Socioeconomic and sex disparities in hypertension and diabetes mellitus care cascade among tribal populations in Odisha, India: findings from the Odisha Tribal Family Health Survey (OTFHS), 2022-23.

BACKGROUND

We assessed sex and socioeconomic disparities in the care cascade, i.e., awareness, treatment, and control (ATC), for hypertension and diabetes among Odisha's tribal communities.

METHODS

We surveyed 14 tribal districts via multistage cluster sampling covering 10,090 households from 2022 to 23. Data from individuals aged > 18 years were analyzed for hypertension (BP > 140/90 mmHg) and diabetes (RBS > 200 mg/dL). The outcomes included (i) awareness (prior diagnosis or medication use), (ii) treatment (self-reported medication use), and (iii) control (BP < 140/90 mmHg for hypertension, RBS < 180 mg/dL for diabetes). Multivariable log-binomial regression was used to estimate adjusted prevalence ratios (aPRs with 95% CIs) for gender and wealth quintile associations with ATC stages.

RESULTS

Of the 21,100 participants, 33.7% had hypertension and 9.7% had diabetes. Among the 6,620 hypertensive individuals, 19% were aware, 13·8% were on treatment, and 6·8% had controlled BP. Women with hypertension (N = 3,609) had significantly better outcomes than men did: awareness (aPR: 1·4;1·2-1·6), treatment (aPR: 1·5; 1·2-1·7), and control (aPR: 1·7; 1·4-2·2). Compared with those in the poorest quintile, hypertensive individuals from the richest quintile (N = 1,804) were more likely to be aware (aPR: 1·5; 1·2-1·9) and on treatment (aPR: 1·5; 1·2-2·7); however, BP control was not significantly different (aPR: 1·6; 0·9-2·8). Among the 1,883 individuals with diabetes, 49% were aware, 44·4% were on treatment, and 40·7% achieved control.

CONCLUSION

Significant socioeconomic and sex inequities persist in hypertension care among Odisha's tribal populations, with better ATC outcomes for women and wealthier individuals. Targeted screening and gender-sensitive approaches are essential for equitable healthcare access.