Socioeconomic Gradients and Distribution of Diabetes, Hypertension, and Obesity in India


Cardiovascular disease (CVD) risk factors such as type 2 diabetes, hypertension, and obesity are more prevalent among Indians with a high socioeconomic status.

In India, there has been a shift in the disease burden from maternal, neonatal, and communicable diseases to noncommunicable diseases. The Global Burden of Disease Study showed that the ischemic heart disease caused the highest number of healthy life years lost in 2016 in India. The burden of diabetes in India also rose by 170% from 1990 to 2016.

This study published in the Journal of the American Medical Association aimed to further understand the socioeconomic inequalities in the burden of the CVD risk factors type 2 diabetes, obesity, and hypertension in the Indian population.

Cross-sectional data of 757,958 individuals from the fourth Indian National Family Health Survey were used in the study. The survey collected data between January 2015 and December 2016. The data included biomarkers such as height, weight, blood pressure, and random blood glucose levels. The markers for socioeconomic status that were used were household wealth, education, and social caste.

The study results reported the following:

  • Obesity was found to be robustly linked with wealth. Indians who were in the highest socioeconomic status group were 8.76 times more likely to be obese than those in the lowest socioeconomic status group (95% CI, 7.70-9.95).
  • Indians in the highest socioeconomic status group were also twice more likely to have type 2 diabetes than those in the lowest socioeconomic status group (OR, 2.31; 95% CI, 1.88-2.85).
  • Hypertension also followed the same trend, with those in the highest socioeconomic status group being 1.58 times more likely to be hypertensive than those in the lowest socioeconomic status group (95% CI, 1.45-1.72).
  • Between 70% and 90% of the burden of all these CVD risk factors was among the higher socioeconomic status, and these results were similar across all the states.

India has undergone tremendous economic growth in the past few decades, which has been associated with a rising burden of CVDs and their risk factors. Hence, optimization of resource allocation, effective prevention and control strategies, continued efforts in improving social circumstances, and promoting positive health behaviors is warranted across all socioeconomic status groups in India to improve CVD outcomes in the population.