The poor in India don’t suffer from fewer “lifestyle diseases” than the rich — they just don’t know it. A new study shows that the actual prevalence of common non-communicable diseases (NCDs) is far higher among the poor than they report, and is as high if not higher among the poor than among the rich.

India is projected to experience more deaths from NCDs such as heart diseases, diabetes and cancer than any other country over the next decade. It is usually believed that such diseases are far more common among the rich, especially in developing countries like India, which still have a high burden of infectious diseases.

A team of researchers from leading medical research institutions across the world, including the Public Health Foundation of India, Harvard and Stanford in the U.S. and Oxford in the U.K. studied self-reported and actual levels of NCDs using standardised measures.

The study, published in the open access peer-reviewed scientific journal PLOS ONE on Monday, looked at the data collected in 2007 by the World Health Organisation for its Study on Global Ageing and Adult Health that covered over 10,000 households in Karnataka, Maharashtra, U.P., Rajasthan, West Bengal and Assam. Five NCDs, angina, hypertension, chronic lung diseases and asthma, vision problems and depression, were selected.

The researchers looked at the proportion of respondents within each wealth quintile (one-fifth of the population) who self-reported having one or more of these five diseases, and contrasted the findings with the proportion of respondents who were found to actually be suffering from the disease by standardised medical tests. They found that while the richest 20 per cent tended to self-report higher rates of prevalence than the poorest 20 per cent, the actual prevalence of the diseases is higher among the poorest 20 per cent than the richest 20 per cent for four out of the five diseases.

The only disease on which the actual levels among the poorest 20 per cent were lower than those self-reported was chronic lung diseases and asthma. “The standardised test for this category measures only hardcore respiratory diseases. It is possible that the poorest quintile suffer from other respiratory diseases, but due to lack of awareness they reported them as one of the diseases measured in this category,” Sukumar Vellakal of the Public Health Foundation of India, lead author of the study, told The Hindu.

“The socio-economic patterning of NCD prevalence differs markedly when assessed by standardised criteria versus self-reported diagnoses. NCDs in India are not necessarily diseases of affluence but also of poverty, indicating likely under-diagnosis and under-reporting of diseases among the poor. Standardised measures should be used, wherever feasible, to estimate the true prevalence of NCDs,” the study concludes.

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