Socio economic status, death and

disease: observations from rural

Kerala
C R Soman, S Safraj
Health Action by People
Change in selected health indicators- Kerala 1956 – 2005

IMR CBR CDR TFR

160 160 50 50 20 20
10 10
40 40 16 16
120 120 8 8
30 30 12 12 6 6
80 80
20 20 8 8 4 4
40 40 10 10 2 2
4 4

0 0 0 0 0 0 0 0
1956 2005 1956 2005 1956 2005 1956 2005

Life Expectancy MMR Severe UN Severe anaemia

80 80 1000 1000 30 30 30 30
25 25 25 25
800 800
60 60
20 20 20 20
600 600
40 40 15 15 15 15
400 400
10 10 10 10
20 20
200 200 5 5 5 5
0 0 0 0 0 0 0 0
1956 2005 1956 2005 1956 2005 1956 2005
Population Registry of Life Style Diseases

Study area 7 contiguous Panchayats

Area 86.67 Sq.km

No. of households 33,152

Total population 162356

-Male 79660
-Female 82696
Sex Ratio 1000 :1040

Density of population 1873/ Sq.km

Percentage rural population: 73

Adults [≥20 years] 107454

Objectives

Set up a community based registry for

•Coronary disease
•Stroke
•Hypertension
•Type 2 diabetes
•Cancer

Initiate community level action on

•Smoking cessation
•Control of hypertension
•Physical activity
•Sound nutritional practices
 Work accomplished to date

• Comprehensive household survey

• Food frequency questionnaire
• Individual lifestyle questionnaire
• Birth registry - 6996 births, since Jan 2004
• Death registry - 4861 deaths, since July 2002
• Cause of death information of 4861 deaths.
• Anthropometry and biochemistry evaluation about 10,000 persons
• Estimation of prevalence of diabetes, hypertension overweight ,
hypercholesterolemia
• Current work started on Jan 2008
• Resurvey of all old households and new households
• First survey of over 6,000 households in Varkala Municipality
• Birth and death enumeration
 Principal causes of death - Prolife: 2002-2007

heart attack
stroke
cancer
old age
COPD
asthma
suicide
diabetes
infection
accident
renal

0 10 20 30
percent of deaths
 Socioeconomic status

A composite index created on the basis of household assets

Assets considered;
Housing- type and nature; type of roof, wall, flooring, toilet
facilities, access to drinking water and electricity.
Ownership- land, domestic animals, vehicles and 15 commonly
used electrical appliances such as TV, mobile
phone etc

Presence of migrants in the family.

Scores assigned to each item. The scores were added to give each household a
total score.
Minimum attainable score was 7 and the maximum 30.
Households divided into 4 groups on the basis of total score.
SES 1 represents the poorest and SES 4 the richest.
Social class distribution of households in rural Varkala

50

40
percent

30

20

10

1 2 3 4
social class

based on 33162 households

Social class distribution of households in rural Varkala

50
PROLIFE
percent 40 PARISHAD

30

20

10

1 2 3 4
social class

households in Varkala: 33162

households in Parishad study: 6000
 SES and death from all causes

death

5000

4500

4000

3500

1 2 3 4
socio economic class
death per 500,000 observation years
 Socio economic status and death from selected causes

asthma infection
death death
500 500

400 400

300 300

200 200

100 100

0 0

1 2 3 4 1 2 3 4
socio economic status socio economic status
death per 500,000 person years death per 500,000 person years

suicide all causes

death
death
5000
350

300
4500

250
4000
200

150 3500

1 2 3 4 1 2 3 4
socio economic status socio economic class
death per 500,000 person years death per 500,000 observation years
 Socio economic status and death from selected causes

heart attack stroke

death death
600
1400
550

1200 500

450
1000

400

1 2 3 4 1 2 3 4
socio economic class socio economic class
death per 500,000 observation years death per 500,000 observation years

cancer all causes

death death
600 5000

500
4500
400

300
4000
200

100 3500

1 2 3 4 1 2 3 4
socio economic class socio economic class
death per 500,000 observation years death per 500,000 observation years
Socio economic status and prevalence of self reported diabetes

20
ses 1
ses 2
15
ses 3
percent

ses 4
10

0
men women
Socio economic status and prevalence of self reported hypertension

20
ses 1
ses 2
15
ses 3
percent

ses 4
10

0
men women
Socio economic status and prevalence of self reported cardiac diseases

8
ses 1
ses 2
6
ses 3
ses 4
percent

0
men women
relation between physical activity and mortality in different socio economic classes

10
sedentary
8 moderate
heavy
6
percent

0
1 2 3 4
ses
 Summary
• Non communicable diseases are the major
cause of death in rural Kerala.
• Heart attack, stroke and cancer account for
nearly 50% of all deaths.
• Burden of mortality concentrated among the
growing middle class.
• Prevalence of common chronic diseases are
higher among the richer classes.