Migrating husbands and changing cardiovascular risk factors in the wife: a cross sectional study in Asian Indian women Rajeev Gupta, 1 Rajiv Gupta, 2 Aachu Agrawal, 3 Anoop Misra, 4 Soneil Guptha, 1 Ravindra M Pandey, 5 Puneet Misra, 5 Naval K Vikram, 6 Sanjit Dey, 7 Shobha Rao, 8 V Usha Menon, 9 N Kamalamma, 10 K Revathi, 11 Beena Mathur, 3 Vinita Sharma 12 ABSTRACT Objective The authors studied the influence of migration of husband on cardiovascular risk factors in Asian Indian women. Methods Population-based studies in women aged 35e70 years were performed in four urban and five rural locations. 4608 (rural 2604 and urban 2004) of the targeted 8000 (57%) were enrolled. Demographic details, lifestyle factors, anthropometry, fasting glucose and cholesterol were measured. Multivariate logistic and quadratic regression was performed to compare influence of migration and its duration on prevalence of risk factors. Results Details of migration were available in 4573 women (rural 2267, ruraleurban migrants 455, urban 1552 and urbanerural migrants 299). Majority were married, and illiteracy was high. Median (interquartile) duration of residence in urban locations among ruraleurban migrants was 9 (4e18) years and in rural areas for urbanerural migrants 23 (18e30) years. In rural, ruraleurban migrants, urban and urbanerural migrants, age-adjusted prevalence (%) of risk factors was tobacco use 41.9, 22.7, 18.8 and 38.1; sedentary lifestyle 69.7, 82.0, 79.9 and 74.6; high-fat diet 33.3, 54.2, 66.1 and 61.1; overweight 21.3, 42.7, 46.3 and 29.7; large waist 8.5, 38.5, 29.2 and 29.2; hypertension 30.4, 49.4, 47.7 and 38.4; hypercholesterolaemia 14.4, 31.3, 26.6 and 9.1 and diabetes 3.9, 15.8, 14.9 and 8.4, respectively (p<0.001). In ruraleurban migrants, there was a significant correlation of duration of migration with waist size, waist-to-hip ratio and systolic blood pressure (quadratic regression, p<0.001). Association of risk factors with migration remained significant, though attenuated, after adjustment for socioeconomic, lifestyle and obesity variables (logistic regression, p<0.01). Conclusions Compared with rural women, ruraleurban migrants and urban have significantly greater cardiometabolic risk factors. Prevalence is lower in urbanerural migrants. There is significant correlation of duration of migration with obesity and blood pressure. Differences are attenuated after adjusting for social and lifestyle variables. INTRODUCTION Human race has evolved with migration. 1 The earliest migration took place from heart of Africa to the Levant and to Europe, Asia, Australasia and the Americas thousands of years ago. 2 In recent years, a different kind of migration is happening and involves either within-country movement from rural to urban areas in low-income countries of Asia and Africa or urban-to-rural migration in high- income countries. 3 Early migrants were more healthy, both physically and mentally, 1 but in recent centuries, it is the socioeconomically weak and unhealthy subjects who migrate to urban areas especially in low-income countries. 4 5 General health status of migrants has been studied in past in different parts of the world. Well-settled migrants in high-income countries achieved rapid socioeconomic prosperity, while migrants from rural-to-urban regions of low-income countries either remained poor or became unhealthier. 4 There are only a limited number of studies that evaluated risk factors for chronic diseases, especially cardio- vascular diseases, among these subjects. 56 Tribal or rural-to-urban migration in Africa, South America, East and South Asia is associated with decreased physical activity, higher intake of dietary fats and salt and lower intake of fruits and vegetables, obesity, truncal obesity, hypertension and multiple lipid, and other cardiometabolic abnormalities. 7e20 Women have always been a part of the migration, although the process is usually initiated by men. 1 It has been recorded from biblical periods that proto- type migrant woman is meek and weak and suffers from vagaries of nature and society. 1 This prototype still exists in many low-income countries. 5 The general health status of the migrant women has been shown to be inferior to men. 6 Influence of migration on cardiovascular risks among the women has not been well studied, and most of the studies among migrant populations in low-income coun- tries have focused on changing cardiovascular risk factors in men. The Kenyan Luo Migrant Study, 16 Cameroonian Study, 15 Chinese Yi Migrant Study, 14 INTERSALT Study 8 as well as recent studies in India 19 and Peru 20 have mainly focused on migrant groups or men and have not specifically looked at maleefemale differences. We performed an epide- miological study in Indian women in rural and urban locations at multiple sites. 21 In this study, migration patterns of women were enquired. To evaluate effects of within-country migration in India, both from rural-to-urban and urban-to-rural, on multiple cardiovascular risk factors, we performed this study. Study among women is important because, although cardiovascular risk may be lower in them, increasing focus on them can have a transformative influence on diet and other 1 Department of Medicine, Fortis Escorts Hospital, Jaipur, India 2 Department of Sociology, University of Rajasthan, Jaipur, India 3 Department of Home Science, University of Rajasthan, Jaipur, India 4 Department of Medicine, Fortis Rajan Dhall Hospital, New Delhi & National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India 5 Department of Community Medicine, All India Institute of Medical Sciences, New Delhi, India 6 Department of Medicine, All India Institute of Medical Sciences, New Delhi, India 7 Department of Physiology, University of Calcutta, Kolkata, India 8 Department of Endocrinology, Agharkar Institute, Pune, India 9 Amritha Institute of Medical Sciences, Kochi, India 10 Gandhigram Rural Institute, Gandhigram, Dindigul, India 11 Pondicherry Science Forum, Pondicherry, India 12 Department of Science and Technology, Government of India, New Delhi, India Correspondence to Dr Rajeev Gupta, Department of Medicine, Fortis Escorts Hospital, JLN Marg, Jaipur 302017, India; rajeevg@satyam.net.in Accepted 18 October 2011 Gupta R, Gupta R, Agrawal A, et al. J Epidemiol Community Health (2011). doi:10.1136/jech-2011-200101 1 of 9 Research report JECH Online First, published on December 6, 2011 as 10.1136/jech-2011-200101 Copyright Article author (or their employer) 2011. Produced by BMJ Publishing Group Ltd under licence.