Urbanization, Human Development and Literacy and Syndemics of Obesity, Hypertension and Hyperglycemia in Rajasthan: National Family Health Survey-4.

Objective: Non-communicable diseases (NCDs) are the new epidemic in India. District-specific prevalence of various NCD risk factors and their macrolevel determinants is unknown. We used National Family Health Survey-4 (NFHS-4) data to map the syndemics of obesity, hypertension and hyperglycemia in Rajasthan, the largest state of the country, and correlated their prevalence with selected social determinants of health- urbanization, human development index (HDI) and literacy.

Methodology: Data on location-adjusted prevalence of various NCD risk factors among women (15-49y) and men (15-54y) were obtained from NFHS-4 data sheets. Heat maps were created to determine geographic distribution of obesity (body mass index, BMI ≥25 kg/m2), hypertension (known and/or BP ≥140/≥90 mmHg) and hyperglycemia (random glucose >140 mg/dl) in all the districts (n=33). We determined correlation of various social determinants with NCD risk factors.

Results: Significant geographic variation was observed in prevalence of obesity, hypertension and hyperglycemia in women and men. High prevalence of obesity and hypertension was observed in central and northwestern districts of the state. In women and men respectively, there was a significant positive correlation of obesity with urbanization (r=0.68, 0.51), HDI (r=0.70, 0.66) and female literacy (r=0.46, 0.34). Prevalence of hypertension also showed significant correlation with urbanization (r=0.18, 0.33), HDI (r=0.38, 0.52) and literacy (r=0.32, 0.21) while no correlation was observed with hyperglycemia.

Conclusion: There is significant geographic variation in prevalence of obesity, hypertension and hyperglycemia in Rajasthan. Significant correlation of obesity and hypertension with urbanization, human development and female literacy is observed..