated birth cohort and cross-sectional datasets, 1989 to 2016

2019 ◽  
Author(s):  
David Bann ◽  
Meg Fluharty ◽  
Rebecca Hardy ◽  
Shaun Scholes
Keyword(s):  
Blood Pressure ◽  
Social Class ◽  
Birth Cohort ◽  
Early Life ◽  
Adult Life ◽  
Socioeconomic Inequalities ◽  
Structural Determinants ◽  
Cross Sectional ◽  
Nationally Representative ◽  
Absolute Magnitudes

ObjectiveTo 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.DesignRepeated observational studies.Setting3 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).Participants147,775 participants with BP outcomes at age 42-46 years (cohorts) or 25 years and over (HSE).Main outcome measureAbsolute differences in systolic BP (SBP) by educational attainment (cohorts and HSE) and early life social class (cohorts).ResultsIn 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.ConclusionSocioeconomic 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.

scholarly journals Socioeconomic inequalities in blood pressure: co-ordinated analysis of 147,775 participants from repeated birth cohort and cross-sectional datasets, 1989 to 2016

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
David Bann ◽  
Meg Fluharty ◽  
Rebecca Hardy ◽  
Shaun Scholes
Keyword(s):  
Blood Pressure ◽  
Social Class ◽  
Birth Cohort ◽  
Early Life ◽  
Antihypertensive Medication ◽  
Medication Use ◽  
Socioeconomic Inequalities ◽  
Hypertension Treatment ◽  
Cross Sectional ◽  
Treatment Thresholds

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. Results In both datasets, lower educational attainment 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 3.0 mmHg (95% CI 1.8, 4.2) in 1994 and 4.3 mmHg (2.3, 6.3) in 2016. Findings were similar for diastolic BP (DBP) and survey-defined hypertension. Inequalities were found across the SBP distribution in both datasets—below and above the hypertension threshold—yet were larger at the upper tail; in HSE, median SBP differences were 2.8 mmHg (1.7, 3.9) yet 5.6 mmHg (4.9, 6.4) at the 90th quantile. Adjustment for antihypertensive medication use had little impact on the magnitude of inequalities; in contrast, associations were largely attenuated after adjustment for body mass index. Finally, cohort data suggested that disadvantage in early and adult life had cumulative independent associations with BP: cohort-pooled differences in SBP were 5.0 mmHg (3.8, 6.1) in a score combining early life social class and own education, yet were 3.4 mmHg (2.4, 4.4) for education alone. Conclusion Socioeconomic inequalities in BP have persisted from 1989 to 2016 in Britain/England, 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, particularly those curtailing the obesogenic environment—targeting detection and treatment alone is unlikely to be sufficient.

scholarly journals Sociodemographic inequalities in the diet of young children in the 1946 British birth cohort

2002 ◽  
Vol 5 (6) ◽  
pp. 733-745 ◽  
Author(s):  
CJ Prynne ◽  
AA Paul ◽  
GD Mishra ◽  
RJ Hardy ◽  
C Bolton-Smith ◽  
...  
Keyword(s):  
Social Class ◽  
Birth Cohort ◽  
Fruits And Vegetables ◽  
Vegetable Consumption ◽  
Food Groups ◽  
Cross Sectional ◽  
Diet Records ◽  
Sociodemographic Disparities ◽  
Nationally Representative ◽  
Post War

AbtsractObjective:To evaluate whether there was food and nutrient equality across occupational social classes and geographical region for members of the 1946 British birth cohort at age 4 years.Design:Cross-sectional analysis of selected food groups, energy and nutrients from one-day recall diet records.Setting:England, Scotland and Wales in 1950.Subjects:Nationally representative sample of 4419 children aged 4 years in 1950 from the MRC National Survey of Health and Development (NSHD) (1946 Birth Cohort).Results:Significant food and nutrient inequalities occurred by region and occupational social class of the father. Disparity in fruit and vegetable consumption primarily led to the nutrient differences, especially with respect to lower vitamin C and carotene intakes in children from Scotland and from a manual social class background. Lower energy intake in Scottish children was attributable to inequality in the consumption of foods providing fat, and also to the retention of the traditional Scottish diet that included porridge and soups. Consumption of some rationed foods – bacon, orange juice and tea – was inequitably distributed by father's social class, but others, in particular meat and spreading fats, were consumed more uniformly. In contrast to fruits and vegetables, which showed marked sociodemographic disparities, other non-rationed foods such as bread and potatoes were consumed universally.Conclusion:Local cultural norms may have played as strong a part in sociodemographic differences in the diet of children in the early 1950s as did the strict, post-war food rationing that prevailed. In consequence, nutritional equality was not achieved, and the relatively low intake of antioxidant vitamins during early childhood in certain population groups may have compromised health in the long term.

scholarly journals Childhood social class and adult adiposity and blood-pressure trajectories 36–53 years: gender-specific results from a British birth cohort

2010 ◽  
Vol 66 (6) ◽  
pp. 512-518 ◽  
Author(s):  
Bjørn Heine Strand ◽  
Emily T Murray ◽  
Jack Guralnik ◽  
Rebecca Hardy ◽  
Diana Kuh
Keyword(s):  
Blood Pressure ◽  
Social Class ◽  
Birth Cohort ◽  
Gender Specific

scholarly journals Childhood maltreatment and biomarkers for cardiometabolic disease in mid-adulthood in a prospective British birth cohort: associations and potential explanations

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e024079 ◽  
Author(s):  
Leah Li ◽  
Snehal M Pinto Pereira ◽  
Christine Power
Keyword(s):  
Blood Pressure ◽  
Child Maltreatment ◽  
Physical Abuse ◽  
Birth Cohort ◽  
Childhood Maltreatment ◽  
Early Life ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Cardiometabolic Disease ◽  
Cardiometabolic Markers

ObjectivesResearch on associations between childhood maltreatment and adult cardiometabolic disease risk is sparse. We aimed to investigate associations between different forms of child maltreatment and mid-adult cardiometabolic markers and whether potential intermediaries could account for the associations observed.Setting1958 British birth cohort.ParticipantsApproximately 9000 cohort members with data on cardiometabolic markers.OutcomesAdult (45y) cardiometabolic markers (blood pressure, lipids and glycated haemoglobin [HbA1c]).ResultsSeventeen per cent of participants were identified as neglected; 6.1%, 1.6% and 10.0% were identified as experiencing physical, sexual and psychological abuse, respectively. Childhood neglect and physical abuse were associated with high body mass index (BMI) and large waist circumference when adjusting for early-life covariates. For neglect, the adjusted odds ratio (AOR) was 1.16 (95% CI: 1.02 to 1.32) and 1.15 (1.02 to 1.30) for general and central obesity, respectively, and for physical abuse, the respective AOR was 1.36 (1.13 to 1.64) and 1.38 (1.16 to 1.65). Neglect was also associated with raised triglycerides by 3.9 (0.3 to 7.5)% and HbA1c by 1.2 (0.4 to 2.0)%, and among females, lower high-density lipoprotein cholesterol (HDL-c) by 0.05 (0.01 to 0.08)mmol/L after adjustment. For physical abuse, the AOR was 1.25 (1.00 to 1.56) for high low-density lipoprotein cholesterol, HbA1c was raised by 2.5 (0.7 to 4.3)% (in males) and HDL-c was lower by 0.06 (0.01 to 0.12)mmol/L (in females). Associations for sexual abuse were similar to those for physical abuse but 95% CIs were wide. For psychological abuse, the AOR for elevated triglycerides was 1.21 (1.02 to 1.44) and HDL-c was lower by 0.04 (0.01 to 0.07)mmol/L. Maltreatments were not associated with raised blood pressure. In analyses of potential intermediary factors, several associations attenuated after adjustment for adult lifestyles (mainly smoking and alcohol consumption rather than physical activity) and child-to-adult BMI.ConclusionsChildhood maltreatments, particularly neglect and physical abuse, were associated with greater adiposity and poorer lipid and HbA1c profiles decades later in adulthood. Associations were modest but independent of early-life factors linked to these outcomes. Findings implicate adult lifestyles as an important intermediary between child maltreatment and outcomes.

scholarly journals Exposure to Famine During Early Life and Abdominal Obesity in Adulthood: Findings from the Great Chinese Famine During 1959–1961

Nutrients ◽  
2019 ◽  
Vol 11 (4) ◽  
pp. 903 ◽  
Author(s):  
Dan Liu ◽  
Dong-mei Yu ◽  
Li-yun Zhao ◽  
Hong-yun Fang ◽  
Jian Zhang ◽  
...  
Keyword(s):  
Abdominal Obesity ◽  
Urban Areas ◽  
Early Life ◽  
Healthy Lifestyle ◽  
Positive Association ◽  
Fetal Life ◽  
Cross Sectional ◽  
Famine Exposure ◽  
Nationally Representative ◽  
The Relationship

Undernutrition during early life may lead to obesity in adulthood. This study was conducted to examine the relationship between famine exposure during early life and the risk of abdominal obesity in adulthood. A total of 18,984 and 16,594 adults were surveyed in 2002 and 2010–2012 in two nationally representative cross-sectional surveys, namely China Nutrition and Health Survey, respectively. The risk of abdominal obesity was evaluated for participants born during 1956–1961 and compared with that of participants born during 1962–1964. The overall prevalence of abdominal obesity in adulthood showed a positive association with famine exposure during early life. The odds ratios of famine exposure were 1.31 (1.19–1.44) and 1.28 (1.17–1.40) in 2002 during fetal life and infancy and 1.09 (1.00–1.19) in 2012 during fetal life, respectively. The relationships between famine exposure and abdominal obesity across the famine exposure groups were distinct among females and those who lived in urban areas and were physical inactive (p < 0.05). Exposure to famine during early life was associated with increased risks of abdominal obesity in adulthood, which was partially alleviated by healthy lifestyle factors (e.g., physical activity).

scholarly journals Relationship between Body Composition and Pulmonary Function in Early Adult Life: A Cross-Sectional Analysis Nested in Two Birth Cohort Studies

PLoS ONE ◽  
2016 ◽  
Vol 11 (9) ◽  
pp. e0163428 ◽  
Author(s):  
Paula Duarte de Oliveira ◽  
Fernando C. Wehrmeister ◽  
Rogelio Pérez-Padilla ◽  
Helen Gonçalves ◽  
Maria Cecília F. Assunção ◽  
...  
Keyword(s):  
Body Composition ◽  
Pulmonary Function ◽  
Cohort Studies ◽  
Birth Cohort ◽  
Adult Life ◽  
Cross Sectional ◽  
Cross Sectional Analysis ◽  
Early Adult Life ◽  
Sectional Analysis

Trends in Social Inequality in Tooth Brushing among Adolescents: 1991-2014

2015 ◽  
Vol 49 (6) ◽  
pp. 595-599 ◽  
Author(s):  
Bjørn E. Holstein ◽  
Lotus Sofie Bast ◽  
Carina Sjöberg Brixval ◽  
Mogens Trab Damsgaard
Keyword(s):  
Social Class ◽  
Social Inequality ◽  
Tooth Brushing ◽  
Cross Sectional ◽  
High Social Class ◽  
Prevalence Difference ◽  
Cross Sectional Studies ◽  
The Absolute ◽  
Nationally Representative ◽  
Representative Samples

This study examines whether social inequality in tooth brushing frequency among adolescents changed from 1991 to 2014. The data material was seven comparable cross-sectional studies of nationally representative samples of 11- to 15-year-olds in Denmark with data about frequency of tooth brushing and occupation of parents. The total number of participants was 31,464, of whom 21.7% brushed their teeth less than the recommended 2 times a day. The absolute social inequality measured as prevalence difference between low and high social class increased from 7.7% in 1991 to 14.6% in 2014. The relative social inequality assessed by odds ratios for infrequent tooth brushing also increased from 1991 to 2014.

scholarly journals May Measurement Month 2019: an analysis of blood pressure screening results from the Democratic Republic of the Congo

2021 ◽  
Vol 23 (Supplement_B) ◽  
pp. B52-B54
Author(s):  
Jean-René M’Buyamba-Kabangu ◽  
Fortunat K Katamba ◽  
Mireille L Ntambwe ◽  
Georges N Ngoyi ◽  
Trésor M Tshiswaka ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ad Hoc ◽  
Democratic Republic ◽  
High Rate ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Republic Of The Congo ◽  
Low Levels ◽  
Nationally Representative ◽  
And Control

Abstract Hypertension, the foremost cause of global morbi-mortality, is linked with a high mortality from numerous cardiovascular endpoints. The May Measurement Month (MMM) campaign is an annual initiative of the International Society of Hypertension (ISH) to collect information on blood pressure (BP) and other risk factors for cardiovascular disease (CVD) in adults. MMM2019 in the Democratic Republic of the Congo (DRC) was an opportunistic cross-sectional survey of volunteers aged ≥18 years that took place in Kinshasa and Mbuji-Mayi after the training of observers to familiarize with the ISH ad hoc methods. We screened 29 857 individuals (mean age: 40 years; 40% female). Hypertension was present in 7624 (25.5%) individuals. Of them, 2520 (33.1%) were aware, 1768 (23.2%) on treatment with 910 (51.5%) controlled BP (systolic BP &lt;140 mmHg and/or diastolic BP &lt;90 mmHg). Of all hypertensives screened, 11.9% had controlled BP. Of all respondents, 16.7% had participated in MMM18 and 60.5% did not have their BP verified during the last year. Fasting, pregnancy, and underweight status were linked with lower BP levels whilst smoking, drinking, antihypertensive medication, previous stroke, diabetes as well as being overweight/obese were associated with higher BP levels. Our results reflect the high rate of hypertension in the DRC with low levels of awareness, treatment, and control. A nationally representative sample is required to establish the nationwide hypertension prevalence.

scholarly journals Knowledge, attitude and behaviour on salt intake and its association with hypertension in the Malaysian population: findings from MyCoSS (Malaysian Community Salt Survey)

2021 ◽  
Vol 40 (S1) ◽  
Author(s):  
Azli Baharudin ◽  
Rashidah Ambak ◽  
Fatimah Othman ◽  
Viola Michael ◽  
Siew Man Cheong ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Salt Intake ◽  
High Salt ◽  
Cross Sectional ◽  
Face To Face ◽  
Salt Consumption ◽  
Malaysian Population ◽  
High Salt Intake ◽  
Nationally Representative ◽  
Research Assistants

Abstract Background High blood pressure or hypertension has become one of the main health problems, worldwide. A number of studies have proven that an increased intake of salt was related to an increased prevalence of cardiovascular diseases. Of late, its relationship with high salt intake has received a lot of attention. Studies in Malaysia have shown both rising hypertension over time as well as high salt consumption. Actions to reduce salt intake are essential to reduce hypertension and its disease burden. As such, we carried out a study to determine associations between knowledge, attitude and behaviour towards salt intake and hypertension among the Malaysian population. Methods Data obtained from the Malaysian Community Salt Survey (MyCoSS) was used partially for this study. The survey used a cross-sectional two-stage sampling design to select a nationally representative sample of Malaysian adults aged 18 years and above living in non-institutional living quarters (LQ). Face-to-face interviews were done by trained research assistants (RA) to obtain information on sociodemography, medical report, as well as knowledge, attitude and behaviour of the respondents towards salt intake and blood pressure. Results Majority of the respondents have been diagnosed with hypertension (61.4%) as well as knowledge of the effects of high salt intake on blood pressure (58.8%). More than half of the respondents (53.3%) said they controlled their salt intake on a regular basis. Those who knew that a high salt diet could contribute to a serious health problem (OR=0.23) as well as those who controlled their salt intake (OR=0.44) were significantly less likely to have hypertension. Conclusion Awareness of the effects of sodium on human health, as well as the behaviour of controlling salt intake, is essential towards lowering the prevalence of hypertension among Malaysians.

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