Intersecting sex-related inequalities in self-reported testing for and prevalence of Non-Communicable Disease (NCD) risk factors in Kerala

Abstract

Background Non-Communicable Diseases (NCDs) are among India’s top burdens, particularly in states like Kerala, which is at an advanced stage of the epidemiological transition. Evidence in India points towards intersectional inequalities in risk factors of NCDs and testing, both of which are understudied in Kerala. We estimated the self-reported testing and prevalence of key NCD risk factors—blood pressure (BP) and blood glucose (BG) comparing Kerala men and women across educational, wealth, religion, as well as caste and tribal status subgroups. Method A multistage random sample survey of 3398 women and 2982 men aged 30 years and over was administered in 4 districts of Kerala from July to October 2019. Descriptive analysis for men and women was undertaken using survey weights. Slope index of Inequality and Relative Concentration Index for wealth and education related inequalities, and, Weighted Mean Difference from Mean and Index of Disparity for caste and tribal status, as well as religion related inequalities were calculated using World Health Organisation’s Health Equity Assessment Toolkit Plus and Stata 12. Results A significantly higher proportion of women reported BP and BG testing by medical personnel in the previous year than men (BP Testing among Women (BPTw): 90.3% vs BP Testing among Men (BPTM):80.8%, BG Testing among Women (BGTw): 86.2% vs BG Testing among Women (BGTM):78.3%). Among those tested, more women (11.2%) than men (7.9%) reported High Blood Pressure (HBP) but not High Blood Glucose (HBG). Testing for BP was concentrated among less-educated women while BG testing was concentrated among both less educated women and men. HBP and HBG were concentrated among less educated and wealthier groups. Although sex differences were insignificant across caste and tribal status and religion subgroups, magnitude of inequalities was high for HBP and HBG. Conclusion Distinct patterns of sex inequalities were present in self-reported testing and prevalence of NCD risk factors in Kerala. Education and wealth seem to be associated with testing while prevalence appeared to vary by religious groups. Given the low rates of illiteracy, it is encouraging but maybe a data artefact that a small population of less-educated persons was getting tested; however, exclusion of poor groups and inequalities by other dimensions raise concerns. Further exploration is needed to understand underlying mechanisms of these inequalities to ensure we leave no one behind.

Participation in community-based healthcare interventions and non-communicable diseases early detection of general population in Indonesia

“…Attending education may give the respondents the chance to gain information directly from their education programs or indirectly from discussions with others. Consistent with previous studies ( Keetile et al, 2021 ; Negi et al, 2022 ; Subramanian et al, 2018 ), we showed that the less wealthy participants were less likely to report having NCDs screening compared to wealthier participants. This reemphasises the notion that individuals with the financial means overcome barriers to accessing care compared to those who are poor.…”

Decomposing socioeconomic inequality in blood pressure and blood glucose testing: evidence from four districts in Kerala, India

“…Overall, was a positive socioeconomic gradient in BP and BG testing in three of the four districts with testing coverage being concentrated among wealthier populations. This is concerning in light of the global evidence that suggests that NCD risk factors cluster in population with low socioeconomic status in LMICs [20] our own study found less educated groups had greater self-reported prevalence of high BP and BG [32]. Research using a large national dataset found that undiagnosed hypertension was common among poorer, less educated (male) individuals even when they visited a health facility [50].…”

“…Th inclusion criteria was decided as household which had at least one member above 30 years. The detailed sampling design, survey method, data collection, sample size calculation and data processing are reported elsewhere [32,38].…”

“…)), social caste group (Scheduled Caste [SC], Scheduled Tribe [ST], Other Backward Caste [OBC], Other), household wealth quintile (poorest, poorer, middle, richer, richest), family history of high blood pressure, high glucose level and heart diseases (no, yes). These variables were decided based on the variable availability in the study data set and well-established literature [20,29,31,32,39,40,41].…”

“…Socioeconomic disparities in the diagnosis and treatment of NCDs, particularly BP and BG, have been explored in several studies [22,32,33,34,35,36]. These studies mostly concentrated on national and state-level estimates, ignoring disparities at the subnational and district levels, which are more important to policymakers' and administrators' needs.…”