The Department of Endocrinology, 
Hypertension in Rural India: The Contribution of Socioeconomic Position.
- School of Clinical Sciences at Monash Health Monash University Melbourne Australia.
- The George Institute for Global Health University of New South Wales Australia.
- Achutha Menon Centre for Health Science Studies Sree Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum Kerala, India.
- Department of Cardiology Westmead Hospital Sydney Australia.
- Melbourne School of Population and Global Health University of Melbourne Carlton Australia.
- School of Public Health and Preventative Medicine Monash University Melbourne Australia.
- Nossal Institute for Global Health Melbourne School of Population and Global Health University of Melbourne Carlton Australia.
- Rishi Valley Rural Health Centre Chittoor District Andhra Pradesh India.
- Global Institute of Public Health Ananthapuri Hospitals and Research Institute Trivandrum Kerala India.
- Peninsula Clinical School Central Clinical School Monash University Frankston Australia.
- Department of Endocrinology, Diabetes and Metabolism Christian Medical College Vellore Tamil Nadu India.
- George Institute for Global Health New Delhi India.
- George Institute for Global Health-Oxford University Oxford United Kingdom.
- Department of Population Medicine and Civilization Diseases Prevention Faculty of Medicine With the Division of Dentistry and Division of Medical Education in English Medical University of Bialystok Bialystok Poland.
- Cardiovascular Disease Program Biomedicine Discovery Institute, and Department of Physiology Monash University Melbourne Australia.
Journal of the American Heart Association Vol. 9 · Issue 7 · pp. e014486
PMID 32223389 DOI 10.1161/jaha.119.014486
Cite This Article
Amanda G Thrift, Rathina Srinivasa Ragavan, Michaela A Riddell, Rohina Joshi, K R Thankappan, Clara Chow, Brian Oldenburg, Ajay S Mahal, Kartik Kalyanram, Kamakshi Kartik, Oduru Suresh, G K Mini, Jordan Ismail, Dilan Giguruwa Gamage, Aniqa Hasan, Velandai K Srikanth, Nihal Thomas, Pallab K Maulik, Rama K Guggilla, Roger G Evans. Hypertension in Rural India: The Contribution of Socioeconomic Position. Journal of the American Heart Association. 2020;9(7):e014486. doi:10.1161/jaha.119.014486
Abstract
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.
Keywords
- education
- lifestyle
- low‐to‐middle income
- risk factors
- socioeconomic position
