No association of income inequality with adult mortality within New Zealand: a multi-level study of 1.4 million 25-64 year olds

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Abstract
Study objectives: (1) to develop an indicator of socioeconomic position based on the social standing of the habitat (SSH), that is, the residential building, its immediate surroundings, and local neighbourhood; (2) to assess the relation of SSH to two usual markers of socioeconomic position (education and occupation) and a known, socially determined health outcome (hypertension). Design: Population survey measuring SSH, detailed educational and occupational histories, and blood pressure. The SSH is a standardised assessment of the external and internal aspects of someone’s building (or house), and of the characteristics of its immediate surroundings and local neighbourhood. Setting: A sample of participants to the Bus Santé survey between 1993 and 1998, in Geneva, Switzerland. Participants: 588 men and women, aged 35 to 74. Main results: The SSH index was highly reproducible (κ=0.8). Concordance of SSH with education or occupation was good for people of either high or low socioeconomic position, but not for those with medium education and/or occupation. There was a higher prevalence of hypertension in the lowest compared with the highest groups, defined on the basis of education or occupation, but the SSH was the only indicator that showed a higher prevalence of hypertension among people in the middle of the social spectrum. Conclusions: People of medium education or occupation are heterogeneous with respect to their habitat. Those living in habitats of medium social standing may be most affected by hypertension but this association could not be revealed on the basis of education and occupation alone. The habitat seems to capture different aspects of the socioeconomic position compared with the usual indicators of social class.