Research Publication

Association of Life-Course Social Mobility With Cardiovascular Disease and Modifiable Risk Factors: Evidence From the Longitudinal Aging Study in India

Dr. Imnameren Longkumer, is a Narotam Sekhsaria Fellow (2025) at the Harvard T.H. Chan School of Public Health India Research Center. Dr. Imnameren is mentored by Professor S.V. Subramanian, Professor of Population Health and Geography, Harvard T.H. Chan School of Public Health.

Assessing cardiovascular disease (CVD) risk in relation to life course socioeconomic position may provide important insights into patterns of social mobility and health. While studies from high income countries (HICs) have demonstrated an inverse association between life course socioeconomic position and cardiovascular disease, findings from lower income countries are heterogeneous. This study examined the association between life course social mobility, cardiovascular disease, and modifiable risk factors among middle aged and older Indian.

This study utilized data from the Longitudinal Aging Study in India (2017-2018), a nationally representative cross-sectional study of adults aged ≥45 years. On the basis of socioeconomic position during childhood (family financial position) and adulthood (monthly per-capita expenditure; household assets), life-course social mobility was classified into 4 categories: consistently high, upward mobility, downward mobility, and consistently low. 

Social mobility patterns indicated that 40.29% remained in consistently high socioeconomic position, 19.32% in consistently low socioeconomic position, whereas 19.57% experienced upward mobility, and 20.82% experienced downward mobility. Compared with those with consistently low socioeconomic position, those in consistently high socioeconomic position were associated with greater odds of congestive heart failure, heart attack, abnormal heart rhythm, heart diseases, and composite cardiovascular disease.

Furthermore, upward social mobility was associated with higher odds of all cardiovascular disease outcomes except abnormal heart rhythm and stroke. Life-course social mobility also showed a graded association with hypertension, body mass index BMI, central adiposity, and diabetes. The positive associations persisted when using adult asset-based social mobility, coarsened exact matching, and multiple sensitivity analyses with various socioeconomic position indicators.

Life course social mobility, particularly sustained socioeconomic advantage and upward mobility, is associated with higher CVD and cardiometabolic risk factors among middle aged and older Indians. These patterns differ from those in HICs and underscore the importance of considering country specific life course socioeconomic processes. Consequently, public health policies could be complemented by microsocial preventive strategies that integrate early life interventions with adult focused strategies addressing life course social mobility to reduce the CVD burden.

Research publication such as this reflect the Harvard Chan India Research Center’s commitment to advancing public health research in India. Through initiatives such as the Narotam Sekhsaria Fellowship, the Center supports postdoctoral researchers in India in generating evidence that can inform public health policy and practice.