Linkages between climatic, environmental, sociodemographic and behavioural factors with morbidity among women in urban India

Urban morbidity among women in India is influenced by exposure to ambient and household indoor air pollution (HIAP), environmental and climatic factors, and sociodemographic and behavioural factors, yet the combined association of these factors remains underexplored. This study aims to examine the prevalence, clusters, and associations between environmental, climatic, sociodemographic and behavioural indicators and morbidity using an urban cluster-level dataset from the National Family Health Survey, fifth round (NFHS-5), and a gridded dataset from NASA. This study analysed a total of 153,980 urban women employing chi-square test, logistic regression, Moran’s I, cluster-outlier analysis, and bivariate LISA (biLISA). This study revealed that the prevalence of morbidity in urban areas is higher among women residing in lower-altitude, higher-temperature, and higher-rainfall areas, and among those exposed to both ambient and indoor air pollution. Further, it examined the significant association between climatic, environmental sociodemographic and behavioural factors with morbidity reflecting, higher temperature (> 25 °C; AOR = 1.119, CI: 1.057–1.185), rainfall (> 150 mm; AOR = 1.088, CI: 1.045–1.132), PM 2.5 concentration (> 40 µg/m 3 ; AOR = 1.243, CI: 1.185–1.305), and HIAP (AOR = 1.093, CI: 1.026–1.164) were significantly associated with the odds of morbidity, whereas residence at higher altitude (> 200 m; AOR = 0.794, CI: 0.765–0.824) had less likelihood of morbidity. The likelihood of urban morbidity is also substantially higher among women aged 40–49 years, women with overweight, tobacco users, alcohol consumers, and from higher wealth groups. The cluster analysis shows morbidity hotspots are located in northern, eastern, central, and southern India, and the biLISA also shows a similar pattern for rainfall, temperature, PM2.5, and HIAP, which exhibit positive directionality with morbidity local clustering. This study integrates satellite-derived climatic and environmental indicators with nationally representative NFHS-5 data to examine spatial patterns and correlates of morbidity among urban women in India. These findings highlight that integrated public health strategies addressing environmental risk reduction, behavioural interventions, and equitable healthcare access are essential to reduce morbidity among women and improve urban health.