Unveiling the twin epidemics of hypertension and diabetes: a cross-sectional analysis of sex-specific prevalence, risk, and hotspots in India's epidemiological transition zones

Abstract

Background: The prevalence of hypertension and diabetes, which often coexist and significantly contribute to the burden of noncommunicable diseases (NCDs), is increasing in India. This study examines the sex-stratified prevalence, coexistence, and bidirectional risks of hypertension and diabetes across states with varying epidemiological transition levels (ETLs) and identifies high-burden hotspots.

Methods: This study analysed data from the fifth round of the National Family Health Survey, covering 614,426 women and 556,199 men aged 30 years and above, with biomarker information on both diabetes and hypertension. The age-standardized prevalence was estimated, and adjusted risk ratios (ARRs) were obtained on multivariate logit scale. Bivariate maps, spatial autocorrelation and hotspot analyses were conducted using ArcGIS Pro to identify geographic clusters associated with twin epidemics.

Results: Individuals diagnosed with hypertension or diabetes were, on average, nearly a decade older than those without. Hypertension prevalence was 30.3% (95%CI:30.14-30.48) among men and 28.6% (95%CI:28.47-28.79) among women, whereas diabetes prevalence was at 19.7% (95%CI:19.58-19.88) in men and 17.4% (95%CI:17.22-17.50) in women. Among individuals with diabetes, 43.1% (95%CI:42.67-43.53) of men and 43.9% (95%CI:43.48-44.36) of women had hypertension, whereas 28.1% (95%CI:27.75-28.37) of hypertensive men and 26.6% (95%CI:26.33-26.93) of hypertensive women were diabetic. Hotspots for twin epidemics were identified in coastal regions, including the southern states with high ETLs, as well as the northern states with high-ETLs and the country's northeastern region. ARR estimates revealed that the risk of hypertension among individuals with diabetes was 39% higher (95%CI:1.38-1.40) in men and 41% higher (95%CI:1.39-1.42) in women than in individuals without diabetes. Similarly, the risk of diabetes among individuals with hypertension was 51% higher (95%CI:1.49-1.52) in men and 55% higher (95%CI:1.53-1.57) in women than in individuals without hypertension.

Conclusion: Our findings highlight the progressive nature of the twin epidemics of diabetes and hypertension, with an increased risk of onset associated with advanced age. The presence of one condition substantially elevates the likelihood of developing the other, highlighting their bidirectional relationship. Achieving Sustainable Development Goal target 3.4 requires addressing these intersecting epidemics as a unified entity for effective management. Targeted interventions should prioritise high-burden hotspots for integrated care strategies to mitigate the twin epidemics of diabetes and hypertension.

Keywords: Adjusted risk ratios; Diabetes; Epidemiological transition levels; Hotspots; Hypertension; Non-communicable diseases (NCDs); Twin epidemics.

Fig. 1

Flowchart of sample selection in the study, NFHS-5 (2019-21)

Fig. 2

Mean and median age of the study population by disease type and gender, NFHS-5 (2019-21)

Fig. 3

Bivariate map showing the prevalence of hypertension and diabetes among men aged 30 and above, NFHS-5 (2019-21)

Fig. 4

Bivariate map showing the prevalence of hypertension and diabetes among women aged 30 and above, NFHS-5 (2019-21)

Fig. 5

Hot spots and cold spots of diabetes among men aged 30 and above who had hypertension, India, NFHS-5 (2029-21)

Fig. 6

Hot spots and cold spots of diabetes among women aged 30 and above who had hypertension, India, NFHS-5 (2029-21)

Fig. 7

Hot spots and cold spots of hypertension among men aged 30 and above who had diabetes, India, NFHS-5 (2029-21)

Fig. 8

Hot spots and cold spots of hypertension among women aged 30 and above who had diabetes, India, NFHS-5 (2029-21)