Abstract
IMPORTANCE Understanding how diabetes and hypertension prevalence varies within a country as large as India is essential for targeting of prevention, screening, and treatment services. However, to our knowledge there has been no prior nationally representative study of these conditions to guide the design of effective policies. OBJECTIVE To determine the prevalence of diabetes and hypertension in India, and its variation by state, rural vs urban location, and individual-level sociodemographic characteristics. DESIGN, SETTING, AND PARTICIPANTS This was a cross-sectional, nationally representative, population-based study carried out between 2012 and 2014. A total of 1 320 555 adults 18 years or older with plasma glucose (PG) and blood pressure (BP) measurements were included in the analysis. EXPOSURES State, rural vs urban location, age, sex, household wealth quintile, education, and marital status. MAIN OUTCOMES AND MEASURES Diabetes (PG level ≥126 mg/dL if the participant had fasted or ≥200 mg/dL if the participant had not fasted) and hypertension (systolic BP≥140 mm Hg or diastolic BP≥90 mm Hg). RESULTS Of the 1 320 555 adults, 701 408 (53.1%) were women. The crude prevalence of diabetes and hypertension was 7.5% (95% CI, 7.3%-7.7%) and 25.3% (95% CI, 25.0%-25.6%), respectively. Notably, hypertension was common even among younger age groups (eg, 18-25 years: 12.1%; 95% CI, 11.8%-12.5%). Being in the richest household wealth quintile compared with being in the poorest quintile was associated with only a modestly higher probability of diabetes (rural: 2.81 percentage points; 95% CI, 2.53-3.08 and urban: 3.47 percentage points; 95% CI, 3.03-3.91) and hypertension (rural: 4.15 percentage points; 95% CI, 3.68-4.61 and urban: 3.01 percentage points; 95% CI, 2.38-3.65). The differences in the probability of both conditions by educational category were generally small (≤2 percentage points). Among states, the crude prevalence of diabetes and hypertension varied from 3.2% (95% CI, 2.7%-3.7%) to 19.9% (95% CI, 17.6%-22.3%), and 18.0% (95% CI, 16.6%-19.5%) to 41.6% (95% CI, 37.8%-45.5%), respectively. CONCLUSIONS AND RELEVANCE Diabetes and hypertension prevalence is high in middle and old age across all geographical areas and sociodemographic groups in India, and hypertension prevalence among young adults is higher than previously thought. Evidence on the variations in prevalence by state, age group, and rural vs urban location is critical to effectively target diabetes and hypertension prevention, screening, and treatment programs to those most in need.
Generated Summary
This cross-sectional, nationally representative, population-based study, conducted between 2012 and 2014, examined the prevalence of diabetes and hypertension in India. A total of 1,320,555 adults aged 18 years or older participated, with plasma glucose (PG) and blood pressure (BP) measurements taken. The study aimed to determine the prevalence of these conditions across different states, urban versus rural locations, and individual-level sociodemographic characteristics. The primary outcomes were diabetes, defined as a PG level ≥126 mg/dL (if the participant had fasted) or ≥200 mg/dL (if the participant had not fasted), and hypertension, defined as systolic BP≥140 mm Hg or diastolic BP≥90 mm Hg. The data was sourced from the District-Level Household Survey-4 (DLHS-4) and the second update of the Annual Health Survey (AHS). Statistical analyses included the calculation of diabetes and hypertension prevalence by various demographic factors, using sampling weights to account for the survey design and data pooling. Multivariable linear probability models (LPMs) were used to investigate the association between diabetes and hypertension and individual-level sociodemographic characteristics, incorporating PSU-level fixed effects.
Key Findings & Statistics
- The study included 1,320,555 adults, with 701,408 (53.1%) being women.
- The crude prevalence of diabetes was 7.5% (95% CI, 7.3%-7.7%), and hypertension was 25.3% (95% CI, 25.0%-25.6%).
- Hypertension was common even among younger age groups; for instance, the 18-25 year age group had a prevalence of 12.1% (95% CI, 11.8%-12.5%).
- Being in the richest household wealth quintile showed only a slightly higher probability of diabetes (rural: 2.81 percentage points; 95% CI, 2.53-3.08; urban: 3.47 percentage points; 95% CI, 3.03-3.91) and hypertension (rural: 4.15 percentage points; 95% CI, 3.68-4.61; urban: 3.01 percentage points; 95% CI, 2.38-3.65).
- The prevalence of diabetes and hypertension varied significantly across different states.
- The crude prevalence of diabetes varied from 3.2% (95% CI, 2.7%-3.7%) to 19.9% (95% CI, 17.6%-22.3%), and hypertension varied from 18.0% (95% CI, 16.6%-19.5%) to 41.6% (95% CI, 37.8%-45.5%).
- The crude (weighted) prevalence of diabetes was 7.3% (95% CI, 7.1%-7.4%) and 7.8% (95% CI, 7.6%-8.0%) among women and men, respectively.
- The age-standardized prevalence of diabetes was 6.1% (95% CI, 6.0%-6.3%) among women and 6.5% (95% CI, 6.4%-6.7%) among men.
- The age-standardized prevalence of hypertension was 20.0% among women and 24.5% among men.
- For instance, among those older than 40 years in the poorest wealth quintile in rural areas, 5.9% (95% CI, 5.5%-6.2%) had diabetes and 30.0% (95% CI, 29.2%-30.7%) had hypertension.
- The age-standardized prevalence of diabetes varied from 2.33% (95% CI, 1.98%-2.75%) among women in Madhya Pradesh to 17.90% (95% CI, 15.37%-20.74%) among men in Goa.
- For hypertension, the age-standardized prevalence ranged from 13.50% (95% CI, 12.19%-14.93%) among women in Chhattisgarh to 43.53% (95% CI, 38.33%-48.87%) among men in Daman and Diu.
- The differences in the probability of both conditions by educational category were generally small (≤2 percentage points).
- The age-standardized prevalence of diabetes was 6.3% (95% CI, 6.2%-6.5%).
Other Important Findings
- Household wealth was positively associated with both diabetes and hypertension; the richest quintile had a modestly higher probability of diabetes and hypertension compared to the poorest quintile.
- Prevalence tended to be higher in urban than rural areas for both conditions.
- The relative differences in prevalence between urban and rural locations and household wealth quintiles were more pronounced for diabetes than for hypertension.
- Men generally had a greater probability of having both conditions compared to women, though the absolute difference was larger for hypertension.
- The differences in the probability of both conditions were higher across age groups compared to any other sociodemographic characteristic.
- Diabetes was most prevalent in the South of India (Andhra Pradesh, Goa, Karnataka, Kerala, and Tamil Nadu) as well as in Delhi and West Bengal.
- Hypertension prevalence was highest in the northern states of Punjab and Himachal Pradesh, the southern state of Kerala, and the northeastern states of Sikkim and Nagaland.
- In younger age groups, the hypertension prevalence estimates for India were higher than those for Central and Eastern Europe, a region that WHO/NCD-RisC identified as having the highest hypertension prevalence globally.
Limitations Noted in the Document
- A significant portion of participants (18.4%) had missing data for either blood glucose measurement or blood pressure readings, mainly because of participant absence.
- The one-time capillary blood glucose measurement is not the recommended method for diagnosing diabetes in clinical settings, although it is suitable for population-based research.
- The study could not distinguish between type 1 and type 2 diabetes.
- Fasting status was not verified through self-report in the AHS.
- The study did not account for the fact that poorer individuals may have lower access to high-quality health care services and less financial risk protection, which could lead to higher prevalence of CVD events.
- The study only examines a single risk factor or disease at a time, which limits the understanding of the relative contribution of the disease to the wealth group’s total disease burden.
Conclusion
The study’s findings reveal that diabetes and hypertension are highly prevalent across various geographical locations and sociodemographic groups in India. The age-standardized prevalence estimates for both diabetes and hypertension are noteworthy. The study’s findings underscore the need for targeted interventions. The variation in prevalence across different states, age groups, and rural versus urban locations provides valuable insights for policymakers. Specifically, the study highlights the need for prioritizing prevention, screening, and treatment programs. The prevalence of hypertension among young adults in India is higher than previously thought. The study emphasizes the need for effectively targeted programs to address diabetes and hypertension. The variations in prevalence, based on state, age, and rural versus urban location, should guide the development of prevention, screening, and treatment strategies. The study’s findings highlight the need for investments in diabetes and hypertension prevention, detection, and treatment programs across the country to avert the negative health, social, and economic consequences of these conditions. “Given the size, growth, rapid urbanization, and aging of India’s population…the country’s success in tackling its diabetes and hypertension epidemic will be crucial to achieving Sustainable Development Goals globally.”