Measuring changes in prevalence of hypertension and diabetes across 720 districts in India using cross-sectional data...

The age of onset for hypertension and diabetes has been declining in India. However, the extent to which the burden of these two non-communicable illnesses among younger adults varies geographically within India is not known. Thus, the purpose of this study is to examine changes in prevalence of hypertension and diabetes among women and men between the ages of 15 and 49 across India's 720 districts from 2016 to 2021.

The study uses repeated cross-sectional data from 2016 and 2021, representative at the district level in India. We analysed women and men between the ages of 15 and 49 for hypertension and diabetes. We used WHO cut-offs for hypertension (systolic blood pressure of 140 mmHg or greater, and/or diastolic blood pressure of 90 mmHg or higher) and diabetes (random blood glucose level of 200 mg/dL or higher). We estimated four-level logistic regression models to derive the district-level prevalence estimates for 720 districts for each outcome for women and men allowing us to assess geographical outcome patterns.

We found considerable variation in rates of hypertension and diabetes across India's 720 districts among women and men between the ages of 15 and 49. The prevalence of hypertension and diabetes increased in hundreds of districts between 2016 and 2021. We also found a moderately negative relationships between the district-level prevalence of hypertension in 2016 and the change in district-level hypertension between 2016 and 2021 among both women and men. Similarly, there was a slight positive relationship between the district-level prevalence of diabetes among men in 2016 and the district-level change in diabetes between 2016 and 2021. Finally, we did not find strong evidence of a relationship between the district-level prevalence of hypertension and diabetes in either 2016 or 2021. This was the case for both women and men.

Our results highlight the need for regional investments in hypertension and diabetes detection, awareness, treatment and prevention programmes that are tailored to the various risk factors in these different regions.