Hypertension among the Elderly in Rural India: Who Bears the Distance Cost of Public Primary Healthcare?

Hypertension is one largest contributor to burden of disease and mortality in India (stroke, ischemic heart disease, renal diseases) with a higher prevalence in urban areas and among the elderly. As India's population is aging and detrimental lifestyle factors (food habits, sedentary lifestyle) are becoming more prevalent in the population, raising awareness and improving the access to care and control will be central in order for India to achieve SDG 3.4 (reduce premature mortality from NCDs). The Indian Health Control Initiative, launched in 2018-19 with the aim to improve the control of hypertension has now been expanded to 138 districts in 26 states and has raised the awareness among patients and the number of visits for hypertension control. As the program relies on public primary health facilities, this paper looks at the way access to public primary care services (sub-centers, PHCs, CHCs) can affect the detection of hypertension in the rural population. Does the geographic distance to public primary care facilities impact the detection of hypertension in rural areas? Does it differ depending on wealth or on how physically mobile people are? We look at 1502 villages and more than 15000 people aged 45 and above from the LASI (The Longitudinal Ageing Study in India) cohort. 42% of the study group suffer from hypertension and only 54% of them are aware of their condition. Detection increased with wealth quintiles as distance to public primary care facilities is also better for wealthier quintiles. After controlling for individual, households and village specific covariates and the impact of public primary care access between poor and non-poor within the same village, we can conclude that improving access to public primary care facilities for the poor elderly is crucial for improving the early detection of hypertension.