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Socioeconomic gradients of cardiovascular risk factors in China and India: results from the China health and retirement longitudinal study and longitudinal aging study in India.

ABSTRACT: OBJECTIVES:Cardiovascular disease has become a major public health challenge in developing countries. The goal of this study is to compare socioeconomic status (SES) gradients of cardiovascular risk factors (CVRF) both within and between China and India. METHODS:We used multivariable logistic regression models to examine the associations between SES and CVRF, using data from the China health and retirement longitudinal study and the longitudinal aging study in India. RESULTS:The results showed that, compared to illiteracy, the odds ratios of completing junior high school for high-risk waist circumference were 4.99 (95% confidence interval: 1.77-14.06) among Indian men, 3.42 (95% confidence interval: 1.66-7.05) among Indian women, but 0.74 (95% confidence interval: 0.59-0.92) among Chinese women. Similar patterns were observed between educational attainment and high-risk body mass index, and between education and hypertension, based on self-reported physician diagnosis and direct blood pressure measurements. CONCLUSIONS:SES is associated with CVRF in both China and India. However, this relationship showed opposite patterns across two countries, suggesting that this association is not fixed, but is subjective to underlying causal pathways, such as patterns of risky health behaviors and different social and health policies.

SUBMITTER: Hu P

PROVIDER: S-EPMC5940550 | biostudies-literature | 2017 Sep

REPOSITORIES: biostudies-literature

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Socioeconomic gradients of cardiovascular risk factors in China and India: results from the China health and retirement longitudinal study and longitudinal aging study in India.

Hu Peifeng P Wang Serena S Lee Jinkook J

International journal of public health 20170412 7

<h4>Objectives</h4>Cardiovascular disease has become a major public health challenge in developing countries. The goal of this study is to compare socioeconomic status (SES) gradients of cardiovascular risk factors (CVRF) both within and between China and India.<h4>Methods</h4>We used multivariable logistic regression models to examine the associations between SES and CVRF, using data from the China health and retirement longitudinal study and the longitudinal aging study in India.<h4>Results</h ...[more]

PMID: 28401249

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Project description:BackgroundChina is facing the challenge of rising prevalence and ballooning burden of chronic non-communicable diseases (NCDs); however, the Chinese middle- and older-aged population considerably lack preventive behaviors. Health shocks (HS), widely defined as sudden health deterioration brought on by diseases or accidents, bring a "teachable moment" to motivate changes in preventive behaviors.ObjectiveThis study aims to examine the effect of HS on changes in preventive behaviors, including personal health practices and preventive care utilization.MethodsHS was defined as any five chronic disease diagnoses (cancer, heart disease, stroke, diabetes, and hypertension). The impacts of HS on smoking, drinking, and exercise, physical examination were estimated. The panel data of 13,705 respondents were obtained from the latest two waves of the China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018. A multilevel propensity score match difference-in-difference (multilevel PSM-DID) model was constructed.ResultsHS significantly decreased smoking (OR = 0.59, p < 0.05) and drinking (OR = 0.62, p < 0.01) and increased the utilization of auxiliary inspection in physical examination (OR = 1.19, p < 0.1). Major HS had significantly considerable and specific effects on reducing smoking and drinking (OR = 0.37 and 0.56, p < 0.01), while minor HS had relatively small effects on reducing smoking (OR = 0.74, p < 0.05) and drinking (OR = 0.69, p < 0.01), but extensive effects on initiating exercise (OR = 1.32, p < 0.05), physical examination (OR = 1.18, p < 0.1), and auxiliary inspection (OR = 1.30, p < 0.05).ConclusionAfter HS, there is a teachable moment to promote positive changes in preventive behaviors. Guided by the 5A's brief intervention model (Ask, Advise, Assess, Assist, Arrange), tailored interventions should be targeted at these populations to reduce the risk of the progression and complications of existing diseases, prevent the related comorbidity, and prolong the expected life-span.

Project description:OBJECTIVES:The prevalence of cardiovascular diseases (CVD) within low-income and middle-income countries has reached epidemic proportions. However, the association between out-of-pocket (OOP) payment and socioeconomic status (SES) of patients with CVD is not well studied. We aimed to understand the financial burden among Chinese middle-aged and older patients with CVD, and whether there was an association with SES. SETTINGS:A nationally representative survey-The China Health and Retirement Longitudinal Survey (CHARLS)-was conducted in 28 provinces of mainland China in 2011 and 2013. PARTICIPANTS:Of the over 18 000 CHARLS respondents, eligible participants were those aged 45 years and over who had been previously diagnosed with CVD. OUTCOME MEASURES:Financial burden was measured by individual OOP payment and household catastrophic health expenditure (CHE) occurrence (ie, the annual household health expenditure was 40% or more of the total non-food household expenditure). Multilevel regression models were used to explore the association between financial burden and SES. RESULTS:Among CHARLS respondents, CVD prevalence increased from 14.7% in 2011 to 16.6% in 2013. Average annual CVD OOP payment increased from 5000 RMB (770 USD) to 6120 RMB (970 USD). Furthermore, CHE occurrence increased from 44.2% to 48.1%. Patients spent almost twice on outpatient as on inpatient services. Two of the three SES indicators (total household expenditure, occupation type) were found to be associated with CVD OOP payment amount, and the likelihood of CHE. Unemployed patients had a higher likelihood of CHE compared with agricultural workers. Rural-urban difference was associated with the likelihood of CHE in 2011 alone. CONCLUSION:The Chinese health system should use this health expenditure pattern among patients with CVD to create more equitable health insurance schemes that financially balance between outpatient and inpatient care, and provide better financial risk protection to patients with low SES.

Project description:IntroductionThe Indian population is rapidly aging with huge proportion of illiterate and socioeconomically disadvantaged people and there is a dearth of research on the relationships between factors of socioeconomic vulnerability and frailty in older people. The present study examined the cross-sectional associations between socioeconomic vulnerability and physical frailty in community-dwelling older individuals in India.Materials and methodsThe data for the study were obtained from the Longitudinal Aging Study in India (LASI), which was conducted in 2017-18. The effective sample size was 14,652 older males and 15,899 older females aged 60 and over. The outcome variable was physical frailty phenotype measured from exhaustion, unintentional weight loss, weak grip strength, low physical activity, and slow walking time. The main explanatory variable was vulnerability status based on education, wealth and caste. The study carried out bivariate analysis to observe the association between vulnerability status and physical frailty. Further, multivariable binary logistic regression analysis was conducted to fulfil the objective of the study.ResultsA proportion of 10.5 and 14.4% of older males and females respectively were in the overall vulnerable category. The prevalence of physical frailty was high among older males from vulnerable population (31.4% vs 26.9%; p < 0.001). The adjusted estimates from multivariate analysis revealed that older adults from vulnerable category had 14% significantly higher odds of being frail in comparison to non-vulnerable category [AOR: 1.14; CI: 1.06,1.24]. The adjusted model further revealed that there were no significant gender differentials in physical frailty among older adults. Model-3 (adjusted model) revealed that older males and females from vulnerable population had 18% [AOR: 1.18; CI: 1.04,1.34] and 8% [AOR: 1.08; CI: 1.01,1.21] significantly higher odds of being physically frail in comparison to older males from non-vulnerable population respectively.ConclusionsAdverse socioeconomic circumstances such as low education, lower wealth and caste status that are associated with increased prevalence of physical frailty raise urgent questions both for public health practitioners and clinicians. The current findings may help to adapt public policies focusing on screening physical frailty in the clinical settings, especially among vulnerable populations as a marker of a possibly reversible vulnerability to adverse outcomes in old age.

Dataset Information

Socioeconomic gradients of cardiovascular risk factors in China and India: results from the China health and retirement longitudinal study and longitudinal aging study in India.

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Socioeconomic gradients of cardiovascular risk factors in China and India: results from the China health and retirement longitudinal study and longitudinal aging study in India.

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