Childhood socio-economic conditions and risk of cardiovascular disease: results from a pooled sample of 14 011 adults from India

Abstract

BackgroundSouth Asians are at an increased risk of premature cardiovascular disease, but the reasons for this are unclear. Poor socio-economic conditions in childhood are associated with an increased risk of cardiovascular disease in many high-income countries and may be particularly relevant to South Asia, where socio-economic deprivation is more prevalent and severe. However, evidence from South Asia is limited.MethodsWe pooled data from two large population-based studies in India to provide a geographically representative and adequately powered sample of Indian adults. We used multilevel linear regression models to assess associations between standard of living index (SLI) in childhood (measured by recalled household assets at age 10–12 years) and major cardiovascular risk factors including adiposity, blood pressure, and fasting blood lipids, glucose and insulin.ResultsData on 14 011 adults (median age 39 years, 56% men) were analysed. SLI in childhood was inversely associated with systolic and diastolic blood pressure, independent of socio-economic conditions in adulthood, with beta coefficients (95% CIs) of −0.70 mmHg (−1.17 to −0.23) and −0.56 mmHg (−0.91 to −0.22), respectively, per SD increase in SLI in childhood. There was no strong evidence for an association between SLI in childhood and other risk factors of cardiovascular disease.ConclusionsPoor socio-economic conditions in childhood may contribute to the increased risk of premature cardiovascular disease among South Asians by raising their blood pressure. Elucidating the mechanisms and improving socio-economic conditions for children in South Asia could provide major reductions in the burden of cardiovascular disease.

Childhood Socioeconomic Position and Risk of Cardiovascular Disease in Adulthood: Systematic Review of Evidence From Low- and Middle-Income Countries

“…These included several large studies from Brazil, India and Indonesia, which did not find evidence that childhood socioeconomic position was associated with diabetes or lipid levels. 35,36,38 This is consistent with some early studies from high-income countries that found blood pressure, but not lipid levels, to be inversely associated with childhood socioeconomic position, 53,54 raising the possibility that different mechanisms may be operating for blood pressure compared with other CVD risk factors. Thirdly, several studies reported differences in the association between childhood socioeconomic position and CVD risk factors between men and women.…”

“…In a pooled dataset from India (N=14011), household assets in childhood were positively associated with total and LDL cholesterol, but these associations were not robust to adjustment for adult socioeconomic position. 36 In a birth cohort from Brazil (N=2063), household income at birth was positively associated with total and LDL cholesterol among males only, which was robust to adjustment for adult socioeconomic position. 43 High-density lipoprotein (HDL) cholesterol was positively associated with childhood socioeconomic position in the same study, although was inversely associated in a cross-sectional study from China, 34 and not associated in two other studies in India and Jamaica.…”

“…33 However in a larger pooled dataset from India (which included these participants as well as participants from the APCAPS study), the positive associations with fasting glucose, insulin and HOMA score were not robust to adjustment for adult socioeconomic position. 36 In a study of older adults from southern China, there was an inverse association between household assets in childhood and fasting glucose in females only, which was not robust to adjustment for adult socioeconomic position. 34 Three out of four cross-sectional studies which examined the association of childhood socioeconomic position with self-reported diabetes found no clear evidence of an association.…”

“…35 In a cross-sectional analysis of two pooled studies from India, household assets in childhood were inversely associated with systolic and diastolic blood pressure after adjusting for adult socioeconomic position. 36 Two cross-sectional surveys from Botswana 37 and Indonesia 38 examined the association of childhood socioeconomic position with self-reported diagnosis of hypertension, both reporting that an inverse association emerged after adjustment for socioeconomic position in adulthood. An analysis of the WHO-SAGE cross-sectional study (conducted in China, Mexico, India, South Africa and Russia, N=38,297) reported the association of CVD risk factors with participants' socioeconomic trajectories between childhood and adulthood.…”