title: Below the poverty line and non-communicable diseases in Kerala: The Epidemiology of Non-communicable Diseases in Rural Areas (ENDIRA) study.
abstract: BACKGROUND
  India carries the greatest burden of global non-communicable diseases (NCDs). Poverty is strongly associated with NCDs but there are few prevalence studies which have measured poverty in India, particularly in rural settings.
  
  
  METHODS
  In Kerala, India, a population of 113,462 individuals was identified. The "Epidemiology of Non-communicable Diseases in Rural Areas" (ENDIRA) study was conducted via ASHAs (Accredited Social Health Activists). Standardised questionnaires were used in household interviews of individuals ≥18years during 2012 to gather sociodemographic, lifestyle and medical data for this population. The Government of Kerala definition of "the poverty line" was used. The association between below poverty line (BPL) status, NCDs and risk factors was analysed in multivariable regression models.
  
  
  RESULTS
  84,456 adults were included in the analyses (25.4% below the poverty line). The prevalence of NCDs was relatively common: myocardial infarction (MI) 1.4%, stroke 0.3%, respiratory diseases 5.0%, and cancer 1.1%. BPL status was not associated with age (p=0.96) or gender (p=0.26). Compared with those above the poverty line (APL), the BPL group was less likely to have diabetes, hypertension or dyslipidaemia (p<0.0001), and more likely to smoke (p<0.0001). Compared with APL, BPL was associated with stroke (OR 1.33, 1.04-1.69; p=0.02) and respiratory disease (OR 1.23, 1.15-1.32; p<0.0001) in multivariable analyses, but not MI or cancer.
  
  
  CONCLUSIONS
  In rural Kerala, BPL status was associated with stroke and respiratory diseases, but not with MI and cancer although it was associated with smoking status, compared with above poverty line status.
authors.affiliation: Amrita Institute of Medical Sciences, Ponekkara, Kochi, Kerala, India. Electronic address: menon7jc@gmail.com.
authors.forename: Jaideep
authors.initials: J
authors.lastname: Menon
authors.affiliation: Blood Bank & Dialysis Unit, Aluva Taluk Hospital, Kochi, Kerala, India. Electronic address: doc.vijayakumar@gmail.com.
authors.forename: N
authors.initials: N
authors.lastname: Vijayakumar
authors.affiliation: Little Flower Hospital & Research Centre, Kerala, India. Electronic address: drjosephkjoseph@gmail.com.
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Joseph
authors.affiliation: MAGJ Hospital, Mookkannoor, Kerala, India. Electronic address: davidpc_7@yahoo.com.
authors.forename: P C
authors.initials: PC
authors.lastname: David
authors.affiliation: Aiswarya Clinic, Sree Moolanagaram, Kerala, India. Electronic address: drmnmenon@gmail.com.
authors.forename: M N
authors.initials: MN
authors.lastname: Menon
authors.affiliation: Lakshmi Hospital, Aluva, Kerala, India. Electronic address: shyammukundan@gmail.com.
authors.forename: Shyam
authors.initials: S
authors.lastname: Mukundan
authors.affiliation: Deva Matha Hospital, Koratty, Kerala, India. Electronic address: drdorphy@yahoo.com.
authors.forename: P D
authors.initials: PD
authors.lastname: Dorphy
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences, Birmingham, UK. Electronic address: a.banerjee.1@bham.ac.uk.
authors.forename: Amitava
authors.initials: A
authors.lastname: Banerjee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D012907:Smoking / Q000453:epidemiology*; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology*; D011795:Surveys and Questionnaires
keywords: Cardiovascular disease; Non-communicable disease; Poverty; Smoking