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Childhood socio-economic conditions and risk of cardiovascular disease: results from a pooled sample of 14 011 adults from India
  1. Poppy Alice Carson Mallinson1,
  2. Judith Lieber2,
  3. Santhi Bhogadi3,
  4. Sanjay Kinra1
  1. 1Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
  2. 2Department of Population Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
  3. 3Public Health Foundation of India, New Delhi, India
  1. Correspondence to Poppy Mallinson, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; poppy.mallinson1{at}


Background South Asians are at an increased risk of premature cardiovascular disease, but the reasons for this are unclear. Poor socio-economic conditions in childhood are associated with an increased risk of cardiovascular disease in many high-income countries and may be particularly relevant to South Asia, where socio-economic deprivation is more prevalent and severe. However, evidence from South Asia is limited.

Methods We pooled data from two large population-based studies in India to provide a geographically representative and adequately powered sample of Indian adults. We used multilevel linear regression models to assess associations between standard of living index (SLI) in childhood (measured by recalled household assets at age 10–12 years) and major cardiovascular risk factors including adiposity, blood pressure, and fasting blood lipids, glucose and insulin.

Results Data on 14 011 adults (median age 39 years, 56% men) were analysed. SLI in childhood was inversely associated with systolic and diastolic blood pressure, independent of socio-economic conditions in adulthood, with beta coefficients (95% CIs) of −0.70 mmHg (−1.17 to −0.23) and −0.56 mmHg (−0.91 to −0.22), respectively, per SD increase in SLI in childhood. There was no strong evidence for an association between SLI in childhood and other risk factors of cardiovascular disease.

Conclusions Poor socio-economic conditions in childhood may contribute to the increased risk of premature cardiovascular disease among South Asians by raising their blood pressure. Elucidating the mechanisms and improving socio-economic conditions for children in South Asia could provide major reductions in the burden of cardiovascular disease.


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  • Contributors PACM and SK conceived the study. PACM conducted the study (including management and analysis of data), wrote the first draft of the manuscript and is responsible for the overall content as guarantor. SK and JL contributed to study planning and interpretation of results. SB conducted project management and data management. All authors (PACM, JL, SB and SK) contributed to the writing of subsequent drafts of the manuscript and have given approval for the final version to be published.

  • Funding This work was supported by the Medical Research Council UK (MR/N013638/1) through a studentship to PACM. The Andhra Pradesh Children and Parents’ Study and the Indian Migration Study were funded by the Wellcome Trust (strategic award 084774 and project grant GR070797MF, respectively).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethical approval Ethical approval for the Andhra Pradesh Children and Parents’ Study was granted by the National Institute of Nutrition Institutional Ethical Committee (reference number A2-2009) and Public Health Foundation of India Institutional Ethics Committee (reference number 52/10). Ethical approval for the Indian Migration Study was granted by the All India Institute of Medical Sciences Ethics Committee (reference number A-60/4/8/2004).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing Data cannot be made fully available without restriction because of stipulations in our original participant consent forms. Data are available to researchers through completion of a collaborator form (

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