Care cascades of diabetes and hypertension among late adolescents in India

Abstract

BACKGROUND: Diabetes and hypertension are the most prevalent morbidities in India and are quickly becoming common among the younger age groups. Adolescents aged 10-19 years, accounting for one-fifth of the country's population, are at an increasing risk of developing these conditions. We aim to examine the prevalence, awareness, treatment, and control (ATC) of diabetes and hypertension among late adolescents (15-19 years) in India. METHODS: We used microdata of 204 346 late adolescents from India's fifth round of the National Family and Health Survey, 2019-21. We defined hypertensive adolescents as those diagnosed with hypertension or those with a systolic blood pressure (BP) measurement of ≥130 mm Hg, diastolic BP measurements of levels ≥80 mm Hg, or those who used medication to lower BP at the time of the survey. Diabetic adolescents were those diagnosed as such by health professionals, those with glucose levels above 140 mg/dL, or those taking any medication to control high blood glucose levels at the time of the survey. We estimated the age-sex-adjusted prevalence of both conditions and their ATC rates, referred to as cascade care. We used the Erreygers' Concentration Index to examine the socioeconomic inequality in cascade care. We used multivariable logistic regression to estimate the average marginal effects while controlling for sociodemographic characteristics. RESULTS: Of 204 346 late adolescents, 27.8% (95% confidence interval (CI) = 27.6, 28.2) had either of the two conditions, with 3.5% (95% CI = 3.4, 3.6) being diabetic and 24.3% (95% CI = 24.0, 24.6) having hypertension. The ATC rate of diabetes was 13.5% (95% CI = 12.4, 14.7), 13.1% (95% CI = 11.9, 14.2), and 12.1% (95% CI = 11.0, 13.3), respectively. For hypertension, the ATC rate was extremely low at 6.2% (95% CI = 5.8, 6.5), 3.5% (95% CI = 3.3, 3.7), and 3.3% (95% CI = 3.1, 3.5), respectively. There was a pro-rich socioeconomic inequality in the prevalence of hypertension and a pro-poor inequality in the prevalence of diabetes among late adolescents. We observed significant variations in both conditions across the regions of India. CONCLUSIONS: The high prevalence and low care cascade levels of diabetes and hypertension among late adolescents in India are concerning. A multipronged strategy that includes screening, diagnosis, and timely interventions at school and home can reduce the burden of hypertension and diabetes among the prospective workforce in India. Sensitising adolescents through school curricula under the New Education Policy (2020) is recommended to reduce the burden of these conditions. We also recommend that longitudinal and intervention studies focussed on this age group be undertaken in the future to help reduce the disease burden.