Diabetes is a growing epidemic and a major threat to most of the households in India. Yet, there is little evidence on the extent of awareness, treatment, and control (ATC) among adults in the country. In this study, we estimate the prevalence and ATC of diabetes among adults across various sociodemographic groups and states of India. We used data on 2,078,315 individuals aged 15 years and over from the recent fifth round, the most recent one, of the National Family Health Survey (NFHS-5), 2019–2021, that was carried out across all the states of India. Diabetic individuals were identified as those who had random blood glucose above 140 mg/dL or were taking diabetes medication or has doctor-diagnosed diabetes. Diabetic individuals who reported diagnosis were labelled as aware, those who reported taking medication for controlling blood glucose levels were labelled as treated and those whose blood glucose levels were < 140 mg/dL were labelled as controlled. The estimates of prevalence of diabetes, and ATC were age-sex adjusted and disaggregated by household wealth quintile, education, age, sex, urban–rural residence, caste, religion, marital status, household size, and state. Concentration index was used to quantify socioeconomic inequalities and multivariable logistic regression was used to estimate the adjusted differences in those outcomes. We estimated diabetes prevalence to be 16.1% (15.9–16.1%). Among those with diabetes, 27.5% (27.1–27.9%) were aware, 21.5% (21.1–21.7%) were taking treatment and 7% (6.8–7.1%) had their diabetes under control. Across the states of India, the adjusted rates of awareness varied from 14.4% (12.1–16.8%) to 54.4% (40.3–68.4%), of treatment from 9.3% (7.5–11.1%) to 41.2% (39.9–42.6%), and of control from 2.7% (1.6–3.7%) to 11.9% (9.7–14.0%). The age-sex adjusted rates were lower (p < 0.001) among the poorer and less educated individuals as well as among males, residents of rural areas, and those from the socially backward groups Among individuals with diabetes, the richest fifth were respectively 12.4 percentage points (pp) (11.3–13.4; p < 0.001), 10.5 pp (9.7–11.4; p < 0.001), and 2.3 pp (1.6–3.0; p < 0.001) more likely to be aware, getting treated, and having diabetes under control, than the poorest fifth. The concentration indices of ATC were 0.089 (0.085–0.092), 0.083 (0.079–0.085) and 0.017 (0.015–0.018) respectively. Overall, the ATC of diabetes is low in India. It is especially low the poorer and the less educated individuals. Targeted interventions and management can reduce the diabetes burden in India.
Estimates of out-of-pocket (OOP) payment on health care are increasingly used in research and policy. In India, estimates of OOP payment are usually derived from health surveys carried out by the National Sample Survey (NSS). The questions on OOP payment on delivery care have recently integrated in the last two rounds of India's National Family and Health Survey (NFHS-4 & NFHS-5). There are several issues relating to design of questions, reporting and recording of responses that have bearing on reliability of OOP estimates. This paper compares the OOP estimates from latest rounds of two of the large-scale population-based surveys; NFHS-5, 2019-21 and the National Sample Survey (NSS), 2018. We also highlight the type of question canvassed and its implications on OOP estimates of NFHS-5 survey. We used 155,624 births that were reported between in NFHS-5 and a total of 27,664 hospitalised cases for delivery care that were recorded in 75th round of NSS health survey, 2018. We have used descriptive statistics and two-part regression model to examine variations of OOP across surveys. We found large variations in distribution of OOP payment in NFHS-5 and NSS survey. Based on births during the five years preceding the survey, the OOP payment on institutional birth from public health centres in India from NFHS-5 was INR 8377;2,894 (95% CI:2843-2945) compared to INR 8377;2,738 (95% CI: 2644-2832) from NSS. Variations are similar for those availing services from private health centres. Controlling for socio-economic and demographic characteristics, the OOP payment from NFHS was lower among poorest and higher among richest compared to NSS. The variations in OOP across two surveys were larger across states of India. The variations in OOP payment across surveys were possibly due to structure of questions, recall bias, and variations in price level. We suggest to canvass standardised questions across surveys to obtain reliable OOP estimates across surveys.
Diabetes is a growing epidemic and a major threat to most of the households in India. There is little evidence on awareness, treatment, and control (ATC) among adults in India is limited. We estimate the prevalence and ATC of diabetes among adults across various sociodemographic groups and states of India. We used 2,078,315 individuals aged 15 years and over from the recent fifth round of National Family Health Survey (NFHS-5), 2019-21, that was carried out across all states of India. Diabetes individuals were identified as those who had random blood glucose above 140 mg/dL or taking diabetes medication or doctor diagnosed diabetes. Individuals who were measured as diabetic and (i) reported diagnosis were labelled as aware, (ii) reported taking medication for controlling blood glucose levels as treated and (iii) had measured blood glucose levels < 140 mg/dL as controlled. The estimates of diabetes prevalence, and ATC were age-sex adjusted, and disaggregated by household wealth quintile, education, age, sex, urban-rural, caste, religion, marital status, household size and state. Concentration indices was used to quantify socioeconomic inequalities and multivariable logistic regression was used to estimate adjusted differences in these outcomes. We estimated diabetes prevalence at 16.1% (15.9–16.1%). Among those with diabetes, 27.5% (27.1–27.9%) were aware, 21.5% (21.1–21.7%) were treated and 7% (6.8–7.1%) were under control. Across states of India, adjusted rates of ATC varied from 14.4% (12.1–16.8%) to 54.4% (40.3–68.4%), from 9.3% (7.5–11.1%) to 41.2% (39.9–42.6%), and from 2.7% (1.6–3.7%) to 11.9% (9.7–14.0%), respectively. Age–sex adjusted rates were lower (p < 0.001) in poorer, less educated, and social backward groups, as well as for male and residents of rural areas. Among individuals with diabetes, the richest fifth were 12.4 percentage points (pp) (11.3–13.4; p < 0.001), 10.5 pp (9.7–11.4; p < 0.001), and 2.3 pp (1.6-3.0; p < 0.001) more likely to be aware, getting treated, and having control, respectively, than the poorest fifth. The concentration index of ATC was 0.089 (0.085–0.092), 0.083 (0.079–0.085) and 0.017 (0.015–0.018) respectively. Overall, the ATC of diabetes is low in India. The ATC was much lower among adults belonging to poorer class and were less educated. Targeted intervention and management can reduce the diabetes burden in India.
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