Deprivation status and mid-term change in blood pressure, total cholesterol and smoking status in middle life: a cohort study

Abstract

Background: Individuals of lower socioeconomic status have an adverse cardiovascular disease risk factor profile. We examined whether deprivation status influences within-individual change over time in blood pressure (BP), cholesterol and smoking status during middle life.

Methods: Records of participants of a primary care-based cardiovascular disease risk factor screening programme who were aged 35-55 years and had a first screening episode between 1989 and 1993 and a subsequent screening episode, were analysed. Deprivation status was defined using quintiles of the Townsend score. Using regression, mean annual change in BP, and total cholesterol was calculated for each deprivation group; and the effect of deprivation group status was examined. The probability of quitting smoking was also examined by deprivation group.

Results: Of all participants, 13,812 (72.1%) men and 16 932 (77.0%) women had complete follow-up (i.e. two screening episodes). Mean annual increase in systolic BP was significantly greater with increasing deprivation group [by +0.24 and +0.28 mmHg/incremental deprivation group in men and women, respectively (95% confidence interval: +0.09 to +0.39 men, and +0.13 to +0.42 women)]. Deprivation status did not influence change in cholesterol (P=0.620, men, P=0.289, women). The probability of quitting smoking was significantly greater with increasing deprivation group in women [odds ratio 1.06 (95% confidence interval: 1.01-1.12)], but no effect was observed in men (P=0.389).

Discussion: The results are suggestive of a 'mixed' picture of widening (e.g. systolic and diastolic BP) as well as narrowing (e.g. smoking in women) socioeconomic inequalities in cardiovascular risk factor inequalities.