Educational status and cardiovascular risk profile in Indians
- K. Srinath Reddy*†‡,
- Dorairaj Prabhakaran†,
- Panniyammakal Jeemon†,
- K. R. Thankappan§,
- Prashant Joshi¶,
- Vivek Chaturvedi†,
- Lakshmy Ramakrishnan† and
- Farooque Ahmed‖
- *Public Health Foundation of India and
- †Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India;
- §Achutha Menon Centre for Health Sciences and Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala 695011, India;
- ¶Department of Medicine, Government Medical College Nagpur, Nagpur, Maharashtra 440033, India; and
- ‖Khajabandanawaz Institute of Medical Sciences, Gulberga, Karnataka 585106, India
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Edited by Barry R. Bloom, Harvard School of Public Health, Boston, MA, and approved July 9, 2007 (received for review February 1, 2007)
Abstract
The inverse graded relationship of education and risk factors of coronary heart disease (CHD) has been reported from Western populations. To examine whether risk factors of CHD are predicted by level of education and influenced by the level of urbanization in Indian industrial populations, a cross-sectional survey (n = 19,973; response rate, 87.6%) was carried out among employees and their family members in 10 medium-to-large industries in highly urban, urban, and periurban regions of India. Information on behavioral, clinical, and biochemical risk factors of CHD was obtained through standardized instruments, and educational status was assessed in terms of the highest educational level attained. Data from 19,969 individuals were used for analysis. Tobacco use and hypertension were significantly more prevalent in the low- (56.6% and 33.8%, respectively) compared with the high-education group (12.5% and 22.7%, respectively; P < 0.001). However, dyslipidemia prevalence was significantly higher in the high-education group (27.1% as compared with 16.9% in the lowest-education group; P < 0.01). When stratified by the level of urbanization, industrial populations located in highly urbanized centers were observed to have an inverse graded relationship (i.e., higher-education groups had lower prevalence) for tobacco use, hypertension, diabetes, and overweight, whereas in less-urbanized locations, we found such a relationship only for tobacco use and hypertension. This study indicates the growing vulnerability of lower socioeconomic groups to CHD. Preventive strategies to reduce major CHD risk factors should focus on effectively addressing these social disparities.
Footnotes
- ‡To whom correspondence should be addressed. E-mail: ksreddy{at}ccdcinida.org
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Author contributions: K.S.R. and D.P. designed research; P. Jeemon, K.R.T., P. Joshi, V.C., L.R., and F.A. performed research; K.S.R., D.P., and P. Jeemon analyzed data; and K.S.R., D.P., and P. Jeemon wrote the paper.
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This paper is part of a special series on Sustainable Health. See the related editorial on page 15969 and accompanying articles on pages 16038, 16044, and 16194.
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The authors declare no conflict of interest.
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This article is a PNAS Direct Submission.
- Abbreviations:
- CHD,
- coronary heart disease;
- SES,
- socioeconomic status;
- ES,
- educational status.
- © 2007 by The National Academy of Sciences of the USA
