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

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.

Figure 1.. Prevalence of Diabetes and Hypertension by Rural-Urban Location, Sex, and Household Wealth Quintile^a

A, Diabetes prevalence. B, Hypertension prevalence. ^aDiabetes prevalence under the assumption that all Annual Health Survey participants had not fasted are shown in eFigure 3 in the Supplement.

Figure 2.. The Predicted Probability of Diabetes and Hypertension by Age Group, Rural or Urban Location, and Household Wealth Quintile

A, Diabetes prevalence. B, Hypertension prevalence. Predicted probabilities were obtained from multivariable logistic regressions of diabetes and hypertension on individuals’ sociodemographic characteristics (age group, household wealth quintile, education, marital status, sex, and rural vs urban location), district-level fixed effects, and an interaction term between age group and household wealth quintile. Predicted probabilities assuming that all Annual Health Survey respondents had not fasted are shown in eFigure 6 in the Supplement.

Figure 3.. Age-Standardized, State-Level Prevalence of Diabetes and Hypertension by Rural vs Urban Location Within Each State

A, Diabetes prevalence. B, Hypertension prevalence. No data were available for Jammu and Kashmir, and Gujarat. The Union Territories of Chandigarh, Daman and Diu, and Puducherry are not visible in the map owing to their small area. Point estimates and 95% CIs for each state are shown in eTable 7 in the Supplement. AP indicates Andhra Pradesh; AR, Arunachal Pradesh; AS, Assam; BR, Bihar; CG, Chhattisgarh; CH, Chandigarh; DD, Daman and Diu; DL, Delhi; GA, Goa; HR, Haryana; HP, Himachal Pradesh; JH, Jharkhand; KA, Karnataka; KL, Kerala; MP, Madhya Pradesh; MH, Maharashtra; MN, Manipur; ML, Meghalaya; MZ, Mizoram; NL, Nagaland; OD, Odisha (Orissa); PB, Punjab; PY, Puducherry; RJ, Rajasthan; SK, Sikkim; TN, Tamil Nadu; TS, Telangana State; TR, Tripura; UP, Uttar Pradesh; UK, Uttarakhand (Uttaranchal); WB, West Bengal.