District Level Variation in Hypertension Epidemiology in India and Influence of Social Determinants: National Family Health Survey-5

ABSTRACT BACKGROUND Enumeration of state and district-level variation in hypertension prevalence in India and to evaluate the influence of social determinants. METHODS We used data from the Fifth National Family Health Survey (NFHS-5) from 707 districts and 825,954 participants (women 724,115, men 101,839 men) on prevalence of hypertension defined according to standard criteria. Data on multiple social determinants were also obtained from NFHS-5 report. RESULTS Age-standardized prevalence of hypertension was 22.4% (women 21.3%, men 24.0%) with the highest prevalence in women and men, respectively, in Sikkim (34.5 and 41.6%) and Punjab (31.2 and 37.7%) and lowest in Rajasthan (15.4 and 17.9%) and Ladakh (15.7 and 17.4%). Prevalence was more in western and southern Indian districts. High prevalence of hypertension in the young (<30y) was observed in northeastern and northern states. District-level hypertension prevalence correlated negatively with multi-dimensional poverty index (R 2 women 0.299, men 0.245) and positively with female literacy (women 0.165, men 0.134). Among women, districts with the highest availability of electricity, clean water, sanitation, clean cooking fuels, healthcare service delivery and better nutrition were associated with more hypertension on univariate and multivariate analyses (p<0.05). CONCLUSIONS The study shows significant geographical variation in hypertension prevalence in India. Hypertension is more in men with high prevalence of premature hypertension. Better district-level development (less poverty, more literacy) and healthcare services are associated with greater hypertension prevalence in women. SUMMARY TABLE What is known about the topic Significant state-level variation in hypertension prevalence in India has been reported but district-level variation is not known. Social determinants are important in hypertension but not well studied, especially in women. What this study adds The study shows a significant district-level variation with greater hypertension prevalence in southern and western India. Hypertension among the young, <30 years, is more in less developed districts. Social determinants of hypertension in women are less poverty, more literacy and availability of healthcare services.