India’s consistently rich more prone to heart disease than the poor: study

A vast study of 65,364 Indians has revealed that people with a consistently high socioeconomic position are more prone to heart disease than the consistently poor.

In fact, those with sustained life-course socioeconomic advantage had nearly twice (1.8 times) the odds of heart failure and 1.7 times the chances of a heart attack than those who experienced sustained socioeconomic disadvantage, found the study, published in the American Journal of Preventive Medicine. 

The cardiac conditions among the sustained rich in India ranged from a higher likelihood of congestive heart failure, heart attack, abnormal heart rhythm, heart diseases and composite cardiovascular disease.

What the study did

For the study, scientist from the All India Institute of Medical Sciences, New Delhi and the Harvard T.H. Chan School of Public Health in Boston, studied Indians aged 45 and older, looking into their childhood too. The study sampled both rural and urban residents, men and women, and several religious and caste groups, and documented information on health, social, and economic indicators.

The scientists studied heart health in the context of life-course socio-economic mobility, not just their static status: the categories included consistently high economic positions (in both childhood and adulthood); upward mobility (low economic status in childhood but high in adulthood); downward mobility (high economic status in childhood but low in adulthood); and consistently low economic position in both periods.

The understanding of how life-course social mobility is associated with heart disease and risk factors is crucial in tackling India’s health, added the paper.

What causes heart disease

Several mechanisms may possibly contribute to the malaise, lead author Imnameren Longkumer, Narotam Sekhsaria Fellow at the Harvard T.H. Chan School of Public Health India Research Center and senior author S.V. Subramanian, professor of population health and geography at Harvard University said.

“Economic advancement can increase access to processed foods, refined carbohydrates, sugary beverages, and energy-dense diets, while occupational and domestic life may become less physically active,” they said.

This data, however serves as a snapshot of a country that is undergoing an epidemiological transition. As socioeconomic patterns change over time, cardiovascular disease and its risk factors become more widespread among disadvantaged groups as well, said Prof. Subramanian.

Financial impacts

Another study published earlier this year in Global Heart Journalreflected on the catastrophic financial impact of heart disease among India’s poor, who find themselves riddled in debt: the cost of treating heart failure patients with a single hospitalisation averaged ₹1.19 lakh.

Co-author Jeemon P., of the Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, told The Hindu that hospitalisation for cardiovascular disease is highly resource-intensive, and for many families, the financial consequences do not end when the patient is discharged. “The out-of-pocket expenditure associated with heart disease can be substantial and may push vulnerable households into financial distress or financial toxicity,” he added.

Although social health insurance schemes provide an important degree of financial protection, particularly for people from lower socioeconomic groups, families may still have to bear a significant proportion of the total cost — sometimes as much as 75% of their healthcare expenditure, said Dr. Jeemon.