Table 1
Sample characteristics.1
| CHARACTERISTIC | TOTAL | FEMALE | MALE |
|---|---|---|---|
| N | 734794 | 628997 | 105797 |
| Diabetes, n (%) | 20300 (2·8) | 16186 (2·6) | 4114 (3·9) |
| Hypertension, n (%) | 130324 (17·7) | 108133 (17·2) | 22191 (21·0) |
| Age Group, n (%), years | |||
| 15–19 | 131180 (17·9) | 113255 (18·0) | 17925 (16·9) |
| 20–24 | 115584 (15·7) | 100109 (15·9) | 15475 (14·6) |
| 25–29 | 112842 (15·4) | 97751 (15·5) | 15091 (14·3) |
| 30–34 | 102252 (13·9) | 88465 (14·1) | 13787 (13·0) |
| 35–39 | 98826 (13·4) | 85618 (13·6) | 13208 (12·5) |
| 40–44 | 85079 (11·6) | 73670 (11·7) | 11409 (10·8) |
| 45–49 | 80817 (11·0) | 70129 (11·1) | 10688 (10·1) |
| 50–54 | 8214 (1·1) | – | 8214 (7·8) |
| Missing, n (%) | 0 (0·0) | 0 (0·0) | 0 (0·0) |
| Education, n (%) | |||
| < Primary school | 238788 (32·5) | 217540 (34·6) | 21248 (20·1) |
| Primary school completed | 49127 (6·7) | 42383 (6·7) | 6744 (6·4) |
| Secondary school unfinished | 295492 (40·2) | 245899 (39·1) | 49593 (46·9) |
| Secondary school or above | 151387 (20·6) | 123175 (19·6) | 28212 (26·7) |
| Missing, n (%) | 0 (0·0) | 0 (0·0) | 0 (0·0) |
| Household wealth quintile, n (%) | |||
| Q1 (Poorest) | 135426 (18·4) | 117136 (18·6) | 18290 (17·3) |
| Q2 | 145921 (19·9) | 125363 (19·9) | 20558 (19·4) |
| Q3 | 151445 (20·6) | 129777 (20·6) | 21668 (20·5) |
| Q4 | 149181 (20·3) | 126996 (20·2) | 22185 (21·0) |
| Q5 (Richest) | 152821 (20·8) | 129725 (20·6) | 23096 (21·8) |
| Missing, n (%) | 0 (0·0) | 0 (0·0) | 0 (0·0) |
| BMI, n (%) | |||
| <18·5 kg/m2 | 159996 (21·8) | 139780 (22·2) | 20216 (19·1) |
| 18·5–22·9 kg/m2 | 342101 (46·6) | 291976 (46·4) | 50125 (47·4) |
| 23·0–24·9 kg/m2 | 96420 (13·1) | 79872 (12·7) | 16548 (15·6) |
| 25·0–27·4 kg/m2 | 69622 (9·5) | 58506 (9·3) | 11116 (10·5) |
| 27·5–29·9 kg/m2 | 35432 (4·8) | 30735 (4·9) | 4697 (4·4) |
| ≥ 30·0 kg/m2 | 30189 (4·1) | 27316 (4·3) | 2873 (2·7) |
| Missing, n (%) | 1034 (0·1) | 812 (0·1) | 222 (0·2) |
| Tobacco consumption, n (%) | |||
| Current smoker | 42487 (5·8) | 13147 (2·1) | 29340 (27·7) |
| Missing, n (%) | 0 (0·0) | 0 (0·0) | 0 (0·0) |
| Currently married, n (%) | 506850 (69·0) | 440207 (70·0) | 66643 (63·0) |
| Missing, n (%) | 0 (0·0) | 0 (0·0) | 0 (0·0) |
| Urban area, n (%) | 217024 (29·5) | 183852 (29·2) | 33172 (31·4) |
| Missing, n (%) | 0 (0·0) | 0 (0·0) | 0 (0·0) |
[i] Abbreviations: n = number; Q = quintile.
1 The numbers and percentages in this table were not weighted using sampling weights.
Figure 1
The cascade of care for co-morbid diabetes and hypertension in India, by sex and rural/urban location.
1 Each set of bars shows the percentage of those with co-morbid diabetes and hypertension who were aware of having both conditions, reported to be on treatment for both conditions, and achieved control of both conditions.
2 The p-values compare the proportion who reached each cascade step between men and women, and urban and rural areas. These were calculated using a Pearson’s Chi-Squared test with Rao and Scott adjustment.
3 The numbers plotted in this figure are shown in eTable2–3.
Figure 2
The cascade of care for co-morbid diabetes and hypertension in India by state.1,2,3
1 Union Territories are included in the map but some are not visible due to their small size.
2 Point estimates and 95% confidence intervals for all states and Union Territories can be found in eTable7–9.
3 AN indicates Andaman and Nicobar Islands; AP, Andhra Pradesh; AR, Arunachal Pradesh; AS, Assam; BR, Bihar; CG, Chhattisgarh; CH, Chandigarh; DD, Daman and Diu; DL, Delhi; DN, Dadra and Nagar Haveli; GA, Goa; GJ, Gujarat; HR, Haryana; HP, Himachal Pradesh; JH, Jharkhand; JK, Jammu and Kashmir; KA, Karnataka; KL, Kerala; LD, Lakshadweep; MP, Madhya Pradesh; MH, Maharashtra; MN, Manipur; ML, Meghalaya; MZ, Mizoram; NL, Nagaland; OD, Odisha (Orissa); PB, Punjab; PY, Puducherry; RJ, Rajasthan; SK, Sikkim; TN, Tamil Nadu; TS, Telangana State; TR, Tripura; UP, Uttar Pradesh; UK, Uttarakhand (Uttaranchal); WB, West Bengal.
Table 2
Individual-level predictors of reaching each cascade step among those with co-morbid diabetes and hypertension.1,2
| AWARE | TREATED | CONTROLLED | ||||||
|---|---|---|---|---|---|---|---|---|
| RR (95% CI) | P | RR (95% CI) | P | RR (95% CI) | P | |||
| Female | 1·71 (1·52–1·92) | <0·001 | 1·85 (1·54–2·21) | <0·001 | 2·27 (1·55–3·32) | <0·001 | ||
| Age group, y | ||||||||
| 15–19 | 1·00 (Reference) | 1·00 (Reference) | 1·00 (Reference) | |||||
| 20–24 | 1·15 (0·66–1·99) | 0·631 | 0·50 (0·16–1·57) | 0·235 | 0·40 (0·11–1·39) | 0·148 | ||
| 25–29 | 1·08 (0·63–1·85) | 0·778 | 0·76 (0·29–1·94) | 0·56 | 0·38 (0·13–1·16) | 0·088 | ||
| 30–34 | 0·95 (0·56–1·61) | 0·843 | 0·62 (0·25–1·56) | 0·314 | 0·14 (0·05–0·45) | 0·001 | ||
| 35–40 | 1·08 (0·64–1·82) | 0·778 | 0·94 (0·38–2·30) | 0·894 | 0·24 (0·08–0·69) | 0·008 | ||
| 40–44 | 1·14 (0·68–1·92) | 0·617 | 1·23 (0·51–2·98) | 0·649 | 0·28 (0·10–0·77) | 0·014 | ||
| 45–49 | 1·38 (0·82–2·31) | 0·224 | 1·70 (0·70–4·12) | 0·239 | 0·37 (0·13–1·03) | 0·058 | ||
| 50–54 | 1·71 (0·99–2·95) | 0·055 | 1·99 (0·79–5·00) | 0·145 | 0·42 (0·13–1·36) | 0·148 | ||
| Household wealth quintile | ||||||||
| Q1 (Poorest) | 1·00 (Reference) | 1·00 (Reference) | 1·00 (Reference) | |||||
| Q2 | 1·13 (0·97–1·31) | 0·115 | 1·39 (1·07–1·82) | 0·015 | 0·94 (0·58–1·52) | 0·804 | ||
| Q3 | 1·22 (1·05–1·42) | 0·008 | 1·43 (1·10–1·85) | 0·008 | 0·84 (0·53–1·35) | 0·482 | ||
| Q4 | 1·35 (1·17–1·56) | <0·001 | 1·69 (1·30–2·19) | <0·001 | 1·12 (0·70–1·79) | 0·628 | ||
| Q5 (Richest) | 1·43 (1·23–1·67) | <0·001 | 2·01 (1·54–2·63) | <0·001 | 1·23 (0·75–2·03) | 0·414 | ||
| Education | ||||||||
| < Primary school | 1·00 (Reference) | 1·00 (Reference) | 1·00 (Reference) | |||||
| Primary school finished | 1·09 (0·96–1·23) | 0·175 | 1·12 (0·92–1·36) | 0·248 | 1·17 (0·75–1·81) | 0·482 | ||
| Secondary school unfinished | 1·13 (1·04–1·23) | 0·006 | 1·05 (0·92–1·21) | 0·441 | 0·92 (0·67–1·27) | 0·625 | ||
| Secondary school or above | 1·19 (1·06–1·32) | 0·002 | 1·13 (0·95–1·34) | 0·159 | 1·25 (0·84–1·88) | 0·276 | ||
| Currently married | 1·08 (0·96–1·20) | 0·184 | 1·13 (0·95–1·35) | 0·159 | 1·40 (0·94–2·08) | 0·094 | ||
| Urban | 1·25 (1·15–1·35) | <0·001 | 1·63 (1·43–1·86) | <0·001 | 1·68 (1·25–2·26) | 0·001 | ||
[i] Abbreviations: RR = Risk Ratio; CI = Confidence Interval; Q = Quintile.
1 These regressions were run among those with co-morbid diabetes and hypertension, whereby ‘aware,’ ‘treated,’ and ‘controlled’ refers to being aware, treated, and controlled for both conditions. We used the same sample for all three regressions. That is, we did not restrict the sample for ‘treated’ to those who were aware of their co-morbid diabetes and hypertension. Neither did we restrict the sample for ‘controlled’ to those who were treated for their co-morbid diabetes and hypertension.
2 The regressions included all variables listed in the table and a binary indicator for each of 640 districts (district-level fixed effects) as independent variables. All standard errors were adjusted for clustering at the level of the primary sampling unit.
Figure 3
Care cascades in relation to the number of CVD risk factors as well as asthma and anemia.1,2,3,4
1 CVD risk factors were diabetes, hypertension, current smoking, and obesity.
2 The p-values were for a one-way analysis of variance (with a Wald Chi-Squared test statistic) testing the null hypothesis that all bars in a set (i.e., separately for aware, treated, and controlled) were of the same height.
3 The numbers plotted in this figure are shown in eTable14–16.
4 Estimates separately for those with asthma but without anemia, with anemia but without asthma, and with both asthma and anemia are shown in eFigure3.
Table 3
Associations between having multiple cardiovascular disease risk factors (as well as asthma and anemia) and the probability of reaching each cascade step.1,2
| BP EVER MEASURED | AWARE OF HYPERTENSION | HYPERTENSION TREATED | HYPERTENSION CONTROLLED | |||||
|---|---|---|---|---|---|---|---|---|
| Has hypertension and … | RR (95% CI) | P | RR (95% CI) | P | RR (95% CI) | P | RR (95% CI) | P |
| diabetes | 1·04 (1·04–1·05) | <0·001 | 1·12 (1·09–1·14) | <0·001 | 1·52 (1·47–1·58) | <0·001 | 1·33 (1·25–1·41) | <0·001 |
| obesity | 1·02 (1·01–1·03) | <0·001 | 1·01 (1·00–1·03) | 0·063 | 1·30 (1·26–1·34) | <0·001 | 1·08 (1·04–1·13) | <0·001 |
| smokes | 0·98 (0·97–0·99) | <0·001 | 0·98 (0·96–1·00) | 0·024 | 0·96 (0·92–1·00) | 0·059 | 0·96 (0·91–1·02) | 0·188 |
| asthma | 1·05 (1·04–1·07) | <0·001 | 1·14 (1·11–1·18) | <0·001 | 1·19 (1·12–1·27) | <0·001 | 1·15 (1·04–1·27) | 0·004 |
| anemia | 1·02 (1·01–1·02) | <0·001 | 1·09 (1·08–1·10) | <0·001 | 1·12 (1·08–1·15) | <0·001 | 1·23 (1·18–1·28) | <0·001 |
| AWARE OF DIABETES | DIABETES TREATED | DIABETES CONTROLLED | ||||||
| Has diabetes and … | – | – | RR (95% CI) | P | RR (95% CI) | P | RR (95% CI) | P |
| hypertension | – | – | 0·96 (0·93–0·98) | 0·002 | 1·00 (0·97–1·04) | 0·817 | 0·83 (0·79–0·88) | <0·001 |
| obesity | – | – | 0·92 (0·89–0·94) | <0·001 | 0·94 (0·91–0·97) | 0·001 | 0·82 (0·79–0·88) | <0·001 |
| smokes | – | – | 1·01 (0·97–1·05) | 0·753 | 0·99 (0·94–1·04) | 0·613 | 1·02 (0·95–1·10) | 0·621 |
| asthma | – | – | 1·58 (1·53–1·63) | <0·001 | 1·58 (1·49–1·68) | <0·001 | 1·89 (1·76–2·03) | <0·001 |
| anemia | – | – | 1·02 (0·99–1·05) | 0·245 | 1·01 (0·97–1·05) | 0·715 | 0·99 (0·93–1·04) | 0·642 |
| AWARE OF BOTH | BOTH TREATED | BOTH CONTROLLED | ||||||
| Has diabetes, hypertension, and … | – | – | RR (95% CI) | P | RR (95% CI) | P | RR (95% CI) | P |
| obesity | – | – | 1·03 (0·96–1·10) | 0·393 | 1·31 (1·18–1·46) | <0·001 | 1·16 (0·91–1·48) | 0·225 |
| smokes | – | – | 0·99 (0·88–1·09) | 0·702 | 0·91 (0·77–1·08) | 0·291 | 0·95 (0·64–1·39) | 0·774 |
| asthma | – | – | 1·63 (1·47–1·81) | <0·001 | 1·37 (1·14–1·66) | 0·001 | 1·93 (1·34–2·78) | <0·001 |
| anemia | – | – | 1·15 (1·07–1·25) | <0·001 | 1·25 (1·10–1·42) | 0·001 | 1·29 (0·98–1·70) | 0·070 |
[i] Abbreviations: RR = Risk Ratio; CI = Confidence Interval; BP = Blood pressure.
1 These analyses depict – among each of the three samples (those with hypertension, those with diabetes, and those with co-morbid diabetes and hypertension) – the relative risk of reaching each care cascade step that is associated with having each additional CVD risk factor as well as asthma and anemia.
2 The regressions were run separately for each care cascade step and – in addition to the CVD risk factor, anemia or asthma shown in the table – contained age group, household wealth quintile, education, currently married, urban vs. rural location, sex, and a binary indicator for each of 640 districts (district-level fixed effects) as independent variables. Standard errors were adjusted for clustering at the level of the primary sampling unit.