Geldsetzer P, et al. - Researchers focused on the disparities concerning cardiovascular disease (CVD) risk and the factors that determine risk among states in India, by rural-urban location, and by individual-level sociodemographic characteristics. This information would be of use to inform health system planning and effective targeting of interventions. They found that CVD risk varied substantially among states and sociodemographic groups in India. This information can be used to target those most at risk and most in need, by directing CVD programs to such populations. Across all four risk scoring systems, similar patterns of variation in CVD risk among the Indian population were seen, however, the CVD risk scores used have not been validated in South Asian populations.

Methods

• Including 797,540 adults aged 30 to 74 years across India, two large household surveys were conducted between 2012 and 2014 for this study.
• The predicted 10-year risk of a CVD event, as calculated with the Framingham risk score, was the main outcome variable.
• Secondary analyses were carried out using the Harvard–NHANES, Globorisk, and WHO–ISH scores.
• By state, rural-urban residence, age, sex, household wealth, and education, assessment of CVD risk and the prevalence of CVD risk factors was performed.

Results

• Data revealed mean CVD risk varied from 13.2% (95% CI: 12.7%–13.6%) in Jharkhand to 19.5% (95% CI: 19.1%–19.9%) in Kerala.
• In North, Northeast, and South India, the highest CVD risk was reported.
• Positive associations of both district-level wealth quintile (based on median household wealth in a district) and urbanization with CVD risk were observed.
• Among both sexes, positive relation of household wealth quintile and living in an urban area with CVD risk was found, but the links were stronger among women vs men.
• A greater prevalence of smoking was reported in poorer household wealth quintiles and in rural areas, while a positive relation between body mass index, high blood glucose, and systolic blood pressure with household wealth and urban location was also evident.
• Men, compared to women, demonstrated a substantially higher (age-standardized) smoking prevalence (26.2% [95% CI: 25.7%–26.7%] vs 1.8% [95% CI: 1.7%–1.9%]) and mean systolic blood pressure (126.9 mm Hg [95% CI: 126.7–127.1] vs 124.3 mm Hg [95% CI: 124.1–124.5]).