Abstract
BackgroundWhether non-communicable diseases (NCDs) are diseases of poverty or affluence in low-and-middle income countries has been vigorously debated. Most analyses of NCDs have used self-reported data, which is biased by differential access to healthcare services between groups of different socioeconomic status (SES). We sought to compare self-reported diagnoses versus standardised measures of NCD prevalence across SES groups in India.MethodsWe calculated age-adjusted prevalence rates of common NCDs from the Study on Global Ageing and Adult Health, a nationally representative cross-sectional survey. We compared self-reported diagnoses to standardized measures of disease for five NCDs. We calculated wealth-related and education-related disparities in NCD prevalence by calculating concentration index (C), which ranges from −1 to +1 (concentration of disease among lower and higher SES groups, respectively).FindingsNCD prevalence was higher (range 5.2 to 19.1%) for standardised measures than self-reported diagnoses (range 3.1 to 9.4%). Several NCDs were particularly concentrated among higher SES groups according to self-reported diagnoses (Csrd) but were concentrated either among lower SES groups or showed no strong socioeconomic gradient using standardized measures (Csm): age-standardised wealth-related C: angina Csrd 0.02 vs. Csm −0.17; asthma and lung diseases Csrd −0.05 vs. Csm −0.04 (age-standardised education-related Csrd 0.04 vs. Csm −0.05); vision problems Csrd 0.07 vs. Csm −0.05; depression Csrd 0.07 vs. Csm −0.13. Indicating similar trends of standardized measures detecting more cases among low SES, concentration of hypertension declined among higher SES (Csrd 0.19 vs. Csm 0.03).ConclusionsThe socio-economic patterning of NCD prevalence differs markedly when assessed by standardized 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. Standardized measures should be used, wherever feasible, to estimate the true prevalence of NCDs.
Highlights
Non-communicable disease (NCDs) are increasingly dominating health care needs in low and middle income countries (LMICs) with their importance gaining increased policy recognition over the past decade [1,2,3,4]
The socio-economic patterning of non-communicable diseases (NCDs) prevalence differs markedly when assessed by standardized criteria versus self-reported diagnoses
We developed a standardized measure of NCD prevalence by utilizing various standardized criteria available and compared standardised diagnostic measures with self-reported diagnoses to examine the extent to which socio-economic inequality in NCD prevalence documented in previous studies may be due to artefact and differential access to healthcare services between groups of different socioeconomic status (SES)
Summary
Non-communicable disease (NCDs) are increasingly dominating health care needs in low and middle income countries (LMICs) with their importance gaining increased policy recognition over the past decade [1,2,3,4]. Among LMICs, India is considered a important nation to study the emerging burden of NCDs. India is projected to experience more deaths from NCDs than any other country over the decade, due to the size of population and worsening risk factor profile, associated with recent dramatic economic growth [9,10,11,12,13,14]. Most analyses of NCDs have used self-reported data, which is biased by differential access to healthcare services between groups of different socioeconomic status (SES).
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