Determinants of behavioural and biological risk factors for cardiovascular diseases from state level STEPS survey (2017–19) in Madhya Pradesh

Abstract

Background National and statewide assessment of cardiovascular risk factors needs to be conducted periodically in order to inform public health policy and prioritise allocation of funds, especially in LMICs. Although there have been studies from India which have explored the determinants of cardiovascular risk factors, they have mostly been from high epidemiological transition states. The present study assessed the determinants of cardiovascular (CVD) risk factors in a low epidemiological transition state (Madhya Pradesh) using the WHO STEPwise approach to surveillance (STEPS). Methods A total of 5,680 persons aged 18–69 years were selected from the state of Madhya Pradesh through multi-stage cluster random sampling. Key CVD risk factors we sought to evaluate were from behavioural (tobacco, alcohol, physical activity, diet) and biological domains (overweight or obese, Hypertension, Diabetes, and Raised serum cholesterol). Key socio-demographic factors of interest were the caste and tribe groups, and rural vs urban location, in addition to known influencers of CVD risk such as age, gender and education level Results Those belonging to the scheduled tribes were more at risk of consuming tobacco (OR 2.13 (95% CI [1.52–2.98]), and a diet with less than five servings of fruits and vegetables (OR 2.78 (95% CI [1.06–7.24]), but had had the least risk of physical inactivity (OR 0.31 (95% CI [0.02–0.54]). Residence in a rural area also reduced the odds of physical inactivity (OR 0.65 (95% CI [0.46–0.92])). Lack of formal education was a risk factor for both tobacco consumption and alcohol intake (OR 1.40 (95% CI [1.08–1.82]) for tobacco use; 1.68 (95% CI [1.14–2.49]) for alcohol intake). Those belonging to schedules tribes had much lower risk of being obese (OR 0.25; 95% CI [0.17–0.37]), but were at similar risk of all other clinical CVD risk factors as compared to other caste groups. Conclusion In the current study we explored socio-demographic determinants of behavioural and biological CVD risks, and found that in Madhya Pradesh, belonging to a scheduled tribe or living in a rural location, protects against being physically inactive or being overweight or obese. Increasing age confers a greater CVD-risk in all domains. Being a male, and lack of formal education confers a greater risk for behavioural domains, but not for most clinical risk domains. Future efforts at curbing CVDs should be therefore two pronged –a population-based strategy targeting biological risk factors, and a more focussed approach directed at those displaying risky behaviour.

Prevalence and associated factors of physical inactivity among middle-aged and older adults in India: results of a national cross-sectional community survey

“…This study is one of the first investigations assessing physical inactivity (prevalence and associated factors) among ageing adults (≥45 years) in a national population sample in India in 2017–2018. The study found an overall prevalence of physical inactivity of 36.7%, which is higher than in a previous national survey among ageing adults (≥50 years) in 2007–2008 in India (22.0%)7 and among adults (18–69 years, 2017–2019) in Madhya Pradesh, (19.6%),5 but lower than in Tamil Nadu in 2010 (aged 30–64 years) (63.3%–40.6%),4 and among adults (18–69 years) in a rural population in South-India (46.8%) 6. The physical inactivity level found in this study compares with previous national studies in other countries in the Southeast and East Asian region, for example, for example in China (≥45 years) (44.1%)9 but was higher than for example in Malaysia (≥60 years) (29.8%) 10.…”

“… 3 We lack recent national data on physical inactivity in middle-aged and older adults in India. In various local studies in India, for example, in Tamil Nadu in 2010 (aged 30–64 years), the prevalence of inadequate physical activity was 63.3% in the urban area and 40.6% in the rural area, 4 in Madhya Pradesh, among adults (18–69 years, 2017–2019) the prevalence of inadequate physical activity was 19.6%, 5 and among adults (18–69 years) in a rural population in South-India, the proportion of physical inactivity was 46.8%. 6 In a national study among middle-aged and older adults (≥50 years) in 2007–2008 in India, the prevalence of low physical activity was 22.0%.…”