Table 1
Comparison of setting, designs, participant recruitment and data collection of CARRS, UDAY and SSS.
| CARRS | UDAY | SSS | |||||
|---|---|---|---|---|---|---|---|
| Setting | North | South | North | South | North | ||
| Residence | Metropolitan cities | Smaller city | Rural | Smaller city | Rural | Rural | |
| District | Delhi | Chennai | Sonipat | Vishakhapatnam | Solan | ||
| Household sampling | Multistage cluster random | Volunteer sampling | |||||
| Individual sampling | 1 man and 1 woman from each household (selected by Kish method) | ||||||
| Age groups | ≥20 years | ≥30 years | ≥20 years | ||||
| Exclusion criteria | Pregnant, bedridden and participants who were unable to comprehend the questionnaires due cognitive deficiencies were excluded | ||||||
| Study period | October 2010 – November 2011 | July 2014 – February 2015 | 2013–14 | ||||
| Laboratory | PHFI | MDRF | PHFI | PHFI | |||
| Data collection tools | |||||||
| Age, sex, education, household assets | Questionnaire | ||||||
| Current Smoking | Questionnaire- Self-reported use of smoked tobacco- ever and current | ||||||
| Physical activity | International Physical Activity Questionnaire – Short Form (IPAQ-SF) | Global Physical Activity Questionnaire (GPAQ) | IPAQ-SF | ||||
| Fruits and vegetables servings | Food frequency questionnaire (FFQ) | WHO STEPS questions on fruit and vegetable intake | FFQ | ||||
| Blood pressure | Omron HEM – 7080; | Omron HEM – 7200 | Omron T9P | ||||
| BMI | Weight – Tanita – BC 601; Height – Seca 214 stadiometer | Weight – Omron 286; Height – Seca 214 stadiometer | |||||
| Fasting plasma glucose | Hexokinase/Kinetic | ||||||
| Total Cholesterol | Cholesterol Oxidase Peroxidase (CHOD-POD) end-point | ||||||
[i] Notes: Abbreviations CARRS- Centre for Cardiometabolic Risk Reduction in South Asia; UDAY- Comprehensive Diabetes Prevention and Management Program study; SSS- Solan Surveillance study; PHFI- Public Health Foundation of India; MDRF- Madras Diabetes Research Foundation; WHO-STEPS- World Health Organization- STEPwise approach to surveillance.
Figure 1
Flow chart of participant selections from CARRS, UDAY, and SSS.
Notes: Abbreviations CARRS- Centre of Cardiometabolic Risk Reduction in South Asia; SSS- Solan Surveillance Study; h/o CVD- history of CVD.
* Missing outcome- If data is missing on one or more of tobacco use, diet, physical activity, blood pressure, body mass index, fasting plasma glucose or total cholesterol.
Table 2
Sociodemographic characteristics of study population free of cardiovascular diseases.
| VARIABLES | METROPOLITAN CITIES | SMALLER CITIES | RURAL | TOTAL | P-VALUE* |
|---|---|---|---|---|---|
| n = 7106 | n = 4948 | n = 10,090 | n = 22,144 | ||
| COL % (95% CI) | COL % (95% CI) | COL % (95% CI) | COL % (95% CI) | ||
| Age Mean (SD) | 45.7 (11.1) | 46.9 (12.1) | 47.5 (12.3) | 46.8 (11.9) | <0.001 |
| Age group | |||||
| 30–44 | 51.3 (50.1, 52.5) | 47.5 (46.1, 48.9) | 45.7 (44.7, 46.6) | 47.9 (47.2, 48.5) | <0.001 |
| 45–60 | 34.8 (33.7, 35.9) | 34.7 (33.4, 36.1) | 33.9 (33.0, 34.8) | 34.4 (33.7, 35.0) | |
| >60 | 13.9 (13.1, 14.8) | 17.8 (16.7, 18.9) | 20.5 (19.7, 21.3) | 17.8 (17.3, 18.3) | |
| Sex | |||||
| Men | 45.2 (44.1, 46.4) | 46.3 (44.9, 47.7) | 42.1 (41.2, 43.1) | 44.0 (43.4, 44.7) | <0.001 |
| Women | 54.8 (53.6, 55.9) | 53.7 (52.3, 55.1) | 57.9 (56.9, 58.8) | 56.0 (55.3, 56.6) | |
| Education | |||||
| Up to primary schooling | 20.3 (19.4, 21.3) | 24.8 (23.6, 26.1) | 38.9 (37.9, 39.8) | 29.8 (29.2, 30.4) | <0.001 |
| Secondary school | 63.2 (62.1, 64.4) | 47.6 (46.2, 49.0) | 54.6 (53.6, 55.6) | 55.8 (55.2, 56.5) | |
| Graduation and above | 16.4 (15.6, 17.3) | 27.5 (26.3, 28.8) | 6.5 (6.1, 7.0) | 14.4 (13.9, 14.9) | |
| Asset tertile | |||||
| Low | 38.2 (37.0, 39.3) | 20.0 (18.9, 21.1) | 38.8 (37.7, 39.8) | 34.2 (33.5, 34.8) | <0.001 |
| Middle | 37.0 (35.9, 38.1) | 36.9 (35.6, 38.3) | 35.8 (34.8, 36.8) | 36.5 (35.8, 37.1) | |
| High | 24.8 (23.8, 25.8) | 43.1 (41.7, 44.5) | 25.5 (24.6, 26.4) | 29.4 (28.8, 30.0) | |
[i] Notes: Metropolitan cities- Delhi and Chennai; Smaller cities- urban Sonipat and Visakhapatnam; Rural- rural areas of Sonipat, Visakhapatnam and Solan; Abbreviations: SD- standard deviation. * Using chi-square (for percentages) or one-way ANOVA (for means) tests.
Table 3
Distribution of individual ideal cardiac health metrics in the study population free from cardiovascular diseases.
| VARIABLES | DEFINITION | METROPOLITAN CITIES | SMALLER CITIES | RURAL | TOTAL | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| n = 7,106 | n = 4,948 | n = 10,090 | n = 22,144 | |||||||
| CRUDE | STANDARDIZED* | CRUDE | STANDARDIZED* | CRUDE | STANDARDIZED* | CRUDE | STANDARDIZED* | P-VALUE * | ||
| Smoking | ||||||||||
| Ideal | Non-smoker | 85.4 (84.5, 86.2) | 84.2 (83.3, 85.1) | 81.9 (80.8, 82.9) | 80.3 (79.2, 81.4) | 73.8 (72.9, 74.6) | 70.5 (69.6, 71.4) | 79.3 (78.8, 79.8) | 76.7 (76.1, 77.2) | <0.001 |
| Intermediate | Past smoker | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
| Poor | Current smoker | 14.6 (13.8, 15.4) | 15.8 (14.9, 16.7) | 18.1 (17.1, 19.2) | 19.7 (18.6, 20.8) | 26.2 (25.4, 27.1) | 29.5 (28.6, 30.4) | 20.7 (20.1, 21.2) | 23.3 (22.7, 23.9) | |
| Diet (fruits and vegetable consumption) | ||||||||||
| Ideal | ≥ 5 servings | 0.5 (0.3, 0.7) | 0.4 (0.3, 0.6) | 11.7 (10.9, 12.7) | 11.4 (10.4, 12.3) | 3.2 (2.9, 3.6) | 3.3 (2.9, 3.7) | 4.2 (4.0, 4.5) | 4.2 (3.9, 4.5) | <0.001 |
| Intermediate | 2–4 servings | 45.6 (44.4, 46.7) | 45.7 (44.4, 47.1) | 52.0 (50.6, 53.4) | 52.0 (50.4, 53.5) | 41.6 (40.7, 42.6) | 41.4 (40.4, 42.5) | 45.2 (44.6, 45.9) | 45.1 (44.4, 45.8) | |
| Poor | <2 servings | 54.0 (52.8, 55.1) | 53.8 (52.5, 55.2) | 36.2 (34.9, 37.6) | 36.7 (35.2, 38.1) | 55.1 (54.2, 56.1) | 55.2 (54.2, 56.3) | 50.5 (49.9, 51.2) | 50.7 (50.0, 51.4) | |
| Mean servings | 1.5(1.5, 1.5) | 1.5(1.5, 1.5) | 2.9 (2.8, 2.9) | 2.8 (2.8, 2.9) | 2.1 (2.1, 2.1) | 2.1 (2.1, 2.1) | 2.1 (2.1, 2.1) | 2.1 (2.1, 2.1) | <0.001 | |
| Physical activity | ||||||||||
| Ideal | High activity | 66.4 (65.3, 67.5) | 60.8 (59.5, 62.1) | 57.8 (56.5, 59.2) | 53.9 (52.4, 55.3) | 81.4 (80.6, 82.1) | 78.7 (77.8, 79.5) | 71.3 (70.7, 71.9) | 67.5 (66.8, 68.2) | <0.001 |
| Intermediate | Moderate activity | 25.9 (24.9, 26.9) | 29.0 (27.7, 30.2) | 26.5 (25.3, 27.8) | 27.9 (26.5, 29.3) | 10.9 (10.3, 11.6) | 12.0 (11.3, 12.7) | 19.2 (18.7, 19.7) | 20.9 (20.3, 21.5) | |
| Poor | Low activity | 7.7 (7.1, 8.4) | 10.2 (9.3, 11.1) | 15.6 (14.6, 16.7) | 18.2 (17.0, 19.4) | 7.7 (7.2, 8.2) | 9.3 (8.7, 10.0) | 9.5 (9.1, 9.9) | 11.6 (11.1, 12.1) | |
| Mean MET minutes | 4478.0 (4410.7, 4545.2) | 4159.1 (4084.0, 4234.2) | 5636.0 (5464.6, 5807.4) | 5254.9 (5084.0, 5425.9) | 9700.3 (9568.1, 9832.6) | 9244.7 (9108.5, 9380.9) | 7,119.6 (7,038.5, 7,200.7) | 6708.3 (6624.2, 6792.4) | <0.001 | |
| Blood Pressure (BP in mm/Hg) | ||||||||||
| Ideal | <120/80 | 32.2 (31.1, 33.3) | 28.5 (27.4, 29.6) | 38.2 (36.9, 39.6) | 34.5 (33.2, 35.8) | 41.4 (40.4, 42.3) | 38.5 (37.5, 39.5) | 37.7 (37.1, 38.4) | 34.5 (33.9, 35.2) | <0.001 |
| Intermediate | 120–139/80–89 | 38.3 (37.2, 39.5) | 37.9 (36.6, 39.3) | 36.9 (35.6, 38.3) | 37.9 (36.4, 39.4) | 38.5 (37.5, 39.4) | 39.0 (37.9, 40.0) | 38.1 (37.5, 38.7) | 38.4 (37.7, 39.1) | |
| Poor | ≥140/90 | 29.4 (28.4, 30.5) | 33.6 (32.3, 34.9) | 24.9 (23.7, 26.1) | 27.6 (26.3, 29.0) | 20.1 (19.4, 20.9) | 22.5 (21.6, 23.4) | 24.2 (23.6, 24.8) | 27.1 (26.4, 27.7) | |
| Mean Systolic BP | 125.5 (125.0, 125.9) | 128.5 (127.9, 129.0) | 126.6 (126.0, 127.2) | 128.6 (128.0, 129.2) | 123.9 (123.5, 124.2) | 125.5 (125.1, 125.9) | 125.0 (124.7, 125.2) | 127 (126.7, 127.3) | ||
| Mean Diastolic BP | 83.1 (82.9, 83.4) | 83.5 (83.1, 83.8) | 77.4 (77.1, 77.7) | 77.2 (76.8, 77.5) | 76.9 (76.7, 77.2) | 77.1 (76.8, 77.3) | 79.0 (78.9, 79.2) | 79.1 (78.9, 79.2) | <0.001 | |
| Body mass index (BMI in kg/m2) | ||||||||||
| Ideal | <25.0 | 44.4 (43.2, 45.5) | 47.0 (45.6, 48.3) | 46.7 (45.3, 48.1) | 48.2 (46.7, 49.7) | 72.1 (71.2, 73.0) | 73.3 (72.4, 74.2) | 57.5 (56.9, 58.2) | 59.6 (58.9, 60.3) | <0.001 |
| Intermediate | 25.0–29.9 | 36.0 (34.9, 37.1) | 34.3 (33.0, 35.6) | 36.5 (35.1, 37.8) | 35.4 (34.0, 36.9) | 21.5 (20.7, 22.3) | 20.8 (19.9, 21.6) | 29.5 (28.9, 30.1) | 28.3 (27.6, 28.9) | |
| Poor | ≥ 30 | 19.6 (18.7, 20.5) | 18.7 (17.7, 19.8) | 16.8 (15.8, 17.9) | 16.4 (15.3, 17.5) | 6.4 (5.9, 6.9) | 5.9 (5.5, 6.4) | 12.9 (12.5, 13.4) | 12.1 (11.7, 12.6) | |
| Mean BMI | 26.0 (25.9, 26.1) | 25.7 (25.6, 25.8) | 25.7 (25.6, 25.9) | 25.6 (25.4, 25.8) | 22.9 (22.8, 23.0) | 22.7 (22.7, 22.8) | 24.5 (24.4, 24.6) | 24.3 (24.2, 24.4) | <0.001 | |
| Fasting plasma glucose (FPG in mg/dl) | ||||||||||
| Ideal | <100 | 50.0 (48.9, 51.2) | 48.1 (46.8, 49.4) | 65.6 (64.3, 66.9) | 64.4 (63.0, 65.8) | 78.4 (77.6, 79.2) | 77.9 (77.0, 78.8) | 66.5 (65.8,67.1) | 65.8 (65.1, 66.5) | <0.001 |
| Intermediate | 100–125 | 33.0 (31.9, 34.1) | 33.1 (31.8, 34.4) | 20.7 (19.6, 21.9) | 21.0 (19.8, 22.3) | 16.3 (15.6, 17.0) | 16.5 (15.7, 17.2) | 22.7 (22.1,23.2) | 22.6 (22.0, 23.3) | |
| Poor | ≥126 | 16.9 (16.1, 17.8) | 18.9(17.8, 20.0) | 13.7 (12.8, 14.7) | 14.6 (13.5, 15.6) | 5.3 (4.9, 5.7) | 5.7 (5.2, 6.1) | 10.9 (10.5, 11.3) | 11.6 (11.1, 12.0) | |
| Mean FPG | 113.8 (112.7, 114.8) | 115.1 (113.8, 116.4) | 103.9 (102.7, 105.1) | 104.6 (103.3, 106.0) | 94.4 (93.9, 95.0) | 94.9 (94.2, 95.5) | 102.8 (102.2, 103.3) | 103.2 (102.6, 103.8) | <0.001 | |
| Total Cholesterol (TC in mg/dl) | ||||||||||
| Ideal | <200 | 66.1 (65.0, 67.2) | 64.1 (62.8, 65.4) | 66.2 (64.9, 67.5) | 65.8 (64.4, 67.2) | 66.5 (65.6, 67.4) | 65.9 (65.0, 66.9) | 66.3 (65.7, 66.9) | 65.4 (64.7, 66.1) | 0.07 |
| Intermediate | 200–239 | 25.0 (24.0, 26.1) | 26.2 (25.0, 27.4) | 24.5 (23.3, 25.7) | 24.7 (23.4, 26.0) | 23.6 (22.8, 24.4) | 23.7 (22.8, 24.6) | 24.3 (23.7,24.8) | 24.7 (24.0, 25.3) | |
| Poor | ≥240 | 8.8 (8.2, 9.5) | 9.7 (8.9, 10.6) | 9.3 (8.5, 10.2) | 9.5 (8.6, 10.4) | 9.9 (9.3, 10.5) | 10.3 (9.7, 11.0) | 9.4 (9.1, 9.8) | 10.0 (9.5, 10.4) | |
| Mean TC | 186.5 (185.6, 187.4) | 187.7 (186.6, 188.7) | 185.9 (184.8, 187.0) | 185.8 (184.6, 187.1) | 185.5 (184.7, 186.3) | 186.1 (185.2, 186.9) | 185.9 (185.4, 186.4) | 186.5 (185.9, 187.1) | 0.29 | |
[i] Notes: All values are in column percentages and 95% confidence interval unless specified; MET minutes – metabolic equivalents minutes; * Age and sex standardized to 2010 South Asia population.
#Chi square test for categorical variables and One-way ANOVA for means of the standardized estimates.
Table 4
Prevalence of ideal cardiac health metrics in three levels of residence in India.
| NUMBER OF IDEAL CARDIAC HEALTH METRICS# | METROPOLITAN CITIES | SMALLER CITIES | RURAL | TOTAL | ||||
|---|---|---|---|---|---|---|---|---|
| n = 7,106 | n = 4,948 | n = 10,090 | n = 22,144 | |||||
| CRUDE % (95% CI) | STANDARDIZED* % (95% CI) | CRUDE % (95% CI) | STANDARDIZED* % (95% CI) | CRUDE % (95% CI) | STANDARDIZED* % (95% CI) | CRUDE % (95% CI) | STANDARDIZED* % (95% CI) | |
| 0 | 0.5 (0.3, 0.7) | 0.5 (0.3, 0.7) | 0.4 (0.3, 0.7) | 0.5 (0.3, 0.7) | 0.1 (0.1, 0.2) | 0.2 (0.1, 0.3) | 0.3 (0.2, 0.4) | 0.3 (0.3, 0.4) |
| Any 1 | 5.5 (5.0, 6.1) | 6.7 (5.9, 7.4) | 4.5 (3.9, 5.1) | 5.0 (4.3, 5.7) | 1.6 (1.3, 1.8) | 1.8 (1.5, 2.2) | 3.5 (3.3, 3.7) | 4.0 (3.7, 4.3) |
| Any 2 | 18.8 (17.9, 19.7) | 21.4 (20.2, 22.6) | 15.3 (14.3, 16.3) | 16.8 (15.6, 18.0) | 7.4 (6.9, 7.9) | 8.1 (7.5, 8.7) | 12.8 (12.4, 13.2) | 14.0 (13.5, 14.6) |
| Any 3 | 27.6 (26.5, 28.6) | 27.7 (26.5, 28.9) | 24.8 (23.6, 26.0) | 25.6 (24.3, 27.0) | 19.4 (18.7, 20.2) | 20.8 (19.9, 21.6) | 23.2 (22.7, 23.8) | 24.2 (23.6, 24.8) |
| Any 4 | 25.5 (24.5, 26.5) | 23.9 (22.8, 25.0) | 26.3 (25.0, 27.5) | 26.2 (24.8, 27.5) | 29.7 (28.8, 30.6) | 30.2 (29.2, 31.2) | 27.6 (27.0, 28.2) | 27.5 (26.9, 28.2) |
| Any 5 | 15.8 (15.0,16.7) | 14.2 (13.3, 15.1) | 19.3 (18.3, 20.5) | 17.6 (16.5, 18.7) | 27.8 (27.0, 28.7) | 26.9 (26.0, 27.8) | 22.1 (21.5, 22.6) | 20.8 (20.2, 21.4) |
| Any 6 | 6.4 (5.8, 7.0) | 5.6 (5.1, 6.2) | 8.9 (8.1, 9.7) | 7.9 (7.2, 8.6) | 13.8 (13.1, 14.5) | 11.8 (11.2, 12.4) | 10.3 (9.9, 10.7) | 8.9 (8.6, 9.3) |
| Any 7 | 0.0 (0.0, 0.1) | 0.0 (0.0, 0.0) | 0.5 (0.4, 0.8) | 0.4 (0.2, 0.6) | 0.2 (0.1, 0.3) | 0.2 (0.1, 0.3) | 0.2 (0.2, 0.3) | 0.2 (0.1, 0.3) |
| Mean (SD) | 3.5 (3.4, 3.5) | 3.3 (3.3, 3.3) | 3.7 (3.6, 3.7) | 3.6 (3.6, 3.6) | 4.2 (4.1, 4.2) | 4.1 (4.1, 4.1) | 3.8 (3.8, 3.8) | 3.7 (3.7, 3.8) |
[i] Notes:
The ideal CVH metrics included are not smoking, diet, physical activity, body mass index, blood pressure, fasting plasma glucose and total cholesterol.
All values are in column percentage (95% confidence interval) except when specified. # mutually exclusive categories; * Age and sex standardized to 2010 South Asia population.
The differences number of ideal CVH across the three types of settings and mean metrics were significant at p-value <0.001 for both crude and standardized estimates using the chi-square test and one way ANOVA, respectively.
Figure 2
Adjusted prevalence of good, moderate and poor cardiovascular health by socio-demographic factors (N = 22,144).
Notes: The bars show precentages and line represents 95% confidence intervals.
* Adjusted for age, sex, education, asset index and place of residence.
Figure 3
Adjusted prevalence of good, moderate and poor cardiovascular health by asset index in Metropolitan cities, smaller cities, and rural areas.
Note: The bars show percentages.
*Adjusted for age, sex, and education.