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 prev alence of coronary heart disease and coronary risk factors in India. D esign-Total community cross sectional survey with a doctor administere d questionnaire, physical examination, and electrocardiography. Settin g-A cluster of three villages in rural Rajasthan, western India. Subje cts-3148 residents aged over 20 (1982 men, 1166 women) divided into va rious groups according to years of formal schooling. Results-Illiterac y and low educational levels were associated with less prestigious occ upations (agricultural and farm labouring) and inferior housing. There was an inverse correlation of educational level with age (rank correl ation: men -0.45, women -0.49). The prevalence of coronary heart disea se (diagnosed by electrocardiography) was significantly higher among u neducated and less educated people and showed an inverse relation with education in both sexes. Among uneducated and less educated people th ere was a higher prevalence of the coronary risk factors smoking and h ypertension. Educational level showed a significant inverse correlatio n with systolic and diastolic blood pressure. Logistic regression anal ysis with adjustment for age showed that educational level had an inve rse relation with prevalence of electrocardiographically diagnosed cor onary 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 h eart disease with educational level abated after adjustment for smokin g, 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.