Undiagnosed hypertension and its associated factors in India: A rural-urban contrast from the National Family Health Survey (2019-21)

Undiagnosed hypertension extracts significant social cost, with money spent on complications already accounting for one-fifths of total health expenditure. Widespread socioeconomic disparities and inequity in health care access between rural and urban areas is expected. It is important to identify the different factors associated with undiagnosed hypertension in the working age population (15-49-years) residing in urban and rural areas, both of whom are vital to the economic development of our country. Data from the National Family Health Survey-5 (2019-21) for men and women aged 15-49 years was extracted and analysed. Operational definitions were prepared to identify known and undiagnosed hypertension. Distribution of undiagnosed hypertension according to sociodemographic, anthropometric and health-related behaviour was studied using frequencies and weighted proportions. Choropleth maps were used to depict state-wise distribution of undiagnosed hypertension. Multivariable logistic regression was used to find risk factors and protective factors for undiagnosed hypertension for men and women in rural and urban areas. The prevalence of undiagnosed hypertension was 11.7%. among men and 7.2% among women. The proportion of men with undiagnosed hypertension (66.3%) was significantly higher than the proportion of women (41.4%). Urban-rural differences were noted in various states. Education and empowerment of rural women through provision of means of socioeconomic enhancement and strengthening of community-based screening and referral under the national programme were some of the major policy implications of our findings. Future research is warranted in areas such as health insurance coverage, working away from home, owning a mobile telephone and other interventions to improve health-seeking behaviour in the rural areas.