Rejoinder: Need for a data-driven discussion on the socioeconomic patterning of cardiovascular health in India

We thank each of the commentators for their responses1–4 to our review of the evidence underlying the association of socioeconomic status and cardiovascular health in India. To briefly recap, we conducted a systematic review of studies that reported an association between measures of socioeconomic status (SES) (specifically, education, household income, occupation, household assets/standard of living index, or a composite of two or more measures) and seven cardiovascular disease (CVD) and related risk factors (CVRF; smoking, diet, physical inactivity, hypertension, diabetes, abnormal lipids and obesity), and risk factor-associated CVD-related mortality (ischaemic heart disease (IHD) and stroke) in India.5 We found that with the exception of smoking, and low fruit and vegetable intake, CVRF were more prevalent among high SES groups in India than the low SES groups (see Figure 1 and Supplementary Table 1 of our review).5 Regarding risk factor-associated CVD-related mortality, whereas data are available from several studies,6–11 only two of these describe the SES patterning of such mortality, and the current evidence seems to support socioeconomic patterning in both directions. In the largest study,11 the mortality rates appeared to be higher among the lower SES groups for CVD and stroke, whereas the proportion of deaths from CVD and IHD causes was found to be greatest among higher SES groups (see Figure 2 of our review).5by Malavika A. Subramanyam et al.