Rajagiri College of Social Sciences (Autonomous), Rajagiri P. O, Kalamassery, Kochi, Kerala, 683 104, India.
International Centre for Mental Health Social Research, Department of Social Policy and Social Work, University of York, York, Heslington, YO10 5DD, UK.
BMC Cardiovasc Disord. 2020 Jul 8;20(1):327. doi: 10.1186/s12872-020-01595-x.
Cardiovascular disease (CVD) is the leading cause of mortality in India. Social and behavioural factors are strongly interrelated in the prevention and control of CVD. The ability to make lifestyle changes to control hypertension and diabetes (major risk factors for CVD) is determined by factors such as education, gender, caste, poverty, and urbanicity. This study aimed to improve our understanding of the inter-relationship of social and behavioural factors in the management of elevated serum glucose and high blood pressure and co-morbid mental health conditions.
A population-based catchment area cross sectional survey was conducted in Kerala, India. Data were collected from residents aged over 30 years (n = 997) using standardized tools and clinical measures. We performed latent class analysis incrementally to extract homogeneous latent classes of individuals based on their responses to social and behavioural risk factors in the survey. Using structural equation models, we assessed the mediating effect of depression and anxiety, and social or behavioural risk factors, on management of high blood pressure and raised serum glucose levels.
The prevalence of high blood pressure and blood glucose in the sample was 33 and 26% respectively. Latent class analysis found three clusters of risk factors. One had a predominance of behavioural characteristics, another of social risk factors and the third was a low risk group. Age, female sex, and marital status had an effect on high blood pressure and high glucose, though were mediated by mental health, social and behavioural risk factors.
Interventions to improve the management of risk factors for CVD need to address social risk factors and be sensitive to the needs of population sub-groups that may require additional support to access health services. An integration of social and health services may be required to achieve this.
心血管疾病（CVD）是印度的主要死亡原因。社会和行为因素在 CVD 的预防和控制中密切相关。控制高血压和糖尿病（CVD 的主要危险因素）的生活方式改变能力取决于教育、性别、种姓、贫困和城市化等因素。本研究旨在更好地了解社会和行为因素在控制血清葡萄糖升高和高血压以及并发心理健康状况方面的相互关系。
在印度喀拉拉邦进行了一项基于人群的集水区横断面调查。使用标准化工具和临床测量方法收集了 30 岁以上居民的数据（n=997）。我们逐步进行潜在类别分析，根据调查中社会和行为危险因素的反应，对个体进行同质潜在类别提取。使用结构方程模型，我们评估了抑郁和焦虑以及社会或行为危险因素对高血压和升高的血清葡萄糖水平管理的中介作用。
该样本中高血压和血糖水平的患病率分别为 33%和 26%。潜在类别分析发现了三个危险因素聚类。一个以行为特征为主，另一个以社会风险因素为主，第三个是低风险组。年龄、女性和婚姻状况对高血压和高血糖有影响，但受心理健康、社会和行为危险因素的影响。
改善 CVD 危险因素管理的干预措施需要解决社会风险因素，并针对可能需要额外支持来获得卫生服务的人群亚组的需求保持敏感。可能需要整合社会和卫生服务来实现这一目标。
