Social networks and cardiovascular disease in South Asia: Preliminary findings from urban Delhi Pubblico

Abstract

Abstract

Social networks and cardiovascular disease in South Asia: Preliminary findings from urban Delhi

Background: Cardiovascular disease follows a unique Asian Indian phenotype in South
Asia and continues to increase substantially among Asian Indian adults, particularly
urban and migrant populations. Recent findings suggest clustering of chronic disease
and cardiovascular risk within social networks. We employed a social network
perspective to the cardiovascular disease epidemic among South Asians using a
representative urban, adult population of Asian Indians.

Methods: This study analyzed existing social network analysis theory and methodology
in the context of urban South Asian populations and cardiovascular disease risk. We
developed a pilot to collect egocentric social network information of urban adults living
in Delhi, India. The pilot was implemented as an amendment to an ongoing
cardiometabolic surveillance study, COE-CARRS. The pilot additionally collected social
network information relevant to cardiovascular health, though the instrument is
modifiable for application among South Asians in other settings. Personal network
information was linked with demographic and cardiometabolic data from COE-CARRS,
and network attributes were modeled against the primary outcome of waist
circumference in regression analyses.

Results: The average network size of urban Asian Indians is 3.8 persons. Family
relationships, particularly kin, formed the majority of social networks, with female
relatives named more often than males. Neighborhood relationships comprised only 5%
of nominated networks on average, indicating the relevance of social space over physical
space in personal networks. Regression analyses revealed little evidence of egocentric
social network attributes' association with an individual's waist circumference.

Conclusion: Our instrument successfully captured social network information in urban
Asian Indians, with particular relevance to cardiovascular risk factors. Future analyses
will employ a longitudinal sociometric design to formally map the network topography
of urban adult Indians. Furthermore, contextualization of religious belief, migratory
status, and gender roles will be included in the sociometric design due to these
attributes' potential relevance to chronic health, especially cardiovascular health.

Table of Contents

Table of Contents

Chapter 1: Introduction to Social Networks and Cardiovascular Disease in India
A. Brief history of social network analysis application to chronic disease

B. Cardiovascular disease in India

C. Urban India context

D. Application of social network perspective to investigate the cardiovascular disease epidemic in urban Delhi

Chapter 2: Conceptual Framework of Ego Waist Circumference

Chapter 3: Review of Cardiovascular Disease in India

A. Global cardiovascular disease burden

B. Burden of disease in India

C. Cardiovascular disease in India

a. Emerging Asian Indian phenotype

b. Metabolic mechanism of the Asian Indian phenotype

D. Cardiovascular disease in urban India

E. Delhi

a. Geographic context

Figure 2: National Capital Territory (NCT) of Delhi (2011)

b. Demographics

c. Cardiovascular disease in Delhi

Chapter 4: Review of Social Network Analysis

A. Definitions and constructs

a. Description of social network analysis

i. Social network theory

ii. Mechanisms of social network effect

b. Social network instruments

c. Egocentric Social Networks

B. Social Networks and health

a. Brief history of social network applications to health

b. Social networks and cardiovascular disease

C. Social networks of urban Indian populations

a. Traditional living arrangements

b. Urbanization and social networks

Chapter 5: Development and Piloting of Social Network Instrument

A. Design and development

B. Piloting

Chapter 6: Social Networks and Cardiovascular Risk Analysis

A. Methodology

a. Data Sources

Figure 3: Schematic sampling scheme for COE-CARRS in Delhi

b. Primary outcome: waist circumference as the diagnostic criteria of South Asian CVD risk

c. Ego attributes

d. Alter attributes

e. Data management and analyses

B. Results

a. Ego descriptive statistics

b. Network attributes

c. Network prediction of ego health

i. Bivariate association with ego waist circumference

ii. Linear regression on ego waist circumference

iii. Logistic regression on ego waist circumference

Chapter 7: Discussion, Conclusion and Recommendations

A. Discussion

B. Limitations

C. Future work

D. Public health implications and recommendations

References

Tables and Figures

Figure 1: Determinants of ego waist circumference

Table 1: Primary source questions gathering social network information

Table 2: Descriptive statistics on adult Indian sample, by ego waist circumference action level, Delhi 2011 (n=208)

Table 3: Tie composition of ego-nominated networks, overall and by position nomination from closest (position 1) (n=208)

Table 4: Linear regression of ego waist circumference (cm) on network (% full network) and ego characteristics

Table 5: Linear regression of ego waist circumference (cm) on network (any alter) and ego characteristics

Table 6: Linear regression of ego waist circumference (cm) on network (first named alter) and ego characteristics

Table 7: Logistic regression of Action Level 2 ego waist circumference (cm) on network (% full network) and ego characteristics

Table 8: Logistic regression of Action Level 2 ego waist circumference (cm) on network (any alter) and ego characteristics

Table 9: Logistic regression of Action Level 2 ego waist circumference (cm) on network (first named alter) and ego characteristics

Appendix: Social Network Pilot Instrument

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Parola chiave	social networks, india, cardiovascular disease, cvd, social network analysis, sna, urban
Committee Chair / Thesis Advisor	Argeseanu, Solveig, Emory University
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.)

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