Urban Housing and Hypertension Among Women in India: Comparing Slum and Non-Slum Contexts Using National Survey Data

Housing conditions are increasingly recognized as critical determinants of non-communicable diseases; however, their influence on hypertension (HTN) risk remains underexplored in low- and middle-income countries. In urban India, structural disparities in housing are especially pronounced between slum and non-slum areas, making comparative analysis crucial for understanding context-specific health risks. This study examines the relationship between multidimensional housing conditions and HTN risk among women aged 18-49, drawing on data from 68,422 respondents in the fourth National Family Health Survey. A composite housing index was developed to capture six dimensions: structural quality, housing services access, indoor air quality, crowding, tenure security, and asset ownership. Survey-weighted logistic regressions were used to assess associations between housing conditions and HTN, controlling for key socio-demographic and health-related factors. We found that overall HTN prevalence was lower in slum households (11.6%) than in non-slum households (16.0%). Unexpectedly, slum households reported better structural durability and indoor air quality than non-slum households, suggesting incremental improvements in notified or tenure-secure slums. Better tenure security and asset ownership were found to be protective factors for HTN risk, while better structural quality was associated with higher HTN odds in non-slum areas. Crowding showed contrasting effects: in slums, higher crowding increased HTN risk, whereas in non-slums, lower crowding was associated with higher HTN. These findings highlight the context-dependent nature of housing-health links. Targeted interventions that address both physical infrastructure and broader living conditions can play a vital role in reducing urban hypertension disparities among women in India.