Socioeconomic Patterning of Cardiovascular Disease and its Risk Factors among Indians: A Systematic Review of Literature

Objective: To investigate the socioeconomic patterning of cardiovascular disease (CVD), its mortality and associated risk factors in the Indian population. Methods: Studies conducted on Indian population between January 1992 and the second week of April 2015 satisfying predefined inclusion and exclusion criteria were selected. PubMed, Ebscohost, Google scholar and Google were searched for CVD prevalence, CVD mortality and its six risk factors (alcohol, tobacco, hypertension, diabetes, obesity and sedentary lifestyle w.r.t. socioeconomic status (SES)). Result: 3, 550, 404 participants and 1, 71, 657 households were studied though 72 selected studies. Of these 13, 31, 23, 20, 21 and 16 articles investigated alcohol, tobacco, hypertension, diabetes, obesity and sedentary lifestyle, respectively, and 11 studies investigated the trend of CVD and its mortality w.r.t. to SES. Higher SES is found to be positively associated with hypertension, diabetes, obesity and sedentary lifestyle, whereas lower SES is found to be positively associated with alcohol and tobacco consumption only. No consensus has been found among studies over socioeconomic patterning of CVD, but the burden of its mortality has been found to be positively associated with lower SES. Conclusion: Even after 25 years of liberalisation of the Indian economy, the association between the CVD and SES is still positive. Rich people are getting more affected by CVD risk factors, but the burden of CVD mortality lies with poor people who cannot afford expensive drugs and interventional treatment. Poor healthcare facilities, high out-of-pocket expenditure and not-so-favourable policies are adversely affecting the CVD health of the weaker sections of India.