Below The Poverty Line and Non-Communicable Diseases In Kerala: The Epidemiology of Non-communicable Diseases in Rural Areas (ENDIRA) study
India carries the greatest burden of global non-communicable diseases (NCDs). Poverty is associated with NCDs but there are few community-based studies of prevalence which have measured poverty in India.
METHODS:
In Kerala, India, a population of 113,462 individuals was defined by five panchyats (village councils), consisting of 75 wards in Ernakulam district. The "Epidemiology of Non-communicable Diseases in Rural Areas" (ENDIRA) study was conducted via ASHAs (Accredited Social Health Activists), who are non-physician health workers employed by State Government of Kerala to each cover one ward. Standardised questionnaires were used in interviews of individuals ≥18 years during 2012 to gather sociodemographic, lifestyle and medical data for this population. The Government of Kerala definition of “the poverty line” was used.
RESULTS:
ASHAs recruited 84456 adults (25.4% below the poverty line, BPL). NCDs were relatively common: myocardial infarction (MI) 1.4%, stroke 0.3%, respiratory diseases 5.0%, and cancer 1.1%. 84.1% of the population was vegetarian, 15.9% ate meat/fish ≥ 1 day per week, 4.2% had ≥1 alcoholic drink per week and 8.1% smoked regularly. BPL status was not associated with age (p=0.96) or gender (p=0.26). Compared with those above the poverty line (APL), individuals BPL were less likely to have diabetes, hypertension or dyslipidaemia(p<0.0001), and more likely to smoke (p<0.0001). NCDs were not more common in individuals BPL versus APL: MI (1.3% vs 1.5%), stroke (0.4% vs 0.3%), cancer (1.0% vs 1.1%) and respiratory diseases (2.1% vs 1.9%). Compared with APL, BPL was not associated with MI (odds ratio, OR 0.92, 0.80-1.05; p=0.22) or stroke (OR 1.23, 0.97-1.57; p=0.06), in contrast to traditional risk factors (age, hypertension, diabetes, dyslipidaemia, smoking and male gender).
CONCLUSIONS:
In rural Kerala, BPL status was not associated with MI, stroke, cancer or respiratory diseases, although it was associated with smoking status, compared with above poverty line status.