Hypertension and diabetes are growing challenges in India. Until recently, there were no sufficiently large data sources to study these two risk factors at local levels – where many health policy decisions are made. An international team of researchers with the participation of Prof. Dr. Nikkil Sudharsanan, Head of the Assistant Professorship of Behavioral Science for Disease Prevention and Health Care, took advantage of a new large data source to study diabetes and hypertension care in India from the national down to the district level.
The studies use data from the National Family Health Survey (NFHS). The NFHS is a large-scale, multi-stage survey conducted in a representative sample of households across India. Since its first implementation in 1992/93, a total of five rounds of the survey have been conducted, most recently in 2019-2021, covering around 1.9 million adults from 28 states, eight union territories and 707 districts. The results provide statewide and nationwide information on fertility, infant and child mortality, family planning, maternal and child health, reproductive health, nutrition, anemia, and utilization and quality of health and family planning services.
„A major advantage of the survey is that it’s one of the largest health surveys ever done globally,” explains Prof. Sudharsanan. “The idea was to use this unprecedently large and detailed survey to provide the most up-to-date information about the state of hypertension and diabetes in the country. Both of these conditions are really important in India because cardiovascular disease is leading cause of death. Many people have hypertension and a very rapidly growing proportion have diabetes. Our goal was to provide a snapshot of the most recent picture of what’s going on in the country in terms of hypertension and diabetes.”
The findings on adult diabetes care in India were published in the journal "JAMA Internal Medicine" under the title "National Estimates of the Adult Diabetes Care Continuum in India, 2019-2021". The journal has an impact factor of 44.409. In addition, an article on "Hypertension Diagnosis, Treatment, and Control in India", which deals with hypertension care, appeared in the journal "JAMA Network Open" (impact factor: 13.8).
“For both diabetes and hypertension there is a massive diagnosis gap that’s worse in rural areas,” says the head of the Assistant Professorship of Behavioral Science for Disease Prevention and Health Care. “But it’s not the case that once diagnosed, everyone takes treatment and everyone has controlled risk factors. There are losses in each of those intermediate continuum steps as well. So even among diagnosed people there’s a huge loss in terms of the proportion that take treatment.”
Of the total sample of the NFHS, around 1.65 million participants had their blood sugar measured. Diabetes was diagnosed in 6.5 percent of the participants, only three quarters of whom had also received a diagnosis. Of those diagnosed, only around 60 percent stated that they were taking medication, while around two thirds had their condition checked regularly. Diagnosis and subsequent treatment were more common in urban areas, older age groups and wealthier households.
The hypertension care analysis sample included data from around 1.7 million participants who had a valid blood pressure measurement and were not pregnant at the time of the study. Of these, more than one in four people (28.5%) had high blood pressure. Just over a third of these (36.9%) were actually diagnosed with high blood pressure. Of those who were diagnosed, 44.7% said they were taking medication. However, of those treated, only just over half (52.5%) had their high blood pressure under control. With regard to the individual districts, it was found that there were significant differences between diagnosis, treatment and control. For example, almost two in three people in all states and in both urban and rural areas did not receive a diagnosis. Treatment rates were higher in southern and western India, while they were lower in other parts of the country. Overall, more than 90 percent of adults with hypertension in India were either undiagnosed, untreated or had uncontrolled hypertension despite treatment.
Based on the findings, the research team recommends better monitoring of diabetes and hypertension at the district level, as this can help government health administrations to better prioritize specific interventions and monitor the achievement of targets. Additionally, targeted, decentralized solutions should be developed to improve diabetes and hypertension care in India.
“We’ve used our results in discussions with policy makers,” says Prof. Sudharsanan. “It was very helpful to show them the figures for their state and we definitely noticed that they were more receptive to working with us when we could provide a concrete local picture.”
Prof. Dr. Nikkil Sudharsanan
Rudolf Mößbauer Assistant Professorship of Behavioral Science for Disease Prevention and Health Care
phone: 089 289 24990
Text: Romy Schwaiger
Photos: "JAMA Network"/private