Developing a Punjab Index of Multiple Deprivation to investigate regional health inequalities in North-Western India

Area deprivation indices are effective tools in health inequality research to identify social disparities and variations in health risks between different areas. We developed an index of multiple area deprivation for the Indian state of Punjab at the district level and present an application to inequalities in diabetes, general obesity (based on BMI), and abdominal obesity with respect to area deprivation and compare the results with household-level wealth-related inequalities. We used data from multiple sources and applied factor analysis to derive the Punjab Index of Multiple Deprivation (PIMD). Information on outcome variables and households’ socio-economic status was obtained from the 5th round of the National Family Health Survey (NFHS-5), conducted in 2019–21. It included 69,109 individuals from Punjab aged 15 and above. Deprivation-related and wealth-related inequalities in diabetes, general obesity and abdominal obesity were measured using the concentration index. The overall prevalence is 6.13% for diabetes, 39.33% for general obesity and 58.26% for abdominal obesity in Punjab. Our results suggest a significant concentration of diabetes (C = 0.1595), general obesity (C = 0.1187) and abdominal obesity (C = 0.0755) by wealth among richer individuals and a significant concentration of diabetes (C = 0.0526), general obesity (C= 0.053) and abdominal obesity (C=0.0275) by deprivation in better-off areas. Area deprivation is an important determinant of the socio-economic gradients in diabetes and obesity. Policymakers should address the regionally unequal burden when allocating resources to prevent or mitigate the spread of diabetes in India.