Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.
Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Soc Sci Med. 2019 Oct;239:112514. doi: 10.1016/j.socscimed.2019.112514. Epub 2019 Aug 26.
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.
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.
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.
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.
在中低收入国家（LMICs），糖尿病、高血压和肥胖往往与社会经济地位呈正相关。据推测，随着 LMICs 继续经历经济发展，这些积极的社会经济梯度将会逆转。我们利用印度基于人群的横断面数据，研究一个地区的经济发展状况与个体心血管疾病（CVD）风险因素患病率的社会经济差异之间的关系。
我们分别分析了两个在印度具有代表性的全国性家庭调查数据集-NFHS-4 和 DLHS-4/AHS-这两个数据集在地区层面具有代表性。糖尿病根据毛细血管血糖测量值定义，高血压根据血压测量值定义，肥胖根据身高和体重测量值定义，当前吸烟根据自我报告定义。我们使用了五种不同的地区经济发展衡量标准。我们使用地区层面的回归（绘制比较高和低社会经济地位与地区经济发展的系数）和多层次建模来分析数据。
共有 757655 名和 1618844 名成年人参加了 NFHS-4 和 DLHS-4/AHS，分别。较高的教育程度和家庭财富与更高的糖尿病、高血压和肥胖的发病几率相关，与当前吸烟的发病几率较低相关。对于糖尿病、高血压和肥胖，我们发现一个地区的经济发展水平越高，CVD 风险因素与教育程度之间的正相关关系就越不明显（甚至可能为负相关）。对于吸烟，随着地区经济发展水平的提高，与教育程度的负相关关系趋于减弱。一般来说，当使用家庭财富五分位数作为社会经济地位的衡量标准而不是教育程度时，这些关联并没有表现出明显的趋势。
虽然这项研究提供了一些“反转假说”的证据，但需要进行大规模的纵向研究，以确定随着这些国家经济的持续发展，LMICs 是否应该预期糖尿病、高血压和肥胖的当前正相关社会经济梯度可能会逆转。
