Journal Article

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

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

2023

Overview

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. Highlights • Little is known about sociodemographic and geographic inequalities in the diagnosis and treatment of chronic illness among middle-aged and older adults in India. • Self-reported diagnosed chronic conditions are more prevalent among socially advantaged groups but the disadvantaged are more likely to be untreated. • To ensure more equitable treatment of chronic conditions, efforts to improve access should be directed towards poorer, less educated, and ruralolder people.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Aged patients / Blood pressure / Cardiovascular disease / Care and treatment / Chronic condition / Chronic Disease / Chronic diseases / Chronic illnesses / Consumption / Demographic aspects / Diabetes / Diabetes Mellitus - diagnosis / Diabetes Mellitus - epidemiology / Diabetes Mellitus - therapy / Diagnosis / Distribution / Economic aspects / Estimates / Expenditures / Health Administration / Health care disparities / Health Informatics / Health services / Heart / Households / Humans / Hypertension / Hypertension - epidemiology / India / India - epidemiology / Inequality / LASI / Management / Medical diagnosis / Medicine / Medicine & Public Health / Mortality / Non-communicable disease / Nursing Research / Older people / Population-based studies / Prevalence / Public Health / Social aspects / Sociodemographics / Socioeconomic Factors / Stroke / Treatment