title: Jumping the gun: the problematic discourse on socioeconomic status and cardiovascular health in India.
abstract: There has been an increased focus on non-communicable diseases (NCDs) in India, especially on cardiovascular diseases and associated risk factors. In this essay, we scrutinize the prevailing narrative that cardiovascular risk factors (CVRF) and cardiovascular disease (CVD) are no longer confined to the economically advantaged groups but are an increasing burden among the poor in India. We conducted a comprehensive review of studies reporting the association between socioeconomic status (SES) and CVRF, CVD, and CVD-related mortality in India. With the exception of smoking and low fruit and vegetable intake, the studies clearly suggest that CVRF/CVD is more prevalent among high SES groups in India than among the low SES groups. Although CVD-related mortality rates appear to be higher among the lower SES groups, the proportion of deaths from CVD-related causes was found to be greatest among higher SES groups. The studies on SES and CVRF/CVD also reveal a substantial discrepancy between the data presented and the authors' interpretations and conclusions, along with an unsubstantiated claim that a reversal in the positive SES-CVRF/CVD association has occurred or is occurring in India. We conclude our essay by emphasizing the need to prioritize public health policies that are focused on the health concerns of the majority of the Indian population. Resource allocation in the context of efforts to make health care in India free and universal should reflect the proportional burden of disease on different population groups if it is not to entrench inequity.
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA, Harvard Center for Population and Development Studies, Cambridge, MA, USA, Department of Social Science, Indian Institute of Technology, Gandhinagar, Ahmedabad, Gujarat, India and MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), School of Social and Community Medicine, University of Bristol, UK.
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Corsi
authors.forename: Malavika A
authors.initials: MA
authors.lastname: Subramanyam
authors.forename: George Davey
authors.initials: GD
authors.lastname: Smith
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D004032:Diet / Q000706:statistics & numerical data; D050171:Dyslipidemias / Q000453:epidemiology*; D006291:Health Policy; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007182:Income / Q000706:statistics & numerical data*; D007194:India / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology*; D011203:Poverty / Q000706:statistics & numerical data*; D011634:Public Health; D012307:Risk Factors; D057185:Sedentary Behavior; D012907:Smoking / Q000453:epidemiology; D012923:Social Class; D012959:Socioeconomic Factors
keywords: Cardiovascular risk factors; India; cardiovascular disease; cardiovascular mortality; non-communicable diseases; socioeconomic status