Trends and socioeconomic-spatial inequalities in hypertension among Muslim women in India, 2015-2021: evidence from the National Family Health Surveys.
Hypertension is a growing public health concern in India, but little is known about how socioeconomic and spatial inequalities shape hypertension risk within religious minority populations. This study examines trends and inequalities in hypertension among Muslim women aged 15-49 years in India.
The analysis uses nationally representative data from NFHS-4 (2015-16) and NFHS-5 (2019-21). Hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg, or current use of antihypertensive medication. Weighted prevalence estimates, Poor-Rich ratios, Concentration Indices, survey-weighted logistic regression models, Moran's I, and LISA statistics were used to assess socioeconomic and spatial inequalities.
Hypertension prevalence among Muslim women increased from 12.11% in NFHS-4 to 12.52% in NFHS-5. A strong age gradient persisted: compared with women aged 15-19 years, women aged 40-49 years had substantially higher adjusted odds of hypertension in both NFHS-4 (OR = 9.19) and NFHS-5 (OR = 8.33). In NFHS-5, higher education was associated with lower odds of hypertension (OR = 0.65; 95% CI: 0.50-0.84), while women in the fourth and richest wealth quintiles had higher odds than the poorest quintile (OR = 1.51; 95% CI: 1.22-1.86 and OR = 1.37; 95% CI: 1.07-1.74, respectively). Concentration Index values remained positive for several subgroups, including secondary-educated women (0.104 to 0.125) and employed women (0.042 to 0.123), indicating continued concentration among relatively better-off groups. District-level spatial clustering was statistically significant among Muslim women, with Moran's I increasing from 0.111 in NFHS-4 to 0.210 in NFHS-5 (p < 0.001).
Hypertension among Muslim women is socially and spatially patterned, with evidence of age-related risk, shifting wealth gradients, and persistent geographic clustering. The findings highlight the need for hypertension screening and prevention strategies that account for socioeconomic position, minority status, and subnational spatial inequality.
The analysis uses nationally representative data from NFHS-4 (2015-16) and NFHS-5 (2019-21). Hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg, or current use of antihypertensive medication. Weighted prevalence estimates, Poor-Rich ratios, Concentration Indices, survey-weighted logistic regression models, Moran's I, and LISA statistics were used to assess socioeconomic and spatial inequalities.
Hypertension prevalence among Muslim women increased from 12.11% in NFHS-4 to 12.52% in NFHS-5. A strong age gradient persisted: compared with women aged 15-19 years, women aged 40-49 years had substantially higher adjusted odds of hypertension in both NFHS-4 (OR = 9.19) and NFHS-5 (OR = 8.33). In NFHS-5, higher education was associated with lower odds of hypertension (OR = 0.65; 95% CI: 0.50-0.84), while women in the fourth and richest wealth quintiles had higher odds than the poorest quintile (OR = 1.51; 95% CI: 1.22-1.86 and OR = 1.37; 95% CI: 1.07-1.74, respectively). Concentration Index values remained positive for several subgroups, including secondary-educated women (0.104 to 0.125) and employed women (0.042 to 0.123), indicating continued concentration among relatively better-off groups. District-level spatial clustering was statistically significant among Muslim women, with Moran's I increasing from 0.111 in NFHS-4 to 0.210 in NFHS-5 (p < 0.001).
Hypertension among Muslim women is socially and spatially patterned, with evidence of age-related risk, shifting wealth gradients, and persistent geographic clustering. The findings highlight the need for hypertension screening and prevention strategies that account for socioeconomic position, minority status, and subnational spatial inequality.