Socioeconomic Inequalities in Non-Communicable Diseases Prevalence in India: Disparities between Self-Reported Diagnoses and Standardized Measures

PLoS ONE 8(7)

Posted: 21 Jul 2013

See all articles by Sukumar Vellakkal

Sukumar Vellakkal

Public Health foundation of India (PHFI)

S. V. Subramanian

Harvard University - T.H. Chan School of Public Health

Christopher Millett

Imperial College London

Sanjay Basu

Stanford University - Center for Primary Care and Outcomes Research and Center for Population Health Sciences; Harvard University - Center for Primary Care

David Stuckler

University of Cambridge - Faculty of Human, Social, and Political Science

Shah Ebrahim

Public Health Foundation of India

Date Written: 2013

Abstract

Background: Whether non-communicable diseases (NCDs) are diseases of poverty or affluence in low-and-middle income countries has been vigorously debated. Most analyses of NCDs have used self-reported data, which is biased by differential access to healthcare services between groups of different socioeconomic status (SES). We sought to compare self-reported diagnoses versus standardised measures of NCD prevalence across SES groups in India.

Methods: We calculated age-adjusted prevalence rates of common NCDs from the Study on Global Ageing and Adult Health, a nationally representative cross-sectional survey. We compared self-reported diagnoses to standardized measures of disease for five NCDs. We calculated wealth-related and education-related disparities in NCD prevalence by calculating concentration index (C), which ranges from -1 to 1 (concentration of disease among lower and higher SES groups, respectively).

Findings: NCD prevalence was higher (range 5.2 to 19.1%) for standardised measures than self-reported diagnoses (range 3.1 to 9.4%). Several NCDs were particularly concentrated among higher SES groups according to self-reported diagnoses (Csrd) but were concentrated either among lower SES groups or showed no strong socio-economic gradient using standardized measures (Csm): age-standardised wealth-related C: angina Csrd 0.02 vs. Csm -0.17; asthma and lung diseases Csrd -0.05 vs. Csm -0.04 (age-standardised education-related Csrd 0.04 vs. Csm -0.05); vision problems Csrd 0.07 vs. Csm -0.05; depression Csrd 0.07 vs. Csm -0.13. Indicating similar trends of standardized measures detecting more cases among low SES, concentration of hypertension declined among higher SES (Csrd 0.19 vs. Csm 0.03).

Conclusions: The socio-economic patterning of NCD prevalence differs markedly when assessed by standardized criteria versus self-reported diagnoses. NCDs in India are not necessarily diseases of affluence but also of poverty, indicating likely under-diagnosis and under-reporting of diseases among the poor. Standardized measures should be used, wherever feasible, to estimate the true prevalence of NCDs.

Keywords: Socio-economic Inequalities, Non-Communicable Diseases, India, poor, access to healthcare

JEL Classification: I18

Suggested Citation

Vellakkal, Sukumar and Subramanian, S. V. and Millett, Christopher and Basu, Sanjay and Stuckler, David and Ebrahim, Shah, Socioeconomic Inequalities in Non-Communicable Diseases Prevalence in India: Disparities between Self-Reported Diagnoses and Standardized Measures (2013). PLoS ONE 8(7). Available at SSRN: https://ssrn.com/abstract=2296491

Sukumar Vellakkal (Contact Author)

Public Health foundation of India (PHFI) ( email )

4 Institutional Area
Vasant Kunj
New Delhi, Delhi 110070
India

HOME PAGE: http://www.phfi.org

S. V. Subramanian

Harvard University - T.H. Chan School of Public Health ( email )

677 Huntington Avenue
Boston, MA MA 02115
United States

Christopher Millett

Imperial College London ( email )

South Kensington Campus
Exhibition Road
London, Greater London SW7 2AZ
United Kingdom

Sanjay Basu

Stanford University - Center for Primary Care and Outcomes Research and Center for Population Health Sciences ( email )

1070 Arastradero Road Office 282
Palo Alto, CA 94304
United States

Harvard University - Center for Primary Care ( email )

Cambridge, MA
United States

David Stuckler

University of Cambridge - Faculty of Human, Social, and Political Science ( email )

Cambridge, CB3 9DD
United Kingdom

Shah Ebrahim

Public Health Foundation of India ( email )

4 Institutional Area
Vasant Kunj
New Delhi, Delhi 110070
India

Register to save articles to
your library

Register

Paper statistics

Abstract Views
296
PlumX Metrics