Socioeconomic status and cardiovascular risk in urban South Asia: The CARRS Study.
BACKGROUND
Although South Asians experience cardiovascular disease (CVD) and risk factors at an early age, the distribution of CVD risks across the socioeconomic spectrum remains unclear.


METHODS
We analysed the 2011 Centre for Cardiometabolic Risk Reduction in South Asia survey data including 16,288 non-pregnant adults (≥20 years) that are representative of Chennai and Delhi, India, and Karachi, Pakistan. Socioeconomic status (SES) was defined by highest education (primary schooling, high/secondary schooling, college graduate or greater); wealth tertiles (low, middle, high household assets) and occupation (not working outside home, semi/unskilled, skilled, white-collar work). We estimated age and sex-standardized prevalence of behavioural (daily fruit/vegetables; tobacco use), weight (body mass index; waist-to-height ratio) and metabolic risk factors (diabetes, hypertension, hypercholesterolaemia; hypo-HDL; and hypertriglyceridaemia) by each SES category.


RESULTS
Across cities, 61.2% and 16.1% completed secondary and college educations, respectively; 52.8% reported not working, 22.9% were unskilled; 21.3% were skilled and 3.1% were white-collar workers. For behavioural risk factors, low fruit/vegetable intake, smoked and smokeless tobacco use were more prevalent in lowest education, wealthy and occupation (for men only) groups compared to higher SES counterparts, while weight-related risks (body mass index 25.0-29.9 and ≥30 kg/m(2); waist-to-height ratio ≥0.5) were more common in higher educated and wealthy groups, and technical/professional men. For metabolic risks, a higher prevalence of diabetes, hypertension and dyslipidaemias was observed in more educated and affluent groups, with unclear patterns across occupation groups.


CONCLUSIONS
SES-CVD patterns are heterogeneous, suggesting customized interventions for different SES groups may be warranted. Different behavioural, weight, and metabolic risk factor prevalence patterns across SES indicators may signal on-going epidemiological transition in South Asia.
Rollins School of Public Health, Emory University, USA mkali@emory.edu.
Mohammed K
MK
Ali
Public Health Foundation of India, India.
Binukumar
B
Bhaskarapillai
Public Health Foundation of India, India.
Roopa
R
Shivashankar
Madras Diabetes Research Foundation, India.
Deepa
D
Mohan
Aga Khan University, Pakistan.
Zafar A
ZA
Fatmi
Madras Diabetes Research Foundation, India.
Rajendra
R
Pradeepa
Aga Khan University, Pakistan.
M
M
Masood Kadir
Madras Diabetes Research Foundation, India.
Viswanathan
V
Mohan
All India Institute of Medical Sciences, India.
Nikhil
N
Tandon
Rollins School of Public Health, Emory University, USA.
K M Venkat
KM
Narayan
Public Health Foundation of India, India.
Dorairaj
D
Prabhakaran
D000328:Adult; D000368:Aged; D001211:Asia, Western / Q000453:epidemiology; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D004032:Diet; D050171:Dyslipidemias / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009790:Occupations; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D012923:Social Class; D014505:Urban Population; D065927:Waist-Height Ratio; D055815:Young Adult
Cardiovascular risk factors; South Asians; global cardiovascular health; socioeconomic status