Sociodemographic and geographic inequalities in diagnosis and treatment of older adults’ chronic conditions in India: a nationally representative population-based study

Sanjay K. Mohanty, Abhilasha, Radhe Shyam Mishra, Ashish Kumar Upadhyay, Owen O’Donnell*, Jürgen Maurer

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Context: Expeditious diagnosis and treatment of chronic conditions are critical to control the burden of non-communicable disease in low- and middle-income countries. We aimed to estimate sociodemographic and geographic inequalities in diagnosis and treatment of chronic conditions among adults aged 45 + in India. Methods: We used 2017–18 nationally representative data to estimate prevalence of chronic conditions (hypertension, diabetes, lung disease, heart disease, stroke, arthritis, cholesterol, and neurological) reported as diagnosed and percentages of diagnosed conditions that were untreated by sociodemographic characteristics and state. We used concentration indices to measure socioeconomic inequalities in diagnosis and lack of treatment. Fully adjusted inequalities were estimated with multivariable probit and fractional regression models. Findings: About 46.1% (95% CI: 44.9 to 47.3) of adults aged 45 + reported a diagnosis of at least one chronic condition and 27.5% (95% CI: 26.2 to 28.7) of the reported conditions were untreated. The percentage untreated was highest for neurological conditions (53.2%; 95% CI: 50.1 to 59.6) and lowest for diabetes (10.1%; 95% CI: 8.4 to 11.5). Age- and sex-adjusted prevalence of any diagnosed condition was highest in the richest quartile (55.3%; 95% CI: 53.3 to 57.3) and lowest in the poorest (37.7%: 95% CI: 36.1 to 39.3). Conditional on reported diagnosis, the percentage of conditions untreated was highest in the poorest quartile (34.4%: 95% CI: 32.3 to 36.5) and lowest in the richest (21.1%: 95% CI: 19.2 to 23.1). Concentration indices confirmed these patterns. Multivariable models showed that the percentage of untreated conditions was 6.0 points higher (95% CI: 3.3 to 8.6) in the poorest quartile than in the richest. Between state variations in the prevalence of diagnosed conditions and their treatment were large. Conclusions: Ensuring more equitable treatment of chronic conditions in India requires improved access for poorer, less educated, and rural older people who often remain untreated even once diagnosed.

Original languageEnglish
Article number332
Number of pages15
JournalBmc Health Services Research
Volume23
Issue number1
DOIs
Publication statusE-pub ahead of print - 3 Apr 2023
Externally publishedYes

Bibliographical note

Funding Information:
This was supported by funding from the Swiss National Science Foundation ( https://www.snf.ch ) and the Swiss Agency for Development and Cooperation ( https://www.eda.admin.ch/deza/en/home.html ) through the Swiss Programme for Research on Global Issues for Development ( http://www.r4d.ch ) grant 400640_160374: “Inclusive social protection for chronic health problems” ( https://r4dncd.org ). The content of the Article is solely the responsibility of the authors and does not necessarily represent the views of the Swiss National Science Foundation or the Swiss Agency for Development & Cooperation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Publisher Copyright:
© 2023, The Author(s).

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