Monitoring the social gradient: Inequalities in use of blood pressure monitors in the HUNT study

Abstract

Aim: To investigate the cross-sectional and longitudinal social gradient in use of blood pressure monitors, an innovative health technology. Background: This is one of the first studies of social inequalities in the utilization of an end-user health technology in a universal health care context. The diffusion of innovation (DoI) and fundamental cause (FCT) theories predicts a widening of inequalities with the introduction of a new technology. Data and methods: Two waves (N > 18,000) of the Nord-Trøndelag Health Study (HUNT), conducted in 1997 and 2008. Dependent variables were three self-reported indicators of blood pressure monitor use. Independent variables were educational attainment and income quartiles. Control variables were gender, age, and blood pressure. Results: For the blood pressure monitor variable from 1997, there was evidence of an educational gradient. No social inequalities were found for the 2008 monitor variable. When interacting socio-economic status with a survey wave dummy, results showed a social gradient from 1997 becoming smaller or non-significant in 2008. These results are supportive of the DoI and FCT, suggesting that the use of technology may initially generate health inequalities, which decrease as the technology is diffused across all social strata.