Independent Consultant, 62 Stratford Road, Kensington, CA, 94707, USA.
The George Institute for Global Health, New Delhi, India.
BMC Public Health. 2022 Mar 19;22(1):544. doi: 10.1186/s12889-022-12956-w.
Non-Communicable Diseases (NCDs) are among India's top burdens, particularly in states like Kerala, which is at an advanced stage of the epidemiological transition. Evidence in India points towards intersectional inequalities in risk factors of NCDs and testing, both of which are understudied in Kerala. We estimated the self-reported testing and prevalence of key NCD risk factors-blood pressure (BP) and blood glucose (BG) comparing Kerala men and women across educational, wealth, religion, as well as caste and tribal status subgroups.
A multistage random sample survey of 3398 women and 2982 men aged 30 years and over was administered in 4 districts of Kerala from July to October 2019. Descriptive analysis for men and women was undertaken using survey weights. Slope index of Inequality and Relative Concentration Index for wealth and education related inequalities, and, Weighted Mean Difference from Mean and Index of Disparity for caste and tribal status, as well as religion related inequalities were calculated using World Health Organisation's Health Equity Assessment Toolkit Plus and Stata 12.
A significantly higher proportion of women reported BP and BG testing by medical personnel in the previous year than men (BP Testing among Women (BPT): 90.3% vs BP Testing among Men (BPT):80.8%, BG Testing among Women (BGT): 86.2% vs BG Testing among Women (BGT):78.3%). Among those tested, more women (11.2%) than men (7.9%) reported High Blood Pressure (HBP) but not High Blood Glucose (HBG). Testing for BP was concentrated among less-educated women while BG testing was concentrated among both less educated women and men. HBP and HBG were concentrated among less educated and wealthier groups. Although sex differences were insignificant across caste and tribal status and religion subgroups, magnitude of inequalities was high for HBP and HBG.
Distinct patterns of sex inequalities were present in self-reported testing and prevalence of NCD risk factors in Kerala. Education and wealth seem to be associated with testing while prevalence appeared to vary by religious groups. Given the low rates of illiteracy, it is encouraging but maybe a data artefact that a small population of less-educated persons was getting tested; however, exclusion of poor groups and inequalities by other dimensions raise concerns. Further exploration is needed to understand underlying mechanisms of these inequalities to ensure we leave no one behind.
非传染性疾病（NCDs）是印度的主要负担之一，尤其是在喀拉拉邦等州，该邦正处于流行病学转变的后期阶段。印度的证据表明，NCD 风险因素和检测存在交叉不平等现象，而喀拉拉邦对这两个方面的研究都很少。我们比较了喀拉拉邦男性和女性在教育、财富、宗教以及种姓和部落地位方面的 NCD 风险因素（血压（BP）和血糖（BG））的自我报告检测和流行率。
2019 年 7 月至 10 月，在喀拉拉邦的 4 个地区对 3398 名 30 岁及以上的女性和 2982 名男性进行了多阶段随机抽样调查。使用调查权重对男性和女性进行描述性分析。使用世界卫生组织的健康公平评估工具包和 Stata 12 计算了财富和教育相关不平等的不平等斜率指数和相对集中指数，以及种姓和部落地位以及宗教相关不平等的加权平均差异和差异指数。
与男性相比，报告在过去一年中由医务人员进行 BP 和 BG 检测的女性比例明显更高（女性 BP 检测（BPT）：90.3%比男性 BP 检测（BPT）：80.8%，女性 BG 检测（BGT）：86.2%比男性 BG 检测（BGT）：78.3%）。在接受检测的人群中，报告高血压（HBP）的女性（11.2%）多于男性（7.9%），但报告高血糖（HBG）的女性则少于男性。BP 检测集中在受教育程度较低的女性中，而 BG 检测则集中在受教育程度较低的女性和男性中。HBP 和 HBG 集中在受教育程度较低和财富较多的群体中。尽管在种姓和部落地位以及宗教亚组中性别差异不显著，但 HBP 和 HBG 的不平等程度很高。
喀拉拉邦自我报告的 NCD 风险因素检测和流行率存在明显的性别不平等模式。教育和财富似乎与检测有关，而流行率似乎因宗教群体而异。鉴于识字率较低，令人鼓舞的是，一小部分受教育程度较低的人接受了检测，但排除了贫困群体和其他方面的不平等现象令人担忧。需要进一步探讨这些不平等现象的潜在机制，以确保我们不落下任何人。
