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Abstract
Background Concordance in chronic disease status has been observed within couples. In urban India and Pakistan, little is known about couple concordance in diabetes, hypertension, and dyslipidaemia and associated socioeconomic characteristics and modifiable risk factors.
Methods We analysed cross-sectional data from 2548 couples from the Centre for cArdio-metabolic Risk Reduction in South Asia cohort in Chennai, Delhi and Karachi. We estimated couple concordance in presence of ≥1 of diabetes, hypertension and dyslipidaemia (positive concordance: both spouses (W+H+); negative concordance: neither spouse (W−H−); discordant wife: only wife (W+H−); or discordant husband: only husband (W−H+)). We assessed associations of five socioeconomic and household characteristics, and six modifiable risk factors with couple concordance using multinomial logistic regression models with couples as the unit of analysis (reference: W−H−).
Results Of the couples, 59.4% (95% CI 57.4% to 61.3%) were concordant in chronic conditions (W+H+: 29.2% (95% CI 27.4% to 31.0%); W−H−: 30.2% (95% CI 28.4%− to 32.0%)); and 40.6% (95% CI 38.7% to 42.6%) discordant (W+H−: 13.1% (95% CI 11.8% to 14.4%); W−H+: 27.6% (95% CI 25.9% to 29.4%)). Compared with couples with no conditions (W−H−), couples had higher relative odds of both having at least one condition if they had higher versus lower levels of: income (OR 2.03 (95% CI 1.47 to 2.80)), wealth (OR 2.66 (95% CI 1.98 to 3.58)) and education (wives’ education: OR 1.92 (95% CI 1.29 to 2.86); husbands’ education: OR 2.98 (95% CI 1.92 to 4.66)) or weight status (overweight or obesity in both spouses ORs 7.17 (95% CI 4.99 to 10.30)).
Conclusions Positive couple concordance in major chronic conditions is high in urban India and Pakistan, especially among couples with relatively higher socioeconomic position. This suggests that prevention and management focusing on couples at high risk for concordant chronic conditions may be effective and more so in higher socioeconomic groups.
- CHRONIC DI
- EPIDEMIOLOGY
- PUBLIC HEALTH
- SOCIAL CLASS
Data availability statement
Data are available in a public, open access repository. Data are available on reasonable request. A portion of the data used in this analysis are available through the National Heart, Lung and Blood Institute (NHLBI) Biologic Specimen and Data Repository: https://biolincc.nhlbi.nih.gov/studies/ghcoe_new_delhi/. The deidentified participant dataset for this analysis may be requested from the PRECISION-CARRS Publications, Presentations, & Ancillary Studies (PP&A) Committee through its request form: https://app.smartsheet.com/b/form/4c8baa7b850d4bc4b8096a7321ba0fd6.
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Data availability statement
Data are available in a public, open access repository. Data are available on reasonable request. A portion of the data used in this analysis are available through the National Heart, Lung and Blood Institute (NHLBI) Biologic Specimen and Data Repository: https://biolincc.nhlbi.nih.gov/studies/ghcoe_new_delhi/. The deidentified participant dataset for this analysis may be requested from the PRECISION-CARRS Publications, Presentations, & Ancillary Studies (PP&A) Committee through its request form: https://app.smartsheet.com/b/form/4c8baa7b850d4bc4b8096a7321ba0fd6.
Footnotes
Twitter @jannienielsen26
Contributors JN, RS, SAP, SAC and MKA conceived the idea and designed this study. DP, NT, VM, KMVN and MKA designed the CARRS cohort and supervised data collection. JN and SAP performed the statistical analyses and verified the underlying data. All authors had access to all the data. JN wrote the first draft of the manuscript. RS, DP, NT (Delhi), VM (Chennai) and RI (Karachi) provided context specific info to the idea, analyses and interpretation of results. All authors discussed the results and contributed to the final manuscript. JN and SAP revised the manuscript. JN and SAP are the guarantors of this work.
Funding The CARRS Study was funded by an award to Dorairaj Prabhakaran from the National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health, Department of Health and Human Services (grant number: HHSN268200900026C) and United Health Group, Minneapolis, MN, USA (grant number: OxHA 3143). JN was supported by Independent Research Fund Denmark (award number: DFF-702500053). KMVN, RS, DP, NT and SAC were supported by a grant from the Fogarty International Centre and the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health and FIC (grant number 1 D43 HD065249). SAP, KVN, MKA, NT, DP were supported in part by the National Heart, Lung, and Blood Institute, National Institutes of Health, under the Hypertension Outcomes for T4 Research within Lower Middle-Income Countries (Hy-TREC) programme (award number 5U01HL138635). SAP and SAC were supported in part by the National Heart, Lung and Blood Institute (P01HL154996-01A1). RS was supported by a Wellcome Trust Capacity Strengthening Strategic Award Extension phase to the Public Health Foundation of India and a consortium of UK universities (award number: WT084754/Z/08 /A).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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