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India has high rates of diabetes and hypertension

Overall, the prevalence of diabetes was 6.1% among women and 6.5% among men; for hypertension, 20.0% among women and 24.5% among men

Rates of diabetes and hypertension are high among middle-aged and elderly people across all geographic measures and sociodemographic groups in India, according to the first nationally representative study of those conditions in the country. The international study, led by researchers at Harvard TH Chan School of Public Health, also found unexpectedly high rates of hypertension among young adults.

"India has a window of opportunity to invest in its health system to effectively tackle hypertension and diabetes - both major killers,” said Dr Rifat Atun, co-senior author and professor of global health systems in the Department of Global Health and Population. “The potential for harnessing new technologies to reach the millions affected by these diseases and reverse the course of these epidemics is real. However, because the epidemics are worsening rapidly, now is the time for urgent action.”

India, home to more than a sixth of the world's population, is in the midst of a rapid epidemiological transition. Rates of noncommunicable diseases have risen in recent decades and are likely to continue as India's population ages and urbanizes. Meanwhile, many areas of India still face substantial burdens of infectious diseases and poor maternal and child health.

The researchers wanted to find out how the prevalence of diabetes and hypertension in India varied by state, rural vs urban location, and by sociodemographic characteristics such as education and household wealth. They used health data collected from 1,320,555 adults across India between 2012 and 2014, which included plasma glucose and blood pressure measurements.

The paper, ‘Diabetes and Hypertension in India: A Nationally Representative Study of 1.3 Million Adults’, published in in JAMA Internal Medicine, showed that diabetes and hypertension were prevalent across all geographies and sociodemographic groups. Of the 1,320,555 adults, 701,408 (53.1%) were women and they investigators reported that the crude prevalence of diabetes and hypertension was 7.5% (95% CI, 7.3%-7.7%) and 25.3% (95% CI, 25.0%-25.6%), respectively. Notably, hypertension was common even among younger age groups (eg, 18-25 years: 12.1%; 95% CI, 11.8%-12.5%).  Overall, prevalence of diabetes was 6.1% among women and 6.5% among men; for hypertension, 20.0% among women and 24.5% among men

Being in the richest household wealth quintile compared with being in the poorest quintile was associated with only a modestly higher probability of diabetes (rural: 2.81 percentage points; 95% CI, 2.53-3.08 and urban: 3.47 percentage points; 95% CI, 3.03-3.91) and hypertension (rural: 4.15 percentage points; 95% CI, 3.68-4.61 and urban: 3.01 percentage points; 95% CI, 2.38-3.65). The differences in the probability of both conditions by educational category were generally small (≤2 percentage points). Among states, the crude prevalence of diabetes and hypertension varied from 3.2% (95% CI, 2.7%-3.7%) to 19.9% (95% CI, 17.6%-22.3%), and 18.0% (95% CI, 16.6%-19.5%) to 41.6% (95% CI, 37.8%-45.5%), respectively.

"Diagnosis of hypertension and diabetes is straightforward but mostly untapped due lack of awareness and regular medical checkups," added Dr Ashish Awasthi, co-author and faculty at the Indian Institute of Public Health, Gandhinagar, India. "India needs to focus on these two silent killers as well as other non-communicable diseases to reduce the burden of preventable premature morbidity and mortality. If unchecked, we will see a lot more victims of these two diseases in next two decades."

The study was conducted by researchers from Harvard TH Chan School of Public Health and the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA, the University of Goettingen, Göttingen and the Heidelberg University, Heidelberg, Germany, the University of Witwatersrand, Johannesburg and the Africa Health Research Institute, Mtubatuba, South Africa, King's College London, London, UK, and the Indian Institute of Public Health, Gandhinagar and the Public Health Foundation of India, Delhi, India.

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