District-Level Social Determinants and Hypertension Prevalence among Women in India: National Family Health Survey-5

Introduction: The present study was conducted to assess the role of social determinants of health in explaining district level variation in hypertension prevalence among women in India, using data from the National Family Health Survey-5. Methodology: The NFHS-5 was conducted in 707 districts across all states in India between 2019 and 2021, involving 825,954 participants, with the majority being women . Data on district-level social determinants and prevalence of hypertension among women from the NFHS-5 database was obtained. Descriptive statistics were reported. Results: The age-standardised prevalence of hypertension (95% confidence intervals) was lower in women, 21.3 % (21.2-21.4) than men, 24.0 percent (23.7-24.3). Women living in states with better human development index has more hypertension with greater prevalence in better-developed southern and western Indian districts. District level hypertension prevalence correlated positively with affluence (polynomial R2 0.30) and literacy (R2 0.17) (p <0.001). Better district level indices of social development (health insurance, electricity, drinking water, sanitation, clean fuel, less childhood marriage and less teenage pregnancy), health-service delivery (skilled childbirth services, contraception use, full vaccination), and nutritional status (lower anemia, childhood wasting / stunting, overweight children and adults, hyperglycemia) were associated with greater hyper-tension prevalence (p <0.001). Conclusion: The prevalence of hypertension among women in India is lower than that among men, with notable geographic variation. District level analysis indicates that it is significantly higher in districts with better socioeconomic development, health service delivery parameters, and nutritional status.