IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0068219.html
   My bibliography  Save this article

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

Author

Listed:
  • Sukumar Vellakkal
  • S V Subramanian
  • Christopher Millett
  • Sanjay Basu
  • David Stuckler
  • Shah Ebrahim

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 socioeconomic 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.

Suggested Citation

  • Sukumar Vellakkal & S V Subramanian & Christopher Millett & Sanjay Basu & David Stuckler & Shah Ebrahim, 2013. "Socioeconomic Inequalities in Non-Communicable Diseases Prevalence in India: Disparities between Self-Reported Diagnoses and Standardized Measures," PLOS ONE, Public Library of Science, vol. 8(7), pages 1-12, July.
    • Handle: RePEc:plo:pone00:0068219
    DOI: 10.1371/journal.pone.0068219
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0068219
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0068219&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0068219?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Olusoji Adeyi & Owen Smith & Sylvia Robles, 2007. "Public Policy and the Challenge of Chronic Noncommunicable Diseases," World Bank Publications - Books, The World Bank Group, number 6761.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Sözmen, Kaan & Ünal, Belgin, 2016. "Explaining inequalities in Health Care Utilization among Turkish adults: Findings from Health Survey 2008," Health Policy, Elsevier, vol. 120(1), pages 100-110.
    2. Joko Mulyanto & Dionne S. Kringos & Anton E. Kunst, 2019. "The accuracy of self-report versus objective assessment for estimating socioeconomic inequalities in disease prevalence in Indonesia," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 64(8), pages 1233-1241, November.
    3. Toshiaki Aizawa, 2019. "Transition of the BMI distribution in India: evidence from a distributional decomposition analysis," Journal of Bioeconomics, Springer, vol. 21(1), pages 3-36, April.
    4. Joko Mulyanto & Dionne S Kringos & Anton E Kunst, 2019. "The evolution of income-related inequalities in healthcare utilisation in Indonesia, 1993–2014," PLOS ONE, Public Library of Science, vol. 14(6), pages 1-15, June.
    5. Lee, Jinkook & McGovern, Mark E. & Bloom, David E. & Arokiasamy, P. & Risbud, Arun & O’Brien, Jennifer & Kale, Varsha & Hu, Peifeng, 2015. "Education, gender, and state-level disparities in the health of older Indians: Evidence from biomarker data," Economics & Human Biology, Elsevier, vol. 19(C), pages 145-156.
    6. McGovern, Mark E., 2014. "Comparing the relationship between stature and later life health in six low and middle income countries," The Journal of the Economics of Ageing, Elsevier, vol. 4(C), pages 128-148.
    7. Arokiasamy, Perianayagam & Uttamacharya, Uttamacharya & Kowal, Paul, 2013. "Socioeconomic and age gradients of health of Indian adults: an assessment of self-reported and performance-based measures of health," MPRA Paper 54912, University Library of Munich, Germany, revised Feb 2014.
    8. Mulcahy, Patrick & Mahal, Ajay & McPake, Barbara & Kane, Sumit & Ghosh, Prabir Kumar & Lee, John Tayu, 2021. "Is there an association between public spending on health and choice of healthcare providers across socioeconomic groups in India? - Evidence from a national sample," Social Science & Medicine, Elsevier, vol. 285(C).
    9. John Tayu Lee & Fozia Hamid & Sanghamitra Pati & Rifat Atun & Christopher Millett, 2015. "Impact of Noncommunicable Disease Multimorbidity on Healthcare Utilisation and Out-Of-Pocket Expenditures in Middle-Income Countries: Cross Sectional Analysis," PLOS ONE, Public Library of Science, vol. 10(7), pages 1-18, July.
    10. Tuhin Biswas & Md Saimul Islam & Natalie Linton & Lal B Rawal, 2016. "Socio-Economic Inequality of Chronic Non-Communicable Diseases in Bangladesh," PLOS ONE, Public Library of Science, vol. 11(11), pages 1-12, November.
    11. Saxena, Akshar & Mendenhall, Emily, 2022. "Syndemic thinking in large-scale studies: Case studies of disability, hypertension, and diabetes across income groups in India and China," Social Science & Medicine, Elsevier, vol. 295(C).
    12. Ilke Onur & Malathi Velamuri, 2018. "The gap between self-reported and objective measures of disease status in India," PLOS ONE, Public Library of Science, vol. 13(8), pages 1-18, August.
    13. Mendenhall, Emily & Omondi, Gregory Barnabas & Bosire, Edna & Isaiah, Gitonga & Musau, Abednego & Ndetei, David & Mutiso, Victoria, 2015. "Stress, diabetes, and infection: Syndemic suffering at an urban Kenyan hospital," Social Science & Medicine, Elsevier, vol. 146(C), pages 11-20.
    14. Thomas, Ranjeeta & Burger, Ronelle & Hauck, Katharina, 2018. "Richer, wiser and in better health? The socioeconomic gradient in hypertension prevalence, unawareness and control in South Africa," Social Science & Medicine, Elsevier, vol. 217(C), pages 18-30.
    15. Perianayagam Arokiasamy & Uttamacharya & Kshipra Jain, 2015. "Multi-Morbidity, Functional Limitations, and Self-Rated Health Among Older Adults in India," SAGE Open, , vol. 5(1), pages 21582440155, February.
    16. El-Sayed, Abdulrahman M. & Palma, Anton & Freedman, Lynn P. & Kruk, Margaret E., 2015. "Does health insurance mitigate inequities in non-communicable disease treatment? Evidence from 48 low- and middle-income countries," Health Policy, Elsevier, vol. 119(9), pages 1164-1175.
    17. Jinkook Lee & McGovern, Mark E. & David E. Bloom & P. Arokiasamy & Arun Risbud & Jennifer O?Brien & Varsha Kale & Peifeng Hu, 2015. "Education, Gender, and State-Level Gradients in the Health of Older Indians: Evidence from Biomarker Data," Working Paper 228841, Harvard University OpenScholar.
    18. Regina Moczadlo & Harald Strotmann & Jürgen Volkert, 2015. "Corporate Contributions to Developing Health Capabilities," Journal of Human Development and Capabilities, Taylor & Francis Journals, vol. 16(4), pages 549-566, November.
    19. Chipo Mutyambizi & Frederik Booysen & Andrew Stokes & Milena Pavlova & Wim Groot, 2019. "Lifestyle and socio-economic inequalities in diabetes prevalence in South Africa: A decomposition analysis," PLOS ONE, Public Library of Science, vol. 14(1), pages 1-21, January.
    20. Ila Patnaik & Renuka Sane & Ajay Shah & S. V. Subramaniam, 2021. "Distribution of self-reported health in India: The role of income and geography," Working Papers 6, xKDR.
    21. Kangmennaang, Joseph & Onyango, Elizabeth O. & Luginaah, Isaac & Elliott, Susan J., 2018. "The next Sub Saharan African epidemic? A case study of the determinants of cervical cancer knowledge and screening in Kenya," Social Science & Medicine, Elsevier, vol. 197(C), pages 203-212.
    22. Anubha Agarwal & Devraj Jindal & Vamadevan S Ajay & Dimple Kondal & Siddhartha Mandal & Shreeparna Ghosh & Mumtaj Ali & Kavita Singh & Mark D Huffman & Nikhil Tandon & Dorairaj Prabhakaran, 2019. "Association between socioeconomic position and cardiovascular disease risk factors in rural north India: The Solan Surveillance Study," PLOS ONE, Public Library of Science, vol. 14(7), pages 1-16, July.
    23. Ji-Yeon Shin & Jiseun Lim & Myung Ki & Yeong-Jun Song & Heeran Chun & Dongjin Kim, 2018. "An Assessment of Magnitudes and Patterns of Socioeconomic Inequalities across Various Health Problems: A Large National Cross-Sectional Survey in Korea," IJERPH, MDPI, vol. 15(12), pages 1-13, December.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. World Bank, 2008. "Sri Lanka : Addressing the Needs of an Aging Population," World Bank Publications - Reports 8105, The World Bank Group.
    2. Burggraf, Christine & Teuber, Ramona & Brosig, Stephan & Glauben, Thomas, 2015. "Economic growth and the demand for dietary quality: Evidence from Russia during transition," Economics & Human Biology, Elsevier, vol. 19(C), pages 184-203.
    3. Leowski, Jerzy & Krishnan, Anand, 2009. "Capacity to control noncommunicable diseases in the countries of South-East Asia," Health Policy, Elsevier, vol. 92(1), pages 43-48, September.
    4. Anne Maryse Pierre-Louis & Katherina Ferl & Christina Dinh Wadhwani & Neesha Harnam & Montserrat Meiro-Lorenzo, 2014. "Setting the Stage to Address the Dual Challenge of MDGs and NCDs," Health, Nutrition and Population (HNP) Discussion Paper Series 100278, The World Bank.
    5. World Bank, 2010. "Meeting the Challenges of Health Transition in the Middle East and North Africa : Building Partnerships for Results - Time for Strategic Action," World Bank Publications - Reports 12986, The World Bank Group.
    6. Dean Jamison & Prabhat Jha & David E. Bloom, 2008. "Disease Control," PGDA Working Papers 3508, Program on the Global Demography of Aging.
    7. Mayer-Foulkes David A. & Pescetto-Villouta Claudia, 2012. "Economic Development and Non-Communicable Chronic Diseases," Global Economy Journal, De Gruyter, vol. 12(4), pages 1-44, December.
    8. Akin Ojagbemi & Toyin Bello & Zhehui Luo & Oye Gureje, 2017. "Living Conditions, Low Socioeconomic Position, and Mortality in the Ibadan Study of Aging," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 72(4), pages 646-655.
    9. Alexander Bischoff & Tetanye Ekoe & Nicolas Perone & Slim Slama & Louis Loutan, 2009. "Chronic Disease Management in Sub-Saharan Africa: Whose Business Is It?," IJERPH, MDPI, vol. 6(8), pages 1-13, August.
    10. Babashahi, Saeideh & Hansen, Paul & Sullivan, Trudy, 2021. "Creating a priority list of non-communicable diseases to support health research funding decision-making," Health Policy, Elsevier, vol. 125(2), pages 221-228.
    11. Szlezák, Nicole A & Bloom, Barry R. & Jamison, Dean T. & Keusch, Gerald T. & Clark, William C. & Moon, Suerie & Michaud, Catherine M., 2010. "The Global Health System: Actors, Norms, and Expectations in Transition," Scholarly Articles 5341871, Harvard Kennedy School of Government.
    12. Iga Rudawska, 2013. "Chronic Diseases Burden on the Economy—A Problem Reaching Beyond Health Care," Ekonomia journal, Faculty of Economic Sciences, University of Warsaw, vol. 32.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0068219. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.