Abstract
BackgroundTo determine correlation of multiple parameters of socioeconomic status with cardiovascular risk factors in India.MethodsThe study was performed at eleven cities using cluster sampling. Subjects (n = 6198, men 3426, women 2772) were evaluated for socioeconomic, demographic, biophysical and biochemical factors. They were classified into low, medium and high socioeconomic groups based on educational level (<10, 10–15 and >15 yr formal education), occupational class and socioeconomic scale. Risk factor differences were evaluated using multivariate logistic regression.ResultsAge-adjusted prevalence (%) of risk factors in men and women was overweight or obesity in 41.1 and 45.2, obesity 8.3 and 15.8, high waist circumference 35.7 and 57.5, high waist-hip ratio 69.0 and 83.8, hypertension 32.5 and 30.4, hypercholesterolemia 24.8 and 25.3, low HDL cholesterol 34.1 and 35.1, high triglycerides 41.2 and 31.5, diabetes 16.7 and 14.4 and metabolic syndrome in 32.2 and 40.4 percent. Lifestyle factors were smoking 12.0 and 0.5, other tobacco use 12.7 and 6.3, high fat intake 51.2 and 48.2, low fruits/vegetables intake 25.3 and 28.9, and physical inactivity in 38.8 and 46.1%. Prevalence of > = 3 risk factors was significantly greater in low (28.0%) vs. middle (23.9%) or high (22.1%) educational groups (p<0.01). In low vs. high educational groups there was greater prevalence of high waist-hip ratio (odds ratio 2.18, confidence interval 1.65–2.71), low HDL cholesterol (1.51, 1.27–1.80), hypertriglyceridemia (1.16, 0.99–1.37), smoking/tobacco use (3.27, 2.66–4.01), and low physical activity (1.15, 0.97–1.37); and lower prevalence of high fat diet (0.47, 0.38–0.57),overweight/obesity (0.68, 0.58–0.80) and hypercholesterolemia (0.79, 0.66–0.94). Similar associations were observed with occupational and socioeconomic status.ConclusionsLow educational, occupational and socioeconomic status Asian Indians have greater prevalence of truncal obesity, low HDL cholesterol, hypertriglyceridemia, smoking or tobacco use and low physical activity and clustering of > = 3 major cardiovascular risk factors.
Highlights
India is changing rapidly [1,2]
Low educational status was more among women (47.6%) as compared to men (22.3%) and majority of subjects belonged to middle socioeconomic status
Educational status has been used the most in cardiovascular epidemiological studies as marker of socioeconomic status as it is stable after early childhood and least influenced by social changes or illness in adulthood [34]
Summary
India is changing rapidly [1,2]. The World Bank has reclassified the country from low-income to lower-middle income group indicating increase in national income, increased per capita income and per capita expenditure, and better social and human development indices [3]. Nutritional, maternal and childhood causes of morbidity and mortality in the last century, there has been a shift to preponderance of noncommunicable diseases as major causes of disability and deaths [5] This could be due to social and economic changes that lead to disease transition from communicable to non-communicable diseases [5,6]. With social and economic development and ongoing epidemiological transition in these countries the risk factors become more prevalent among the lower socioeconomic status subjects [8]. In the lower socioeconomic groups the risk factors did not change, decline of cardiovascular mortality was absent or slow [9] In these countries the cardiovascular diseases prevalence is currently more among low socioeconomic classes than in the higher socioeconomic class [10]. To determine correlation of multiple parameters of socioeconomic status with cardiovascular risk factors in India
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