Socioeconomic and sex disparities in hypertension and diabetes mellitus care cascade among tribal populations in Odisha, India: findings from the Odisha Tribal Family Health Survey (OTFHS), 2022–23

BACKGROUND: We assessed sex and socioeconomic disparities in the care cascade, i.e., awareness, treatment, and control (ATC), for hypertension and diabetes among Odisha's tribal communities. METHODS: We surveyed 14 tribal districts via multistage cluster sampling covering 10,090 households from 2022 to 23. Data from individuals aged > 18 years were analyzed for hypertension (BP > 140/90 mmHg) and diabetes (RBS > 200 mg/dL). The outcomes included (i) awareness (prior diagnosis or medication use), (ii) treatment (self-reported medication use), and (iii) control (BP < 140/90 mmHg for hypertension, RBS < 180 mg/dL for diabetes). Multivariable log-binomial regression was used to estimate adjusted prevalence ratios (aPRs with 95% CIs) for gender and wealth quintile associations with ATC stages. RESULTS: Of the 21,100 participants, 33.7% had hypertension and 9.7% had diabetes. Among the 6,620 hypertensive individuals, 19% were aware, 13·8% were on treatment, and 6·8% had controlled BP. Women with hypertension (N = 3,609) had significantly better outcomes than men did: awareness (aPR: 1·4;1·2-1·6), treatment (aPR: 1·5; 1·2-1·7), and control (aPR: 1·7; 1·4-2·2). Compared with those in the poorest quintile, hypertensive individuals from the richest quintile (N = 1,804) were more likely to be aware (aPR: 1·5; 1·2-1·9) and on treatment (aPR: 1·5; 1·2-2·7); however, BP control was not significantly different (aPR: 1·6; 0·9-2·8). Among the 1,883 individuals with diabetes, 49% were aware, 44·4% were on treatment, and 40·7% achieved control. CONCLUSION: Significant socioeconomic and sex inequities persist in hypertension care among Odisha's tribal populations, with better ATC outcomes for women and wealthier individuals. Targeted screening and gender-sensitive approaches are essential for equitable healthcare access.