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Original Investigation
March 2018

Diabetes and Hypertension in India: A Nationally Representative Study of 1.3 Million Adults

Author Affiliations
  • 1Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
  • 2Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
  • 3Department of Economics & Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
  • 4MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Education Campus, University of Witwatersrand, Johannesburg, South Africa
  • 5Centre for Global Health, King's College London, London, England
  • 6Indian Institute of Public Health, Gandhinagar, India
  • 7Public Health Foundation of India, Delhi NCR, India
  • 8Institute of Public Health, Heidelberg University, Heidelberg, Germany
  • 9Africa Health Research Institute, Mtubatuba, South Africa
JAMA Intern Med. 2018;178(3):363-372. doi:10.1001/jamainternmed.2017.8094
Key Points

Question  How does the prevalence of diabetes and hypertension in India vary by geographical area and sociodemographic characteristics?

Findings  Diabetes and hypertension prevalence varied widely among states (by more than a factor of 6 for diabetes and more than a factor of 2 for hypertension); while household wealth and urban location were positively associated with both conditions, the prevalence of diabetes and hypertension among those older than 40 years in the poorest household wealth quintile in rural areas was nonetheless high (5.9% and 30.0%, respectively).

Meaning  The prevalence of diabetes and hypertension in India varies substantially by age, rural vs urban location, and state—knowledge that could be used to target relevant programs to those most in need.

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.

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