1. The interaction between district-level development and individual-level socioeconomic gradients of cardiovascular disease risk factors in India: A cross-sectional study of 2.4 million adults.
- Author
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Jung L, De Neve JW, Chen S, Manne-Goehler J, Jaacks LM, Corsi DJ, Awasthi A, Subramanian SV, Vollmer S, Bärnighausen T, and Geldsetzer P
- Subjects
- Adolescent, Adult, Blood Glucose, Blood Pressure, Body Weights and Measures, Cardiovascular Diseases epidemiology, Cross-Sectional Studies, Female, Health Surveys, Humans, India epidemiology, Male, Middle Aged, Poverty, Prevalence, Risk Factors, Smoking epidemiology, Young Adult, Diabetes Mellitus epidemiology, Economic Development statistics & numerical data, Hypertension epidemiology, Obesity epidemiology, Socioeconomic Factors
- Abstract
Background: Diabetes, hypertension, and obesity tend to be positively associated with socio-economic status in low- and middle-income countries (LMICs). It has been hypothesized that these positive socio-economic gradients will reverse as LMICs continue to undergo economic development. We use population-based cross-sectional data in India to examine how a district's economic development is associated with socio-economic differences in cardiovascular disease (CVD) risk factor prevalence between individuals., Methods: We separately analyzed two nationally representative household survey datasets - the NFHS-4 and the DLHS-4/AHS - that are representative at the district level in India. Diabetes was defined based on a capillary blood glucose measurement, hypertension on blood pressure measurements, obesity on measurements of height and weight, and current smoking on self-report. Five different measures of a district's economic development were used. We analyzed the data using district-level regressions (plotting the coefficient comparing high to low socio-economic status against district-level economic development) and multilevel modeling., Results: 757,655 and 1,618,844 adults participated in the NFHS-4 and DLHS-4/AHS, respectively. Higher education and household wealth were associated with a higher probability of having diabetes, hypertension, and obesity, and a lower probability of being a current smoker. For diabetes, hypertension, and obesity, we found that a higher economic development of a district was associated with a less positive (or even negative) association between the CVD risk factor and education. For smoking, the association with education tended to become less negative as districts had a higher level of economic development. In general, these associations did not show clear trends when household wealth quintile was used as the measure of socio-economic status instead of education., Conclusions: While this study provides some evidence for the "reversal hypothesis", large-scale longitudinal studies are needed to determine whether LMICs should expect a likely reversal of current positive socioeconomic gradients in diabetes, hypertension, and obesity as their countries continue to develop economically., (Copyright © 2019 Elsevier Ltd. All rights reserved.)
- Published
- 2019
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