State-level variations in hypertension management and cardiovascular disease risks in India: Influence of public spending on health and inequalities
Journal
Gerontology
Start Page
1-19
ISSN
0304-324X
1423-0003
Date Issued
2025-11-25
Author(s)
Anindya, Kanya
Zhao, Yang
Vellakkal, Sukumar
Perianayagam, Arokiasamy
Pati, Sanghamitra
Marthias, Tiara
Malik, Mansi
Abstract
Introduction: This study aims to assess the within- and between-states inequality in hypertension management and CVD risk across sociodemographic groups in India; and the correlation between states/UTs expenditure on health, hypertension management, and CVD risk.
Methods: This study utilized cross-sectional data from 2017/2018 Longitudinal Aging Study in India (LASI), with a total sample of 58,848 respondents aged ≥45 years. Hypertension management was assessed based on hypertension awareness, treatment, and control, while 10-year CVD risk was measured using the 2019 WHO CVD risk. We used multilevel logistic regression models to estimate the socioeconomic inequality in hypertension management and 10-year CVD risk, measured by the relative index of inequality (RII).
Results: Rural areas had a substantially poorer coverage of hypertension awareness, treatment, and control compared with urban areas. Richest socioeconomic groups were more likely to be aware of their hypertensive status (RII 1.28, 95% CI 1.16-1.42), to receive antihypertensive treatment (RII 1.47, 95% CI 1.28-1.69), to have their blood pressure controlled (RII 1.60, 95% CI 1.34-1.90), and to have 10-year CVD risk < 10% (1.06, 95% CI 1.01-1.12) compared to the poorest. The VPC ranged from 1.5% for 10-year CVD risk to 9.9% for hypertension control. There was no significant correlation between socioeconomic inequality in hypertension management, 10-year CVD risk, and the per capita public health expenditure of states/UTs.
Conclusion: Differences in state-level health system capacity may disproportionately affect socioeconomically disadvantaged populations, underscoring the need for more equitable hypertension management and cardiovascular health strategies across India.
Publisher
S. Karger AG
Type
journal article