Spousal concordance of diabetes and hypertension in India: an analysis of nationally representative data
Jithin Sam Varghese (1,2), Arpita Ghosh (3), Aryeh D. Stein (1), K.M. Venkat Narayan (1,2), Shivani A. Patel (1,2)
1 Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
2. Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Atlanta, USA
3 The George Institute, New Delhi, India
Understanding whether diabetes and hypertension risks are shared between members of married couples may inform strategies for disease screening and prevention. To date, little is known about diabetes and hypertension concordance among couples in India, where chronic diseases are rapidly rising. We investigated spousal concordance in diabetes and hypertension among Indian adults.
Data were from heterosexual married couples (n = 50,023, women: 18-49y, men: 21-54y) assessed in the nationally representative National Family Health Survey-V (2019-21). We estimated the prevalence ratio (PR) and 95% CI to describe concordance in disease status (i.e. co-occurrence beyond what is statistically expected) between spouses using survey-weighted modified Poisson regression.
The prevalence of diabetes and of hypertension were 7.5% [95%CI: 7.2, 7.9] and 29.1% [28.5, 29.8] in married men and 4.4% [4.1, 4.7] and 20.6% [20.0, 21.1] in married women. Co-occurrence of diabetes and hypertension were 1.0% [0.8, 1.1] and 8.4% [8.0, 8.8], respectively. Married women and men were over twice as likely to have diabetes if their spouses had the condition (husband with diabetes : PR=2.18 [1.83, 2.60]; wife with diabetes: PR=2.07 [1.78, 2.42]). Similarly, married women and men were more likely to have hypertension if their spouses had the disease (husband with hypertension: PR=1.37 [1.30, 1.44]; wife with hypertension: PR=1.32 [1.26, 1.38]). Positive associations of prevalent disease between spouses were consistently observed across age, husband’s education, rurality, household wealth, and social caste groups for both diabetes (PRs ranging from 1.44 to 4.41 and hypertension (PRs ranging from 1.23 to 1.56), with the largest associations were observed when individual age <40 (PRs ranging from 1.55 to 4.41) and in the lowest household wealth quintile (PRs ranging from 1.31 to 2.37).
Diagnosis of diabetes and hypertension were based on self-reports and one time point assessments of biomarkers.
There is substantial diabetes and hypertension concordance in Indian couples, particularly at younger ages and lowest wealth quintiles. This presents opportunities for screening spouses of those diagnosed with diabetes and hypertension.