Background Geographic inequalities in health are widely discussed, with an English North-South divide a popular notion. Data indicate the North-South divide in all cause mortality has persisted, even widening in recent years. Given the impact of cardiovascular disease (CVD) mortality on health inequalities, we aimed to assess the extent of a salient North-South divide in risk factors for CVD, controlling for markers of socioeconomic-position (SEP).
Methods We conducted a cross-sectional analysis using the 2006 Health Survey for England using respondents aged 16 years and over. We assessed the population means of systolic blood pressure, total cholesterol, body mass index (BMI) and smoking prevalence. We built nested regression models (all linear regression except for logistic for smoking) adding; demographic (age /sex /ethnicity), SEP indicators (individual income, education attainment, housing tenure, car ownership, occupational classification and area level IMD), behavioural risk factors and vascular disease status. We tested variables for multi-collinearity, assumptions of normality for linear outcomes and use valid survey weights. We finally examine interactions between the North-South divide and age and sex on the risk factors.
Results The North of England showed more deprived characteristics across markers of SEP; except for greater home-ownership. Controlling for demographic variables, we found a significant North-South difference (excess in North) in systolic blood pressure (1.94 [se=0.38]), BMI (0.47 [0.11]) and smoking prevalence (2.93% [0.50]). The difference in smoking prevalence was entirely abolished by markers of SEP; both systolic blood pressure and BMI differences were attenuated by SEP, behavioural and vascular disease indicators (1.52 [0.38] & 0.31 [0.11] respectively), but remained significant. The North-South divide in systolic blood pressure was attributed to differences in men (2.18 [0.54]), being non-significant in women; and in middle age groups (2.70 [0.76] aged 40- 59, compared with 2.29 [0.78] aged 16–39) and was non-significant aged 60 and over.
Conclusion Smoking is a major factor behind morbidity and mortality. In line with work from different settings, patterns in smoking can be explained through adverse, cross-sectional patterns of SEP. Addressing underlying poverty and disadvantage may be required to fully tackle smoking inequalities. Using a suite of measures designed to address different constructs of SEP, although cross-sectional, we find excesses in blood pressure and BMI in the North of England. These differences may, in part, explain previously found differences in mortality. If we are to understand, and therefore reduce, geographic inequalities, current measures of SEP may require improvement, for example accounting for aspects of the life-course.
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