Educational status, coronary heart disease, and coronary risk factor prevalence in a rural population of India

OBJECTIVE: To define the association between educational level and prevalence of coronary heart disease and coronary risk factors in India. DESIGN: Total community cross sectional survey with a doctor administered questionnaire, physical examination, and electrocardiography. SETTING: A cluster of three villages in rural Rajasthan, western India. SUBJECTS: 3148 residents aged over 20 (1982 men, 1166 women) divided into various groups according to years of formal schooling. RESULTS: Illiteracy and low educational levels were associated with less prestigious occupations (agricultural and farm labouring) and inferior housing. There was an inverse correlation of educational level with age (rank correlation: mean -0.45, women -0.49). The prevalence of coronary heart disease (diagnosed by electrocardiography) was significantly higher among uneducated and less educated people and showed an inverse relation with education in both sexes. Among uneducated and less educated people there was a higher prevalence of the coronary risk factors smoking and hypertension. Educational level showed a significant inverse correlation with systolic and diastolic blood pressure. Logistic regression analysis with adjustment for age showed that educational level had an inverse relation with prevalence of electrocardiographically diagnosed coronary heart disease (odds ratio: men 0.82, women 0.53), hypertension (men 0.88, women 0.56), and smoking (men 0.73, women 0.65) but not with hypercholesterolaemia and obesity. The inverse relation of coronary heart disease with educational level abated after adjustment for smoking, physical activity, body mass index, and blood pressure (odds ratio: men 0.98, women 0.78). CONCLUSION: Uneducated and less educated people in rural India have a higher prevalence of coronary heart disease and of the coronary risk factors smoking and hypertension.