Investigating individual- and area-level socioeconomic gradients of pulse pressure among normotensive and hypertensive participants

Lisa A Matricciani, Catherine Paquet, Natasha J. Howard, Robert Adams, Neil T. Coffee, Anne W. Taylor, Mark Daniel

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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.

Original languageEnglish
Pages (from-to)571-589
Number of pages19
JournalInternational Journal of Environmental Research and Public Health
Issue number2
Publication statusPublished - 4 Feb 2013

Bibliographical note

© 2013 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article
distributed under the terms and conditions of the Creative Commons Attribution license


  • Cardiovascular disease
  • hypertension
  • Sociodemographic determinants
  • Residence characteristics
  • Socioeconomic status
  • Education
  • Employment
  • Geographic information system
  • Income
  • Pulse pressure


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