Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
Department of Population Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK.
J Epidemiol Community Health. 2020 Oct;74(10):831-837. doi: 10.1136/jech-2020-214016. Epub 2020 Jun 7.
South Asians are at an increased risk of premature cardiovascular disease, but the reasons for this are unclear. Poor socio-economic conditions in childhood are associated with an increased risk of cardiovascular disease in many high-income countries and may be particularly relevant to South Asia, where socio-economic deprivation is more prevalent and severe. However, evidence from South Asia is limited.
We pooled data from two large population-based studies in India to provide a geographically representative and adequately powered sample of Indian adults. We used multilevel linear regression models to assess associations between standard of living index (SLI) in childhood (measured by recalled household assets at age 10-12 years) and major cardiovascular risk factors including adiposity, blood pressure, and fasting blood lipids, glucose and insulin.
Data on 14 011 adults (median age 39 years, 56% men) were analysed. SLI in childhood was inversely associated with systolic and diastolic blood pressure, independent of socio-economic conditions in adulthood, with beta coefficients (95% CIs) of -0.70 mmHg (-1.17 to -0.23) and -0.56 mmHg (-0.91 to -0.22), respectively, per SD increase in SLI in childhood. There was no strong evidence for an association between SLI in childhood and other risk factors of cardiovascular disease.
Poor socio-economic conditions in childhood may contribute to the increased risk of premature cardiovascular disease among South Asians by raising their blood pressure. Elucidating the mechanisms and improving socio-economic conditions for children in South Asia could provide major reductions in the burden of cardiovascular disease.
南亚人患心血管疾病的风险较高，且发病时间较早，但具体原因尚不清楚。在许多高收入国家，儿童时期较差的社会经济条件与心血管疾病风险增加有关，这种关联在社会经济贫困更为普遍和严重的南亚地区可能更为显著。然而，南亚地区的相关证据有限。
我们汇总了来自印度两项大型基于人群的研究的数据，为印度成年人提供了具有代表性且样本量足够大的地理区域数据。我们使用多层次线性回归模型评估了儿童时期生活水平指数（SLI）（通过 10-12 岁时回忆的家庭资产来衡量）与主要心血管危险因素（包括肥胖、血压和空腹血脂、血糖和胰岛素）之间的关联。
共分析了 14011 名成年人的数据（中位数年龄 39 岁，56%为男性）。儿童时期的 SLI 与收缩压和舒张压呈负相关，独立于成年后的社会经济状况，其β系数（95%CI）分别为-0.70mmHg（-1.17 至-0.23）和-0.56mmHg（-0.91 至-0.22）。儿童时期 SLI 每增加一个标准差，收缩压和舒张压分别降低 0.70mmHg 和 0.56mmHg。儿童时期的 SLI 与心血管疾病其他危险因素之间没有明显的关联。
儿童时期较差的社会经济条件可能通过升高血压，导致南亚人过早罹患心血管疾病的风险增加。阐明南亚地区儿童时期的机制，并改善其社会经济条件，可能会大幅降低心血管疾病的负担。
