Small Area Geographic Estimates of Cardiovascular Disease Risk Factors in India

Publication information:

Ko S, Oh H, Subramanian SV.
Small Area Geographic Estimates of Cardiovascular Disease Risk Factors in India. JAMA Network Open. 2023;6(10):e2337171.

Abstract

Objectives
With an aging population, India is facing a growing burden of cardiovascular diseases (CVDs). Existing programs on CVD risk factors are mostly based on state and district data, which overlook health disparities within macro units. This study quantifies and geovisualises the extent of small area variability within districts in CVD risk factors (hypertension, diabetes, and obesity) in India.
Design, Settings, and Participants
This cross-sectional study analyzed nationally representative data from the National Family Health Survey 2019-2021, encompassing individuals aged 15 years or older, for hypertension (n = 1 715 895), diabetes (n = 1 807 566), and obesity (n = 776 023). Data analyses were conducted from July 1, 2022, through August 1, 2023.

Results
The final analytic sample consisted of 1 71,5 895 individuals analyzed for hypertension, 1 80,7 566 for diabetes, and 776 ,023 for obesity.  Overall, 21.2% of female and 24.1% of male participants had hypertension, 5.0% of female and 5.4% of men had diabetes, and 6.3% of female and 4.0% of male participants had obesity.

For female participants, small areas (32.0% for diabetes, 34.5% for obesity, and 56.2% for hypertension) and states (30.0% for hypertension, 46.6% for obesity, and 52.8% for diabetes) accounted for the majority of the total geographic variability, while districts accounted for the least (13.8% for hypertension, 15.2% for diabetes, and 18.9% for obesity).

There were moderate to strong positive correlations between district-wide mean and within-district variability (r = 0.66 for hypertension, 0.94 for obesity, and 0.96 for diabetes). For hypertension, a significant discordance between district-wide mean and within-district small area variability was found. Results were largely similar for male participants across all categories.

Conclusion and Relevance
This cross-sectional study found a substantial small area variability, suggesting the necessity of precise policy attention specifically to small areas in program formulation and intervention to prevent and manage CVD risk factors. Targeted action on policy-priority districts with high prevalence and substantial inequality is required for accelerating India’s efforts to reduce the burden of noncommunicable diseases.
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