The Socio-Demographic Characteristics of Diabetes, Hypertension, and Cardiovascular Disease Risk in India

Abstract

Cardiovascular disease (CVD) is the leading cause of mortality in India. Yet, the evidence is sparse on how diabetes, hypertension, and predicted CVD risk vary between population groups in the country. This dissertation aimed to determine how the prevalence of diabetes, hypertension, and predicted CVD risk in India varies by state, rural-urban location, and individual-level socio-demographic characteristics. Data were pooled from the Annual Health Survey (2012-2013) and the District-Level Household Survey-4 (2012-2014). Diabetes was defined as a plasma glucose 126 mg/dl if fasted or 200 mg/dl if non-fasted, and hypertension as a systolic blood pressure (BP) 140mmHg or a diastolic BP 90mmHg. Predicted 10-year CVD risk was calculated for each participant aged 30 to 74 years using the Framingham risk score, and dichotomized into high (30%) or low risk (<30%). 1,320,555 adults aged 18 years were included in the diabetes and hypertension analysis, and 797,932 adults aged 30 to 74 years in the CVD risk analysis. The crude prevalence of diabetes, hypertension, and high CVD risk was 7.3% (7.1 - 7.4), 23.6% (23.4 – 23.7), and 14.6% (14.4 – 14.8) among females, respectively, and 7.8% (7.6 - 8.0), 27.3% (27.1 – 27.5), and 31.7% (31.4 – 32.0) among males, respectively. There was substantial variation in the prevalence of each outcome among states. Being in the richest compared to the poorest household wealth quintile was associated with only a modestly higher probability of diabetes (rural: 2.8 [2.5 - 3.1] percentage points; and urban: 3.5 [3.0 - 3.9] percentage points) and hypertension (rural: 4.2 [3.7 - 4.6] percentage points; and urban: 3.0 [2.4 - 3.7] percentage points). The differences in the probability of all conditions by educational category were generally small. The prevalence of diabetes and hypertension in India is high, and predicted CVD risk was approximately twice as high as has been estimated for the United States. The important variation in the prevalence of each outcome by state and socio-demographic characteristics can inform planning and resource allocation as well as effective targeting of CVD programs to reach those most in need.