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PURE – IndiaOverview
Dubai – Jan 2006
PURE-India: Investigators and sites
BangaloreMario VazAnura V Kurpad
Jaipur: Prof. Rajeev Gupta
ChennaiProf V Mohan
Trivandrum Prof. Soman
ChandigarhProf. Rajesh Kumar
TIME LINE OF PURE-India
July 2000Conceptualisation
Jan 2001Data starts-B’lore
Dec 2001~ 2500 subjects
PURE-India MtgIdentification ofOther centres (3)
Dec 2002~5000Other centres start data
ChandigarhAs 5th centre
Dec2005~ 22,000
ALL
CENTRESChandigarh
Jaipur Bangalore
Chennai Trivandrum
Households surveyed
25421 1583 4988 11668 3113 4069
Eligible households
20530 1431 4462 7972 2715 3950
Eligible individuals 40589 2829 9247 16205 5098 7210
Participants 21934 2110 3801 9465 3096 3462
Response Rate (%) 54 74.6 41.1 58.4 60.7 48
Recruitment Status – PURE India Centers
Urban Rural
Response rate (%) 52 56
Participants 9665 12269
Completed measurements (%)
93 91
Provided blood sample (%)
90 83
PURE – INDIA Recruitment Status
The PURE-India Study is carried out in states with very diverse characteristics
CENTRE States Birth Rate /1000
Infant Mortality Rate / 1000
Life expectancy at birth
Literacy rate (%)
Population density / sq. km
Bangalore Karnataka 22.2 58 63.3 61.1 275
Andhra Pradesh
20.8 66 62.4 67.0 275
Chennai Tamil Nadu 17.8 49 64.1 68.6 478
Trivandrum Kerala 17.2 11 73.3 90.9 819
Jaipur Rajasthan 31.0 79 60 61.0 165
Chandigarh Chandigarh 16.1 24 - 81.2 7903
Haryana 26.7 65 64.1 73.5 477
s
N
Present analysis: numbers
Total Urban Rural
Bangalore 9290 3323 5967
Chennai 2877 1773 1104
Trivandrum 3048 1369 1679
Jaipur 2689 1749 940
Chandigarh 587 264 223
All centres 18491 8478 9913
The PURE-India Study is carried out in states with very diverse characteristics
CENTRE States Relative Human Development Rank
Bangalore Karnataka 3
Andhra Pradesh 4
Chennai Tamil Nadu 2
Trivandrum Kerala 1
Jaipur Rajasthan 5
Chandigarh Chandigarh -
Haryana -
Household income (Rs/month) by location
0
2000
4000
6000
8000
10000
12000
All centres TRIV CHEN BANG JAIP CHAND
urban
rural
~ $ 235
~ $ 45
All centres TRIV CHEN BANG JAIP CHANDurban 9378 6841 7797 9914 11732 10989rural 2360 3074 2156 1852 4068 3491
Education level below high school (%): Urban-Rural - males
0
10
20
30
40
50
60
70
80
90
100
ALL TRIV CHEN BANG JAIP CHAND
Male-urban
Male-rural
ALL TRIV CHEN BANG JAIP CHANDMale-urban 25.6 26.1 32.5 20.2 30.5 30.5Male-rural 78.9 44.4 65.5 86.2 90.2 70.5
Education level below high school (%): Urban-Rural - females
0
10
20
30
40
50
60
70
80
90
100
ALL Triv CHEN BANG JAIP CHAND
Female-urban
Female-rural
ALL Triv CHEN BANG JAIP CHANDFemale-urban 54.6 42.3 59 51.4 66.4 48.8Female-rural 85.9 48.8 92.6 96.1 99 91.7
TV ownership (%) by location
0
10
20
30
40
50
60
70
80
90
100
All centres TRIV CHEN BANG JAIP CHAND
urban
rural
All centres TRIV CHEN BANG JAIP CHANDurban 92.6 88.5 90.2 94.1 94.2 95.9rural 40.2 69 67.9 24.4 26.2 90.2
2-wheeler ownership (%) by location
0
10
20
30
40
50
60
70
All centres TRIV CHEN BANG JAIP CHAND
urban
rural
All centres TRIV CHEN BANG JAIP CHANDurban 53.5 43.2 34.8 60.9 66.5 66.5rural 10.8 15.1 17.5 7.7 10.3 15.3
Kitchen mixer ownership (%) by location
0
10
20
30
40
50
60
70
80
90
All centres TRIV CHEN BANG JAIP CHAND
urban
rural
All centres TRIV CHEN BANG JAIP CHANDurban 75.6 77 70.4 83.2 62.1 75.1rural 16.2 52 22.7 4.5 4.1 11.3
Current tobacco use (%): Urban-Rural - males
0
10
20
30
40
50
60
70
All centres TRIV CHEN BANG JAIP CHAND
Male-urban
Male-rural
All centres TRIV CHEN BANG JAIP CHANDMale-urban 27.4 38.6 27.3 22.9 30.5 25.2Male-rural 50.2 44.1 49.3 49.5 64.7 46.2
Current tobacco use (%): Urban-Rural - females
0
10
20
30
40
50
60
70
All centres TRIV CHEN BANG JAIP CHAND
Female-urban
Female-rural
All centres TRIV CHEN BANG JAIP CHANDFemale-urban 3.3 0 4.2 1 8.5 5.6Female-rural 13.4 0.1 16.9 15.5 28.1 9.7
Current alcohol use (%): Urban-Rural - males
0
10
20
30
40
50
60
70
80
90
100
All centres TRIV CHEN BANG JAIP CHAND
Male-urban
Male-rural
All centres TRIV CHEN BANG JAIP CHANDMale-urban 32.5 56 39 33.6 9.7 88.5Male-rural 30 40.7 49.4 26 20.2 90.9
% of males who are sedentary by location
0
10
20
30
40
50
60
70
80
90
All centres TRIV CHEN BANG JAIP CHAND
urban
rural
All centres TRIV CHEN BANG JAIP CHANDurban 52.1 34.9 37.2 57.5 57.7 80.7rural 35.7 49.9 37.9 30.4 40.3 75.4
% of females who are sedentary by location
0
10
20
30
40
50
60
70
80
90
All centres TRIV CHEN BANG JAIP CHAND
urban
rural
All centres TRIV CHEN BANG JAIP CHANDurban 55.7 22.2 62.8 64.3 55.6 80.4rural 32.1 46 38.3 20.6 47.1 65
Daily dietary intakes in urban and rural populations: Bangalore centre
Rural Urban
Energy (kcal) 1843 2278
Carbohydrate intake (g)
362.4 350.5
Fat intake (g) 23.2 66
Sugar (g) 5.2 28.5
Salt (g) 2.4 8.1
Total vegetables (g) 50 158
Total fruits (g) 49 166
% of males who are overweight/obese (BMI ≥ 25)by location
0
10
20
30
40
50
60
70
All centres TRIV CHEN BANG JAIP CHAND
urban
rural
All centres TRIV CHEN BANG JAIP CHANDurban 40.8 35.3 37.5 41.6 44.6 47.2rural 10.4 29.6 19.8 5.5 4.9 11.6
% females who are overweight/obese (BMI ≥ 25)by location
0
10
20
30
40
50
60
70
All centres TRIV CHEN BANG JAIP CHAND
urban
rural
All centres TRIV CHEN BANG JAIP CHANDurban 53.9 49.2 56.2 56.1 49 69.9rural 17.5 39.7 27.1 6.6 7.8 33.1
Mean Waist-hip ratio: Males by location
0.7
0.75
0.8
0.85
0.9
0.95
All centres TRIV CHEN BANG JAIP CHAND
urban
rural
All centres TRIV CHEN BANG JAIP CHANDurban 0.92 0.92 0.93 0.92 0.9 0.94rural 0.87 0.92 0.92 0.86 0.87 0.89
Mean Waist-hip ratio: Females by location
0.70
0.75
0.80
0.85
0.90
0.95
All centres TRIV CHEN BANG JAIP CHAND
Female-urban
Female-rural
All centres TRIV CHEN BANG JAIP CHANDFemale-urban 0.84 0.84 0.84 0.8 0.88 0.86Female-rural 0.79 0.83 0.85 0.74 0.83 0.85
Serum total cholesterol (mg/dl): Males - by location
50
70
90
110
130
150
170
190
210
230
All centres TRIV CHEN BANG JAIP CHAND
urban
rural
All centres TRIV CHEN BANG JAIP CHANDurban 193.96 222.16 183.53 191.3 190.72 181.57rural 184.43 224.67 174.36 163.41 193.95 187.25
Serum total cholesterol (mg/dl): Females - by location
50.00
100.00
150.00
200.00
250.00
All centres TRIV CHEN BANG JAIP CHAND
Female-urban
Female-rural
All centres TRIV CHEN BANG JAIP CHANDFemale-urban 204.07 231.27 190.4 207.82 190.8 190.55Female-rural 200.32 236.51 174.5 168.84 200.08 185.51
Prevalence of hypertension (%): Males - by location
0
10
20
30
40
50
60
All centres TRIV CHEN BANG JAIP CHAND
urban
rural
All centres TRIV CHEN BANG JAIP CHANDurban 37.2 36.2 36.9 31.7 47.2 54.3rural 18 45.5 24.1 12.7 13.5 15.4
Prevalence of hypertension (%): Females - by location
0
10
20
30
40
50
60
All centres TRIV CHEN BANG JAIP CHAND
urban
rural
All centres TRIV CHEN BANG JAIP CHANDurban 37.5 37.3 34.5 30.2 49.8 52.1rural 19.9 40.3 25.5 10.4 18.1 35.9
Hypertension: known, treated and controlled(%): - by location
0
10
20
30
40
50
60
KNOWN CONTROLLED KNOWN ANDTREATED
TREATED ANDCONTROLLED
urban
rural
All centres TRIV CHEN BANG JAIP CHANDurban 37.5 37.3 34.5 30.2 49.8 52.1rural 19.9 40.3 25.5 10.4 18.1 35.9
Prevalence of diabetes (%):Males - by location
0
5
10
15
20
25
30
35
All centres TRIV CHEN BANG JAIP CHAND
urban
rural
All centres TRIV CHEN BANG JAIP CHANDurban 22.7 27.4 30.9 17.9 23 -rural 7.6 28.1 10.9 3.7 5.7 -
Prevalence of diabetes (%):Females - by location
0
5
10
15
20
25
All centres TRIV CHEN BANG JAIP CHAND
urban
rural
All centres TRIV CHEN BANG JAIP CHANDurban 17.4 19.9 20.3 13.8 17.6 -rural 6.5 16.9 10.7 1.7 7.2 -
Prevalence of CHD (%):Males - by location
0
1
2
3
4
5
6
7
8
9
10
All centres TRIV CHEN BANG JAIP CHAND
urban
rural
All centres TRIV CHEN BANG JAIP CHANDurban 7 6.6 5.6 9 3.8 -rural 5.7 8.5 5.8 5.9 2 -
Prevalence of CHD (%):Females - by location
0
1
2
3
4
5
6
7
8
9
10
All centres TRIV CHEN BANG JAIP CHAND
urban
rural
All centres TRIV CHEN BANG JAIP CHANDurban 4.5 3.7 3.9 6.2 2.7 -rural 3 3.2 1.6 3.8 0.4 -
Daily dietary intakes in urban slums relative to other urban and rural populations
Rural Slums Urban
Energy (kcal) 1843 1971 2278
Carbohydrate intake (g)
362.4 301.1 350.5
Fat intake (g) 23.2 55.4 66
Sugar (g) 5.2 23.6 28.5
Salt (g) 2.4 9.5 8.1
Vegetable intake (g) 50 99 158
a Age and gender adjusted means,
Anthropometric profiles in urban and rural populations
Rural Slum Urban
Weight (kg) a 49 54.7 65.4
BMI (kg/m2) a 19.2 23 25.2
% overweight (BMI ≥ 25<30 kg/m2)
Men 4.9 12.4 39.3
Women 5.9 24.3 41.1
% obese
Men 0.6 2.3 5
Women 0.7 8.7 21.8a Age and gender adjusted
Prevalence: diabetes and hypertension in urban slums relative to other urban and rural
areas
Rural Slum Urban
Diabetes (Hx + FBS ≥ 126 mg/dl)
Men 4.2 8.2 20.5
Women 2 11.0 15.4
Hypertension (Hx + BP ≥ 140/90 mmHg)
Men 14.9 34.5 33.3
Women 12.0 37.0 29.7
Summary
• There is considerable heterogeneity in the variables that we have studied and in disease outcomes, across locations (urban-rural-urban slum), gender and region (centre)
• Urban-rural risk transitions generally follow patterns of development. In Kerala, there is evidence of a reversal of the transition with the rural population.
• Dietary data needs to analysed in most centres – this when available will help us understand some of the changes that we have observed across centres and locations
• Non responder data and issues of response bias are being analysed
CHALLENGES / ISSUES OF THE STUDY• Subjects in rural areas / slums unwilling to participate due to loss of daily wages
• Responder burden due to the length of questionnaires
• Working men unavailable during the day / particular seasons.
• No perceived benefits in some groups slums / urban areas.
• Takes 45 mins to enter one subjects data in the data entry system.
% use of wood as cooking fuel by location
0
10
20
30
40
50
60
70
80
90
100
All centres Bangalore Chennai Jaipur Trivandrum Chandigarh
urban
rural
% use of LPG (gas) as cooking fuel
by location
0
10
20
30
40
50
60
70
80
90
100
All centres TRIV CHEN BANG JAIP CHAND
urban
rural
All centres TRIV CHEN BANG JAIP CHANDurban 77.1 57.5 73 75.6 95.5 98rural 13.1 21.2 37.4 4.7 10 29
Mean Waist circ (cm) : Males by location
50
55
60
65
70
75
80
85
90
All centres TRIV CHEN BANG JAIP CHAND
urban
rural
All centres TRIV CHEN BANG JAIP CHANDurban 86.12 83.09 86.9 86.53 86.08 89.64rural 74.12 80.4 79.62 71.91 72.7 79.14
Mean Waist circ (cm) : Females by location
50
55
60
65
70
75
80
85
90
All centres TRIV CHEN BANG JAIP CHAND
Female-urban
Female-rural
All centres TRIV CHEN BANG JAIP CHANDFemale-urban 81.48 78.76 82.97 79.16 84.53 85.89Female-rural 68.2 74.62 76.71 62.77 68.98 76.89