Council tax valuation banding as a surrogate marker of socioeconomic position in the primary and secondary prevention of coronary heart disease

• Main Author: Harkins, Christopher
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01-01-2012
• Subjects: Public policy

This study will investigate the predictive validity of Council Tax Valuation Banding (CTVB) in identifying high-risk sub-groups within both CHD primary and secondary prevention populations. CTVB is worthy of consideration as a marker of SEP in this context as it appears to have several appealing characteristics appropriate for use in CHD prevention. CTVB is based on the property value; theoretically reflecting both individual material circumstance and to an extent geographical area characteristics. Furthermore CTVB is objective, uncomplicated, universally available and sensitive to the household level. This study originated from an interest in developing practical and applicable methods of identifying highest risk individuals within CHD prevention populations. Firstly a cohort of just under 2,000 men and women, aged between 45-60 years who participated in the Have a Heart Paisley (HaHP) CHD Primary Prevention Programme was examined. These individuals were enrolled in 2006 and underwent comprehensive cardiovascular risk screening. Secondly, in 2009, the HaHP Chronic Disease Register (CDR) was used to pool Secondary Prevention primary care data for just over 3,000 men and women, of all ages with established CHD. Socioeconomic patterning of risk factors and absolute risk was examined in the primary prevention population. Socioeconomic inequalities were examined in risk-factor monitoring and therapies prescribing in the secondary prevention population. SEP for analyses in both populations was measured using the Scottish Index of Multiple Deprivation (SIMD) and CTVB- which was supplied by the Renfrewshire Joint Valuation Board. Both measures of SEP were linked to these data using address information and postcodes. Findings demonstrate some potential for the use of CTVB as a surrogate marker of SEP in health research and cardiovascular preventative strategies. CTVB showed significant association with few classical cardiovascular risk factors in the primary prevention population; body mass index in females, high-density lipoproteins (HDL) cholesterol in females, and rates of current smokers in both males and females (age and age-squared adjusted). However all associations with the exception of rates of current smokers (both males and females) became insignificant when SIMD was added into the statistical modelling. CTVB displayed association with Framingham risk scores in both men and women (age and age-squared adjusted) however added independent predictive power in men only. The associations between SEP (as measured by CTVB) and classical risk factors in the present study are generally weaker than the literature reviewed using established measures of SEP. Particularly striking is the insignificant socioeconomic variance in blood pressure levels when using CTVB, which is at odds with the overwhelming majority of literature in this field to date. In general the analysis reinforces the existence of socioeconomic inequalities in classical risk factors and absolute risk in an asymptomatic population.