Hypertension in Rural India: The Contribution of Socioeconomic Position

Abstract

Background Various indicators of socioeconomic position (SEP) may have opposing effects on the risk of hypertension in disadvantaged settings. For example, high income may reflect sedentary employment, whereas greater education may promote healthy lifestyle choices. We assessed whether education modifies the association between income and hypertension in 3 regions of South India at different stages of epidemiological transition. Methods and Results Using a cross-sectional design, we randomly selected villages within each of rural Trivandrum, West Godavari, and Rishi Valley. Sampling was stratified by age group and sex. We measured blood pressure and anthropometry and administered a questionnaire to identify lifestyle factors and SEP, including education, literacy, and income. Logistic regression was used to assess associations between various components of SEP and hypertension, and interaction analyses were used to determine whether educational attainment modified the association between income and hypertension. Trivandrum, the region of highest SEP, had the greatest prevalence of hypertension, whereas Rishi Valley, the lowest SEP region, had the least. Overall, greater income was associated with greater risk of hypertension. In interaction analyses, there was no evidence that educational attainment modified the association between income and hypertension. Conclusions Education is widely considered to ameliorate the risk of hypertension in high-income countries. Why this effect is absent in rural India merits investigation.

Keywords: education; lifestyle; low‐to‐middle income; risk factors; socioeconomic position.

Figure 1

Flow diagram of participants in 3 rural regions in India, 2014 to 2015. The 8 Mandals in West Godavari were Palakoderu, Undrajavaram, Iragavaram, Mogalthur, Unguturu, Pentapadu, Penumantra, and Attili. Participation was as follows: Rishi Valley, 45%; Godavari, 99%; and Trivandrum, 77%.

Figure 2

Socioeconomic factors associated with waist/hip ratio, body mass index, and alcohol consumption, 3 rural regions in India, 2014 to 2015. Data are presented as age‐ and sex‐adjusted odds ratios, and error bars indicate 95% CIs. Waist/hip ratio above normal is defined as ≥0.8 for women and ≥0.9 for men. Rs, Indian rupee.