State-Level Variations in Hypertension Management and Cardiovascular Disease Risks in India: Public Spending on Health and Socioeconomic Inequalities.

Abstract

Introduction: This study aimed to assess the within- and between-states inequality in hypertension management and cardiovascular disease (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), receive antihypertensive treatment (RII 1.47, 95% CI: 1.28-1.69), have their blood pressure controlled (RII 1.60, 95% CI: 1.34-1.90), and have 10-year CVD risk <10% (1.06, 95% CI: 1.01-1.12) compared to the poorest. The variance partition coefficient 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.

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