High Rates of Diabetes, Hypertension in India, Even in the Young

Pam Harrison

January 30, 2018

High prevalence rates of diabetes, and especially hypertension, are being reported across India, where even among young adults, hypertension is common, according to the first nationally representative sample of 1.3 million adults.

As India is home to more than one sixth of the world's population, "understanding how diabetes and hypertension prevalence varies within a country as large as India is essential for targeting of prevention, screening, and treatment services," Pascal Geldsetzer, MBChB, Harvard TH Chan School of Public Health, Boston, Massachusetts, and colleagues write in their article, published online January 29 in JAMA Internal Medicine.

"An important finding of our study...is the unexpectedly high prevalence of hypertension among young adults in India, which — if ineffectively treated — will likely result in longer lifetime exposure to this risk factor and thus higher cardiovascular disease rates in the future," they stress.

More Than 1 in 10 Young Adults Have Hypertension

Researchers used the District-Level Household Survey-4 and the second update of the Annual Health Survey, both of which were carried out between 2012 and 2014. For each, blood glucose and blood pressure were measured in adult men and women.

"Diabetes was defined as having a high plasma glucose reading (≥ 126 mg/dL [7.0 mmol/L] if patients reported having fasted or ≥ 200 mg/dL [11.1 mmol/L] if patients reported not fasting," study authors explain.

Hypertension was defined as a systolic blood pressure ≥ 140 mm Hg or diastolic blood pressure ≥ 90 mm Hg.

Among women, the crude prevalence rate of diabetes was 7.3%, and among men was 7.8%, the investigators report.

Age-standardized rates of diabetes in India were slightly lower, at 6.1% for women and 6.5% for men.

These rates are similar to age-standardized diabetes rates reported in US women, at 6.4%, the authors point out.

Age-standardized diabetes rates among US men are reportedly higher at 8.1%.

For hypertension, the crude prevalence rate in India was 23.6% among women vs 27.4% among men.

Age-standardized prevalence rates of hypertension in India were again slightly lower at 20% for women and 24.5% for men.

By way of comparison, age-standardized prevalence rates of hypertension in the United States are considerably lower for women and men at 10.8% and 15.5%, respectively.

Researchers also found that hypertension was common even among young Indian adults at a prevalence rate of 12.1% for individuals 18–25 years of age.

"In fact, in younger age groups, our hypertension prevalence estimates for India were higher than those for Central and Eastern Europe," the study authors point out, regions that have been identified as having the highest hypertension rates in the world by international health authorities, they add.

Hypertension prevalence rates in India also ranged from a low of 9.2% among women aged 18–25 years to 48.6% among women older than aged 65 years.

Socioeconomic Status, Urban Vs Rural, Make Little Difference

In contrast with Western countries, the prevalence of diabetes and hypertension varied little between different socioeconomic groups.

Prevalence rates of diabetes and hypertension were "modestly higher" among individuals in the richest quintile compared with those in the poorest quintile. They also didn't vary much between those living in urban vs rural settings.

For example, those in the richest household wealth quintile were only 3.47 percentage points more likely to have diabetes if they were living in an urban area and 2.81 percentage points more likely if living in a rural area compared with the poorest household wealth quintile.

The same was true for high blood pressure. Those in the richest quintile were 3.01 percentage points more likely to have hypertension if they were living in an urban area and 4.15 percentage points more likely if they were living in a rural area than those in the poorest quintile.

"The differences in the probability of both conditions by educational attainment were generally small (≤ 2 percentage points)," researchers add.

But geographic region within India did play a role. The prevalence of diabetes varied from a low of 3.2% to a high of 19.9%, depending on the region surveyed.

For hypertension, rates varied from a low of 18% to a high of 41.6%, again depending on the region surveyed.

"Major investments in targeted diabetes and hypertension prevention, detection, and treatment programs are needed across the country if India is to avert catastrophic health, social, and economic consequences of these conditions and their sequelae," study authors conclude.

The authors have reported no relevant financial relationships.

JAMA Intern Med. Published online January 29, 2018. Abstract

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