Abstract
Cardiovascular disease and risk factors represent a major and increasing burden of death and disability in India, although socioeconomic aspects have been debated in recent years. To conduct a comprehensive equity analysis of the socioeconomic gradients and distribution of diabetes, hypertension, and obesity in India using the latest national data set. Cross-sectional study of data originating from the fourth Indian National Family Health Survey collected from January 20, 2015, to December 4, 2016. The study population was based on a nationally representative cross-sectional sample of women aged 15 to 49 years and men aged 15 to 54 years in India, with a response rate of 97% and 92% among eligible women and men, respectively. Biomarker sampling of survey respondents captured height, weight, blood pressure, and random blood glucose levels. Markers of socioeconomic status (SES) were household wealth, education, and social caste. Descriptive analyses and logistic regression models that account for multistage survey design and sampling weights were estimated. Diabetes, hypertension, and obesity assessed by predetermined thresholds based on biomarker sampling or current medication were the primary outcomes. The survey covered 757 958 individuals (weighted prevalence of 51.2% female). The overall prevalence of diabetes, hypertension, and obesity in the sample was 2.9%, 14.4% and 9.7%, respectively. Positive socioeconomic gradients were observed by household wealth, education, and social caste, and in a majority of states. The magnitude of the SES gradient was strongest for obesity (adjusted odds ratio for highest SES quintile vs lowest, 8.76; 95% CI, 7.70-9.95), followed by diabetes (adjusted odds ratio, 2.31; 95% CI, 1.88-2.85) and hypertension (adjusted odds ratio, 1.58; 95% CI, 1.45-1.72) (P < .001 for all associations). Analyses of the socioeconomic distribution indicated that between 70% and 90% of the population burden of diabetes, hypertension, and obesity was among the higher SES groups, and this figure was similar across states. Cardiovascular risk factors have an uneven distribution in India. Prevention and treatment strategies should reflect the distribution of the risk factor burden.
Highlights
Cardiovascular disease (CVD) and associated risk factors, including type 2 diabetes, hypertension, and obesity, represent a major and increasing burden of death and disability in India.[1]
Positive socioeconomic gradients were observed by household wealth, education, and social caste, and in a majority of states
The magnitude of the socioeconomic status (SES) gradient was strongest for obesity, followed by diabetes and hypertension (P < .001 for all associations)
Summary
Cardiovascular disease (CVD) and associated risk factors, including type 2 diabetes, hypertension, and obesity, represent a major and increasing burden of death and disability in India.[1]. Socioeconomic Distribution of Diabetes, Hypertension, and Obesity in India life-years (a measure of overall disease burden) after previously being ranked sixth in 1990.2 Diabetes was ranked the 13th leading cause of disability-adjusted life-years in 2016, increasing more than 170% since 1990. This trend indicates changes in the burden of premature mortality and morbidity away from communicable, maternal, and neonatal conditions and toward CVD and other noncommunicable diseases at an aggregate scale in India.[2] CVD may be the overall leading cause of mortality, and risk factors such as diabetes are an important component of this overall burden, summary statistics such as the Global Burden of Disease mask large variation in the distribution of CVD and risk factors along socioeconomic status (SES) dimensions given the enormous variation that has been described in India.[3,4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
