Open AccessHypertension in Rural India: The Contribution of Socioeconomic Position
Author(s) -
Thrift Amanda G.,
Ragavan Rathina Srinivasa,
Riddell Michaela A.,
Joshi Rohina,
Thankappan K. R.,
Chow Clara,
Oldenburg Brian,
Mahal Ajay S.,
Kalyanram Kartik,
Kartik Kamakshi,
Suresh Oduru,
Mini G. K.,
Ismail Jordan,
Gamage Dilan Giguruwa,
Hasan Aniqa,
Srikanth Velandai K.,
Thomas Nihal,
Maulik Pallab K.,
Guggilla Rama K.,
Evans Roger G.
Publication year - 2020
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.119.014486
Subject(s) - medicine , socioeconomic status , anthropometry , logistic regression , disadvantaged , educational attainment , environmental health , demography , epidemiology , rural area , cross sectional study , household income , gerontology , population , geography , archaeology , pathology , sociology , political science , law , economics , economic growth
Background Various indicators of socioeconomic position ( SEP ) may have opposing effects on the risk of hypertension in disadvantaged settings. For example, high income may reflect sedentary employment, whereas greater education may promote healthy lifestyle choices. We assessed whether education modifies the association between income and hypertension in 3 regions of South India at different stages of epidemiological transition. Methods and Results Using a cross‐sectional design, we randomly selected villages within each of rural Trivandrum, West Godavari, and Rishi Valley. Sampling was stratified by age group and sex. We measured blood pressure and anthropometry and administered a questionnaire to identify lifestyle factors and SEP , including education, literacy, and income. Logistic regression was used to assess associations between various components of SEP and hypertension, and interaction analyses were used to determine whether educational attainment modified the association between income and hypertension. Trivandrum, the region of highest SEP , had the greatest prevalence of hypertension, whereas Rishi Valley, the lowest SEP region, had the least. Overall, greater income was associated with greater risk of hypertension. In interaction analyses, there was no evidence that educational attainment modified the association between income and hypertension. Conclusions Education is widely considered to ameliorate the risk of hypertension in high‐income countries. Why this effect is absent in rural India merits investigation.