Kar S S, Thakur J S, Virdi N K, Jain S, Kumar R
School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
Natl Med J India. 2010 Jul-Aug;23(4):206-9.
In the past century, most developed countries witnessed a reversal of social gradient in cardiovascular diseases. To examine whether this phenomenon is also under way in developing countries, we assessed the prevalence of selected risk factors for cardiovascular diseases among different social groups living in urban and rural areas of northern India.
Four hundred adults > or =30 years of age, selected by cluster sampling, were surveyed from 8 purposively selected communities of Chandigarh and Haryana during 2004-05. The WHO STEPS tool for surveillance of risk factors was used to enquire about sociodemographic characteristics, tobacco use, alcohol intake, physical activity and to measure weight, height, blood pressure, and waist and hip circumference. Prevalence of risk factors such as tobacco use, physical inactivity, overweight (BMI > or =25 kg/m2), and hypertension (> or = 140/90 mmHg or on anti-hypertension treatment) were estimated according to the area of residence and across educational categories after controlling for the effects of confounding variables.
The prevalence of hypertension in urban (39%; 95% CI 29.5%-49.2%), slum (35%; 95% CI 27.2%-42.9%) and rural (33%; 95% CI 25.4%-40.8%) communities was found to be statistically similar (p > 0.05) after controlling for age, gender and education. The prevalence of physical inactivity (17% v. 12%), central obesity (90% v. 88%), overweight (20% v. 19%) and hypertension (34% v. 36%), were found to be statistically similar among literate and illiterate population after controlling for the effect of age, sex and place of residence (p > 0.05). However, the risk of tobacco use was significantly lower among literates (OR 0.3, 95% CI 0.1-0.8).
In selected communities of northern India, most of the cardiovascular disease risk factors did not have a social gradient except tobacco use, which was more common in the lower social group.
在过去的一个世纪里，大多数发达国家都见证了心血管疾病社会梯度的逆转。为了研究这种现象在发展中国家是否也在发生，我们评估了印度北部城乡不同社会群体中心血管疾病特定危险因素的患病率。
2004 - 2005年期间，通过整群抽样从昌迪加尔和哈里亚纳邦有目的地选择的8个社区中选取了400名年龄≥30岁的成年人进行调查。使用世界卫生组织用于监测危险因素的“STEPS”工具询问社会人口学特征、烟草使用、酒精摄入、身体活动情况，并测量体重、身高、血压以及腰围和臀围。在控制混杂变量的影响后，根据居住地区和教育类别估计烟草使用、身体活动不足、超重（体重指数≥25 kg/m²）和高血压（≥140/90 mmHg或正在接受抗高血压治疗）等危险因素的患病率。
在控制年龄、性别和教育因素后，城市（39%；95%可信区间29.5% - 49.2%）、贫民窟（35%；95%可信区间27.2% - 42.9%）和农村（33%；95%可信区间25.4% - 40.8%）社区的高血压患病率在统计学上相似（p>0.05）。在控制年龄、性别和居住地点的影响后，有文化和无文化人群中身体活动不足（17%对12%）、中心性肥胖（90%对88%）、超重（20%对19%）和高血压（34%对36%）的患病率在统计学上相似（p>0.05）。然而，有文化人群中烟草使用的风险显著较低（比值比0.3，95%可信区间0.1 - 0.8）。
在印度北部选定的社区中，除了烟草使用在较低社会群体中更常见外，大多数心血管疾病危险因素不存在社会梯度。
