Association between socioeconomic status and self-reported diabetes in India: a cross-sectional multilevel analysis
- 1Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- 2Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts, USA
- Correspondence to Professor S V Subramanian;
- Received 18 January 2012
- Accepted 18 June 2012
- Published 18 July 2012
Objectives To quantify the association between socioeconomic status (SES) and type 2 diabetes in India.
Design Nationally representative cross-sectional household survey.
Setting Urban and rural areas across 29 states in India.
Participants 168 135 survey respondents aged 18–49 years (women) and 18–54 years (men).
Primary outcome measure Self-reported diabetes status.
Results Markers of SES were social caste, household wealth and education. The overall prevalence of self-reported diabetes was 1.5%; this increased to 1.9% and 2.5% for those with the highest levels of education and household wealth, respectively. In multilevel logistic regression models (adjusted for age, gender, religion, marital status and place of residence), education (OR 1.87 for higher education vs no education) and household wealth (OR 4.04 for richest quintile vs poorest) were positively related to self-reported diabetes (p<0.0001). In a fully adjusted model including all socioeconomic variables and body mass index, household wealth emerged as positive and statistically significant with an OR for self-reported diabetes of 2.58 (95% credible interval (CrI): 1.99 to 3.40) for the richest quintile of household wealth versus the poorest. Nationally in India, a one-quintile increase in household wealth was associated with an OR of 1.31 (95% CrI 1.20 to 1.42) for self-reported diabetes. This association was consistent across states with the relationship found to be positive in 97% of states (28 of 29) and statistically significant in 69% (20 of 29 states).
Conclusions The authors found that the highest SES groups in India appear to be at greatest risk for type 2 diabetes. This raises important policy implications for addressing the disease burdens among the poor versus those among the non-poor in the context of India, where >40% of the population is living in poverty.
To cite: Corsi DJ, Subramanian SV. Association between socioeconomic status and self-reported diabetes in India: a cross-sectional multilevel analysis. BMJ Open 2012;2:e000895. doi:10.1136/bmjopen-2012-000895
Contributors SVS and DJC planned the study. DJC conducted statistical analyses and drafted the manuscript with supervision from SVS. Both authors participated in interpretation of the results and critical revisions of the manuscript.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The NFHS data are available through the Measure DHS project at http://www.measuredhs.com/
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.