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
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 popul...
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| Main Authors: | , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
2019
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| In: |
Social science & medicine
Year: 2019, Volume: 239 |
| ISSN: | 1873-5347 |
| DOI: | 10.1016/j.socscimed.2019.112514 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.socscimed.2019.112514 Verlag, lizenzpflichtig, Volltext: http://www.sciencedirect.com/science/article/pii/S0277953619305088 
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| Author Notes: | Lara Jung, Jan-Walter De Neve, Simiao Chen, Jennifer Manne-Goehler, Lindsay M. Jaacks, Daniel J. Corsi, Ashish Awasthi, S.V. Subramanian, Sebastian Vollmer, Till Bärnighausen, Pascal Geldsetzer |
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| 245 | 1 | 4 | |a The interaction between district-level development and individual-level socioeconomic gradients of cardiovascular disease risk factors in India |b a cross-sectional study of 2.4 million adults |c Lara Jung, Jan-Walter De Neve, Simiao Chen, Jennifer Manne-Goehler, Lindsay M. Jaacks, Daniel J. Corsi, Ashish Awasthi, S.V. Subramanian, Sebastian Vollmer, Till Bärnighausen, Pascal Geldsetzer |
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| 520 | |a 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. | ||
| 650 | 4 | |a Cardiovascular disease | |
| 650 | 4 | |a Diabetes mellitus | |
| 650 | 4 | |a Economic development | |
| 650 | 4 | |a Hypertension | |
| 650 | 4 | |a India | |
| 650 | 4 | |a Multi-level modeling | |
| 650 | 4 | |a Obesity | |
| 650 | 4 | |a Smoking | |
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