The Phase-1 findings of the 5th edition of the National Family Health Survey (NFHS) were recently released. For the first time, the survey captured data on the proportion of the adult population suffering from lifestyle-induced diseases like Diabetes & Hypertension. The data reveals the growing risk of such diseases in India. Here is a detailed review. 

The Ministry of Health & Family Welfare recently released key findings of  Phase-1 of the National Family and Health Survey 2019-20 (NFHS-5). This is the fifth edition of the survey. Phase-1 includes fact sheets for 17 states and 5 union territories. Phase-II which constitutes the rest of the States/UTs is delayed because of the COVID-19 pandemic in the country. 

The survey provides estimates for 131 key indicators across various categories of Population & Household profile, Marriage & Fertility, Maternal & Child Health, Nutrition, Women Empowerment, etc. While most of the indicators remained the same from NFHS-4 to facilitate comparison, there are also new indicators that were introduced in NFHS-5.  Among the new indicators that were introduced in this survey are ‘Blood Sugar Levels among Adults’ and ‘Hypertension among adults’. Persons of age 15 years or above are surveyed for this purpose. 

In this story, we take a look at the key findings for these indicators which are a reflection of the lifestyle and health of the population. It ought to be noted that NFHS is a sample survey and the sample size varies across the states. The sample size for each of the states is provided in the fact sheets of the respective states. 

These estimates are based on the Clinical, Anthropometric & Biochemical testing (CAB) conducted on the participants of the survey. 

Higher proportion of Men are diabetic with Kerala, Goa & AP leading 

Among the 22 States/UTs, around 16.8% of the male adult population and 14.6% of the female adult population on average are estimated to be diabetic. The measure includes the summation of the population that satisfies any of the below three criteria: 

  • Having High Blood Sugar Levels – (141-160 mg/dl)
  • Having Very High Blood Sugar Levels – (> 160-mg. dl) 
  • Taking Medication to control blood sugar level 

The estimate provided in the report is the summation of the population that satisfies any of the below three criteria.

The results indicate the following:

  • Compared to the female population, a higher proportion of males have high and very high blood sugar levels. 
  • This trend is consistent across the states, where-in the proportion of men who are diabetic is more than that of women. 
  • This is true not only for the total cumulative estimates of diabetic (including those taking medication to control blood sugar) but even for ‘High level’ & ‘Very High level’ of blood sugar, with the exception of A&N Islands and Jammu & Kashmir. In both these UTs,  the proportion of females with ‘Very high’ blood sugar levels is more than that of males. 
  • Analysis of the data related to the States/UTs in Phase-1 indicates that Kerala has the highest proportion of its population as diabetic, both in the case of males and females. It is followed by Goa. 
  • Among the larger states, Andhra Pradesh & West Bengal are estimated to have a higher proportion of the population as diabetic after Kerala. 
  • Bihar & Assam have comparatively lower numbers reported as diabetic compared to the other states.  
  • The survey estimates indicate that the prevalence is higher in urban areas compared to that of rural areas, pointing towards the difference in lifestyle. 

The trends among the States are similar to the “India: Health of Nation’s States” report of 2017, which is a joint effort by ICMR, PHFI (Public Health Foundation of India) & the Institute of Health Metrics & Evaluation (IHME). This report was referred to in the RBI’s assessment on the Impact of COVID-19. 

As per that report,  Kerala, Andhra Pradesh & West Bengal are among the states with a higher proportion of the diabetic population. Other states like Tamil Nadu & Punjab which have a higher proportion of the population suffering from Diabetes are part of Phase-II of NFHS-5. 

It ought to be noted that the comparison of these two reports is only indicative of the trends among the states which are outliers, and the numbers cannot be compared as the criteria for the survey and the report varies. 

Even in the case of Hypertension, Kerala & AP are on the top 

Among the 22 States & UTs, around a quarter of the male population on average is estimated to be having elevated blood pressure or taking medication to control it. Comparatively, 22.5 % of the women population have a challenge with Hypertension. 

The NFHS-5 survey has recorded this data based on three criteria: 

  • Mildly elevated blood pressure (Systolic 140-159 mm of Hg and/or Diastolic 90-99 mm of Hg) (%) 
  • Moderately or severely elevated blood pressure (Systolic ≥160 mm of Hg and/or Diastolic ≥100 mm of Hg) (%) 
  • Taking medicine to control blood pressure 

The estimated percentage of the population affected by Hypertension fall under any of the above categories. 

  • As observed in the case of higher blood sugar levels, the proportion of men suffering from hypertension is higher compared to the proportion of women across the states with Goa & Lakshadweep being an exception. 
  • Only around 5% & 6% of women & men suffering from Hypertension respectively were recorded to have moderate or severe elevated blood pressure. 
  • A major chunk of this population has mildly elevated blood pressure. 
  • Sikkim, one of the smaller NE states that is part of Phase -1 has a comparatively higher proportion of the population having moderate-severe levels of elevated blood pressure. It also has an overall higher proportion of the population suffering from Hypertension. 
  • Among the larger states, Kerala, Telangana and Andhra Pradesh top the list. 
  • Meanwhile, Bihar records a lower proportion of the population suffering from hypertension, as was the case with diabetes. 
  • As is the case with diabetes, hypertension is more prevalent in Urban areas compared to that in Rural areas. 

The trends among the states are in line with the trends indicated in RBI’s assessment of COVID-19, which has based its numbers on the “India: Health of Nation’s States” report. Kerala, Andhra Pradesh & Telangana are among the states which have a higher incidence of Cardio-vascular diseases, meanwhile, Bihar has the least incidence of such number.  

The trends among the States correlate with COVID-19 numbers

As per the information provided by WHO, people suffering from medical problems like cardiovascular diseases, diabetes, respiratory diseases, etc. have a higher chance of contracting COVID-19 infection and are likely to develop a serious illness. 

As per the available data furnished by MOHFW, Maharashtra, Karnataka, Andhra Pradesh, Tamil Nadu & Kerala are the top 5 states with the highest number of recorded COVID-19 cases. 

Among these 5 states, three states are part of NFHS-5 phase -1. We had observed that as per the survey estimates, Kerala and Andhra Pradesh are among the states which have a higher proportion of the population suffering from life-style ailments like Diabetes and Hypertension which could act as co-morbidities for COVID-19. West Bengal & Telangana also feature among the states with a higher proportion of the population suffering from Higher levels of Blood sugar and Hypertension. Even these states among the ones which have recorded a higher number of COVID-19 cases. 

Further confirming the association of these ailments and COVID-19 is the case of Bihar, which has proportionately fewer COVID-19 cases when one takes into consideration the population of the state and the relatively poor healthcare infrastructure. The reason could be the lower proportion of the population suffering from ailments like diabetes and hypertension. 

Including information on lifestyle diseases in NFHS is a good initiative, especially to understand the potential health risks of the population which could further be compounded in the case of a pandemic like COVID-19. Such data also helps the governments plan their response accordingly. 

Apart from including these indicators in NFHS-5, the government has begun taking steps to identify the health risks associated with behaviour & lifestyle changes. The initiative in the form of NPCDCS (National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke) is in place since 2010. 

As per news reports, the Centre has asked the states to use the data generated under NPCDCS to identify the priority group who would be receiving COVID-19 vaccination as part of the initial vaccination drive, which includes people suffering from co-morbidities. 

As per a response provided in Rajya Sabha in February 2019, a total of 1.3 crore population were screened for Hypertension and 97.7 lakhs for Diabetes under NPCDCS. 

Featured Image: Lifestyle diseases in India



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