Figure 1
Flowchart of women (age 15–49 years) participating in the India National and Family Health Survey, NFHS-5 2019–2021.
Data on 644,191 women were analyzed after the exclusion of pregnant women, women with heart disease at the time of survey, and women missing data on all measured cardiometabolic indicators: systolic and diastolic blood pressure, blood glucose, body mass index, and waist circumference.
Table 1
Sociodemographic and reproductive characteristics of Indian women, NFHS-5 2019–2021 (N = 644,191).
| CHARACTERISTIC | UNWEIGHTED SAMPLE SIZE | WEIGHTED PREVALENCE (%) OR MEDIAN | 95% CI OR IQR |
|---|---|---|---|
| Sociodemographic | |||
| Age (years), median | 644,191 | 29.4 | 21.5, 38.4 |
| Education, % | |||
| None or lower than secondary | 226,042 | 34.5 | 34.3, 34.8 |
| Secondary | 329,116 | 50.3 | 50.1, 50.5 |
| Higher than secondary | 89,033 | 15.2 | 15.0, 15.4 |
| Marital status, % | |||
| Never married | 166,699 | 24.4 | 24.2, 24.5 |
| Currently married and together | 449,724 | 71.3 | 71.1, 71.4 |
| Ever married, but currently aparta | 27,768 | 4.4 | 4.3, 4.4 |
| Place of residence, % | |||
| Urban | 157,959 | 31.9 | 31.5, 32.2 |
| Rural | 486,232 | 68.1 | 67.8, 68.5 |
| Reproductive | |||
| Age at menarche (15–24 years subsample, n = 210,743), median | 208,848 | 12.9 | 12.2, 13.7 |
| Age at menarche (15–24 years subsample, n = 210,743), % | |||
| <13 years | 40,753 | 17.3 | 16.9, 17.6 |
| ≥13 years | 168,095 | 82.7 | 82.4, 83.1 |
| Age at first birth (years), median | 443,255 | 19.6 | 17.5, 22.1 |
| Age at first birth, % | |||
| <20 years | 181,058 | 43 | 42.8, 43.3 |
| ≥20 years | 262,197 | 57 | 56.7, 57.2 |
| Menstrual status, % | |||
| Currently menstruating | 549,309 | 84.9 | 84.7, 85.0 |
| Lactational amenorrhea or birth within 6 months | 19,325 | 2.8 | 2.8, 2.9 |
| Absence of period due to unspecified reasons | 31,809 | 5.2 | 5.1, 5.3 |
| Natural/surgical menopause | 41,853 | 6.8 | 6.7, 6.9 |
| Never menstruated | 1,895 | 0.3 | 0.3, 0.3 |
| Parity, median | 644,191 | 1.2 | 0.0, 2.2 |
| Parity, % | |||
| Nulliparous | 200,936 | 30.0 | 29.9, 30.2 |
| 1–2 births | 251,808 | 41.2 | 41.0, 41.4 |
| ≥3 births | 191,447 | 28.7 | 28.6, 28.9 |
| Time since last birth, % | |||
| 0–7 years | 222,497 | 49.1 | 48.8, 49.3 |
| ≥8 years | 220,758 | 50.9 | 50.7, 51.2 |
| Experience of pregnancy loss,b % | 71,969 | 12.2 | 12.1, 12.3 |
| Current use of traditional or modern contraceptivesc | 326,885 | 52.5 | 52.3, 52.7 |
[i] aEither widowed, divorced, separated, or deserted.
bPregnancy that resulted in a miscarriage, abortion, or stillbirth, i.e., did not result in a live birth.
cTraditional contraceptive methods included the folkloric method, withdrawal, and periodic abstinence. Modern contraceptive methods included pills, IUDs, injections, diaphragms, condoms, sterilization, emergency contraception, standard days method, lactational amenorrhea, and foam and jelly.
Figure 2
Cardiometabolic characteristics of Indian women by latent cluster, NFHS-5 2019–2021 (N = 644,191).
Distributions of cardiometabolic measures [systolic blood pressure (A), diastolic blood pressure (B), random blood glucose (C), body mass index (D), and waist circumference (E)] and response probabilities for antihypertensive (F) and anti-hyperglycemic (G) pharmacotherapy use across cardiometabolic clusters.
Table 2
Characteristics of cardiometabolic clusters of Indian women, NFHS-5 2019–2021 (N = 644,191).
| CARDIOMETABOLIC CHARACTERISTIC | CLUSTER | |||||
|---|---|---|---|---|---|---|
| CLUSTER 1: NORMAL | CLUSTER 2: HIGH-NORMAL | CLUSTER 3: ISOLATED-OVERWEIGHT | CLUSTER 4: HYPERTENSION-OVERWEIGHT | CLUSTER 5: GLUCOSE DYSREGULATION-OVERWEIGHT | P-VALUEb | |
| Prevalence of class, n (%) | 229,892 (35.7%) | 294,325 (45.7%) | 74,036 (11.5%) | 40,344 (6.3%) | 5,594 (0.9%) | |
| Predicted marginal meana (95% CI) | ||||||
| Systolic blood pressure (mmHg) | 104.5 (104.3, 104.7) | 120.3 (120.1, 120.5) | 115.5 (115.3, 115.7) | 142.3 (142.1, 142.5) | 126.4 (125.8, 127.0) | <.0001 |
| Diastolic blood pressure (mmHg) | 69.8 (69.7, 69.9) | 80.9 (80.8, 81.1) | 79.5 (79.4, 79.7) | 93.9 (93.7, 94.0) | 84.8 (84.4, 85.1) | <.0001 |
| Random blood glucose (mg/dl) | 107.9 (107.4, 108.3) | 108.6 (108.1, 109.0) | 115.4 (114.9, 115.9) | 115.5 (114.9, 116.0) | 309.3 (306.7, 311.9) | <.0001 |
| Body mass index (kg/m2) | 20.2 (20.1, 20.2) | 21.6 (21.5, 21.6) | 29.0 (29.0, 29.1) | 24.9 (24.8, 25.0) | 26.0 (25.8, 26.1) | <.0001 |
| Waist circumference (cm) | 72.1 (71.9, 72.3) | 76.1 (75.9, 76.3) | 94.2 (93.9, 94.4) | 84.7 (84.4, 85.0) | 88.3 (87.8, 88.8) | <.0001 |
| Average predicted response probabilitya, (95% CI) | ||||||
| Use of antihypertensive pharmacotherapy | 1.4 (1.2, 1.6) | 1.4 (1.2, 1.5) | 3.5 (3.1, 4.0) | 9.0 (8.1, 10.1) | 9.5 (8.3, 10.9) | <.0001 |
| Use of anti-hyperglycemic pharmacotherapy | 0.5 (0.4, 0.7) | 0.5 (0.4, 0.6) | 1.6 (1.3, 2.0) | 2.1 (1.7, 2.6) | 28.0 (23.6, 32.8) | <.0001 |
[i] aModels are adjusted for age, education, wealth, marital status, urbanicity, religion, and health behaviors (tobacco and alcohol use and fruit and vegetable consumption).
bT-test p-values for predicted marginal means and Rao-Scott adjusted p-values for predicted probabilities.
Table 3
Multinomial logistic regression analysis of reproductive factors and cardiometabolic risk clusters among Indian women, NFHS-5 2019–2021 (N = 644,191).
| CHARACTERISTIC | UNADJUSTED PREVALENCE ODDS RATIO (95% CI) [REFERENCE= NORMAL AND HIGH-NORMAL CLUSTERS] | aADJUSTED PREVALENCE ODDS RATIO (95% CI) [REFERENCE= NORMAL AND HIGH-NORMAL CLUSTERS] | |||||
|---|---|---|---|---|---|---|---|
| CLUSTER 3: ISOLATED-OVER-WEIGHT | CLUSTER 4: HYPER-TENSION-OVER-WEIGHT | CLUSTER 5: GLUCOSE DYSRE-GULATION-OVERW-EIGHT | CLUSTER 3: ISOLATED-OVER-WEIGHT | CLUSTER 4: HYPER-TENSION-OVER-WEIGHT | CLUSTER 5: GLUCOSE DYSRE-GULATION-OVERW-EIGHT | ||
| Reproductive milestones | |||||||
| Age at menarche (ref =≥ 13 years)b | |||||||
| <13 years | 1.55 (1.43, 1.67) | 1.18 (0.99, 1.39) | 1.51 (0.92, 2.49) | 1.62 (1.49, 1.75) | 1.21 (1.02, 1.43) | 1.54 (0.94, 2.54) | |
| Age at first birth (ref = ≥ 20 years) | |||||||
| <20 years | 0.85 (0.83, 0.88) | 1.10 (1.06, 1.13) | 1.24 (1.15, 1.34) | 1.15 (1.12, 1.18) | 1.23 (1.19, 1.28) | 1.53 (1.41, 1.66) | |
| Menstrual status (ref = menstruating) | |||||||
| Absence of period due to unspecified reasons | 1.46 (1.39, 1.53) | 2.48 (2.35, 2.61) | 3.01 (2.67, 3.40) | 1.09 (1.03, 1.15) | 1.10 (1.04, 1.16) | 1.32 (1.16, 1.50) | |
| Natural/surgical menopause | 1.93 (1.85, 2.00) | 4.23 (4.01, 4.40) | 5.15 (4.70, 5.64) | 1.04 (1.00, 1.09) | 1.13 (1.08, 1.18) | 1.35 (1.21, 1.49) | |
| Reproductive history | |||||||
| Parity (ref = nulliparous) | |||||||
| 1–2 births | 3.96 (3.82, 4.11) | 5.14 (4.85, 5.44) | 5.76 (5.04, 6.58) | 1.39 (1.31, 1.48) | 1.01 (0.92, 1.10) | 0.96 (0.80, 1.16) | |
| ≥ 3 births | 3.31 (3.12, 3.44) | 7.33 (6.93, 7.74) | 7.25 (6.36, 8.27) | 1.31 (1.23, 1.40) | 0.93 (0.85, 1.02) | 0.87 (0.72, 1.05) | |
| Time since last birth (ref = <8 years) | |||||||
| ≥8 years | 1.76 (1.72, 1.80) | 4.60 (4.44, 4.77) | 5.63 (5.10, 6.20) | 0.99 (0.95, 1.03) | 1.25 (1.18, 1.31) | 1.21 (1.07, 1.37) | |
| Experience of pregnancy loss (ref = no)c | |||||||
| Yes | 1.82 (1.76, 1.87) | 1.66 (1.59, 1.73) | 2.00 (1.82, 2.20) | 1.30 (1.26, 1.34) | 1.21 (1.16, 1.26) | 1.42 (1.29, 1.57) | |
| Current contraceptive use (ref = none) | |||||||
| Traditional or modernd | 1.99 (1.94, 2.04) | 2.23 (2.16, 2.30) | 2.16 (2.00, 2.33) | 0.92 (0.89, 0.95) | 0.93 (0.90, 0.97) | 0.88 (0.81, 0.97) | |
[i] Statistically significant results are in bold.
aModels are adjusted for other reproductive factors (parity, current breastfeeding status, experience of pregnancy loss, and menopausal/hysterectomy status), sociodemographic factors (age, education, wealth index, marital status, urbanicity, and religion), and health behaviors (alcohol and tobacco use and fruit and vegetable consumption).
bAnalysis restricted to women aged 15–24 years, n = 210,743.
cPregnancy that resulted in a miscarriage, abortion, or stillbirth, i.e., did not result in a live birth.
dTraditional contraceptive methods included the folkloric method, withdrawal, and periodic abstinence. Modern contraceptive methods included pills, IUDs, injections, diaphragms, condoms, sterilization, emergency contraception, standard days method, lactational amenorrhea, and foam and jelly.