Rural India

• Although two thirds of India’s 1.2 billion population lives in rural areas, the greater interconnectedness increasingly allows rural populations to adopt urban lifestyles without migration to urban areas.^{1, 2}

• Although the coronary artery disease (CAD) rates are lower in rural than urban India, the overall CAD burden is higher in rural India. This is because far more Indians live in rural areas, where access to health care is limited.^{3, 4} CAD rates are also increasing in rural areas as lifestyles become more westernized.^5-8

• Despite a higher rate of tobacco use, the heart disease and diabetes rates are approximately half in rural than in urban India.^9-12 Nonetheless, the prevalence of cardiovascular disease (CVD) in rural areas is increasing rapidly and is emerging as a major cause of death.

• Although CVD prevalence is likely to remain lower in rural areas relative to urban areas, it is projected to increase considerably over the next few years, reaching a high of 14% among the rural elderly (60-69 year olds).¹³ In a study of 45 villages in the state of Andhra Pradesh, CVD accounted for 32% of deaths in the area.¹⁴

• A cross-sectional survey done in rural Haryana in 1998 revealed a CAD prevalence rate of 6% in rural Indians aged 35-64 years.¹⁵ This CAD rate is 2-fold higher than contemporary U.S. rates and 3-fold higher than the 2% reported in 1974 from the same village.^{16, 17}

• Contemporary data show a high age-standardized prevalence of modifiable risk factors in rural India which indicates that the epidemic of CAD would soon expand to rural India: tobacco use (40% men, 4% women); low fruit and vegetable intake (69% -75% ); dyslipidemia (cholesterol problems) 33% – 35%; high blood pressure 20%- 22% ; diabetes 5% – 6%, metabolic syndrome 24%-33% and obesity 19%- 28%. However, 18%-21% were underweight and thus undernutrition and overnutrition coexist in rural India.^{18, 19}

• Higher prevalence of many risk factors (obesity, dyslipidemia, and diabetes and high blood pressure) is common in those in the high socioeconomic group in rural India.¹⁸  For example, 35% of women in the highest socioeconomic group were obese compared with 13% in the lowest.¹⁸

• Rural populations have limited access to health care and can least afford to pay for the high treatment costs associated with medications, let alone coronary angioplasty and bypass surgery

• Given that two thirds of Indians still live in rural areas, the high prevalence of CVD risk factors there has important public health implications.^{12, 20, 21}

Sources

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2.  Reddy KS. Cardiovascular diseases in the developing countries: dimensions, determinants, dynamics and directions for public health action. Public Health Nutr. 2002;5(1A):231-237.

3. Shah B, Mathur P. Surveillance of cardiovascular disease risk factors in India: the need & scope. Indian J Med Res. Nov 2010;132(5):634-642.

4. Gupta R. Burden of coronary heart disease in India. Indian Heart J. Nov-Dec 2005;57(6):632-638.

5. McKeigue PM, Ferrie JE, Pierpoint T, Marmot MG. Association of early-onset coronary heart disease in South Asian men with glucose intolerance and hyperinsulinemia. Circulation. 1993;87(1):152-161.

6. Chadha SL, Radhakrishan S, Ramachandran K. Epidemiological study of coronary heart disease in urban population of New Delhi. Ind J Med Res. 1990;92 (B):424-430.

7. Ramachandran A, Mary S, Yamuna A, Murugesan N, Snehalatha C. High prevalence of diabetes and cardiovascular risk factors associated with urbanization in India. Diabetes Care. May 2008;31(5):893-898.

8. Ramachandran A, Snehalatha C, Baskar AD, et al. Temporal changes in prevalence of diabetes and impaired glucose tolerance associated with lifestyle transition occurring in the rural population in India. Diabetologia. May 2004;47(5):860-865.

9. Gupta R, Prakash H, Gupta VP, Gupta KD. Prevalence and determinants of coronary heart disease in a rural population of India. J Clin Epidemiol. 1997;50(2):203-209.

10. Kutty VR, Balakrishnan KG, Jayasree AK, Thomas J. Prevalence of coronary heart disease in the rural population of Thiruvananthapuram district, Kerala, India. Int J Cardiol. 1993;39(1):59-70.

11. Sadikot S. M., Nigam A, Das S, et al. The burden of diabetes and impaired glucose tolerance in India using the WHO 1999 criteria: prevalence of diabetes in India study (PODIS). Diabetes Res Clin Pract. Dec 2004;66(3):301-307.

12. Gupta R. Coronary heart disease epidemiology in India: The past, present and future. In: Rao GHR, ed. Coronary Artery Disease in South Asians. New Delhi: JAYPEE; 2001:6-28.

13. Reddy KS, Satija A. The Framingham Heart Study: impact on the prevention and control of cardiovascular diseases in India. Prog Cardiovasc Dis. Jul-Aug 2010;53(1):21-27.

14. Joshi R, Cardona M, Iyengar S, et al. Chronic diseases now a leading cause of death in rural India–mortality data from the Andhra Pradesh Rural Health Initiative. Int J Epidemiol. Sep 22 2006.

15. Reddy KS. Rising burden of cardiovascular diseases in India. In: Sethi KK, ed. Coronary Artery Disease in Indians: A Global  Perspective. Mumbai: Cardiological Society of India; 1998:63-72.

16. Dewan BD, Malhotra K, Gupta S. Epidemiological study of coronary heart disease in a rural community in Haryana. Indian Heart J. 1974;26:68 – 78.

17. Enas EA, Jacob S, Joseph AK. Paradigm change from palliative to preventive cardiology: A critical review of mechanical coronary interventions versus comprehensive medical management. Asian J Clin Card. 2000;3:21-52.

18. Kinra S., Bowen LJ, Lyngdoh T, et al. Sociodemographic patterning of non-communicable disease risk factors in rural India: a cross sectional study. BMJ. 2010;341:c4974.

19. Chow CK, Naidu S, Raju K, et al. Significant lipid, adiposity and metabolic abnormalities amongst 4535 Indians from a developing region of rural Andhra Pradesh. Atherosclerosis. Apr 26 2007.

20. Gupta R, Joshi P, Mohan V, Reddy KS, Yusuf S. Epidemiology and causation of coronary heart disease and stroke in India. Heart. Jan 2008;94(1):16-26.

21. Reddy KS, Prabhakaran D, Chaturvedi V, et al. Methods for establishing a surveillance system for cardiovascular diseases in Indian industrial populations. Bull World Health Organ. Jun 2006;84(6):461-469.