Uncontrolled hypertension among tobacco-users: women of prime childbearing age at risk in India

Abstract

Background: Uncontrolled hypertension and tobacco use are two major public health issues that have implications for reproductive outcomes. This paper examines the association between tobacco-use status and uncontrolled hypertension among prime childbearing age (20-35) women in India.

Methods: We used the India National Family Health Survey (NFHS-4) 2015-2016 to obtain data on hypertension status and tobacco use for 356,853 women aged 20-35. We estimated multivariate logistic regressions to obtain the adjusted odds ratio for tobacco users in favor of having uncontrolled hypertension. We examined the adjusted odds at different wealth index quintiles, at different educational attainment, and at different level of nutritional status measured by body mass index.

Results: We found that the odds of having uncontrolled hypertension for the tobacco user women in India was 1.1 (95% CI: 1.01-1.19) times that of tobacco non-users at prime childbearing age. The odds were higher for tobacco-users at the poorest quintile (1.27, 95% CI: 1.14-1.42) and with no education (1.22, 95% CI: 1.10-1.34). The odds were also higher for tobacco-users who were overweight (1.88, 95% CI: 1.57-2.29) or obese (2.82, 95% CI: 1.88-4.24).

Conclusions: Our findings highlight the disproportionate dual risk of uncontrolled hypertension and tobacco use among lower-income women of prime childbearing age, identifying an opportunity for coordinated tobacco control and hypertension prevention initiatives to ensure better health of reproductive-age women in India.

Keywords: Childbearing age; Hypertension; India; Tobacco.

Fig. 1

Difference in hypertension prevalence between tobacco-user and non-user by wealth index quintiles. Estimates were obtained using complex survey weights. The size of the bubbles reflects share of tobacco-users or non-users across wealth index quintiles. The shares of tobacco-users across quintiles add to one. The shares of non-users across quintiles add to one

Fig. 2

Adjusted odds ratios for any tobacco use in favor of uncontrolled hypertension, by wealth index quintiles. The horizontal lines around the markers represents 95% confidence intervals. Estimates were obtained using complex survey weights. Regressions controlled for age group, nutritional status (BMI), education, marital status, urban/rural residence and state fixed effects

Fig. 3

Adjusted odds ratios for any tobacco use in favor of uncontrolled hypertension, by educational attainment. The horizontal lines around the markers represents 95% confidence intervals. Estimates were obtained using complex survey weights. Regressions controlled for age group, wealth index quintiles, nutritional status (BMI), marital status, urban/rural residence and state fixed effects

Fig. 4

Adjusted odds ratios for any tobacco use in favor of uncontrolled hypertension, by nutritional status (BMI group). The horizontal lines around the markers represents 95% confidence intervals. Estimates were obtained using complex survey weights. Regressions controlled for age group, wealth index quintiles, education, marital status, urban/rural residence and state fixed effects

Fig. 5

Adjusted odds ratios for mutually exclusive types of tobacco use in favor of uncontrolled hypertension. The horizontal lines around the markers represents 95% confidence intervals. Estimates were obtained using complex survey weights. Regressions controlled for age group, nutritional status (BMI), wealth index quintiles, education, marital status, urban/rural residence and state fixed effects