Assessing cardiovascular disease vulnerability in India: a spatially disaggregated index-based framework

In this study, we develop a district-level vulnerability index for cardiovascular diseases in India, addressing the persistent public health challenges posed by socioeconomic, environmental, and infrastructural disparities. Drawing on 26 indicators across seven domains, viz., socioeconomic, physiological, behavioural, healthcare, dietary, and environmental (both indoor and outdoor), we sourced data from the National Family Health Survey-5, Rural Health Statistics 2021-22, and satellite datasets. After preprocessing, curating, and integrating these datasets to a uniform scale, we applied a one-common-factor model to derive weights for each indicator for calculating domain scores. These domain scores were then computed and aggregated into an overall vulnerability score, assigning equal weight to each domain. Further to understand the spatial patterns, we employed Global Moran’s I and Anselin’s Local Moran’s I statistics. The results highlight noticeable vulnerability in eastern and northeastern districts, including Kolkata, Haora, Kamrup Metropolitan, and Paschim Barddhaman, primarily due to degraded air quality, inadequate healthcare access, and suboptimal dietary practices. In contrast, districts in hilly and western regions, such as Bageshwar, Barmer, Rudraprayag, Chamba, Agar Malwa, and Pali, demonstrate lower vulnerability, supported by favourable air quality indices, nutritious diets, and physically active lifestyles influenced by rugged terrain. Global Moran’s I yielded a value of 0.636 (Z = 27.17, pseudo p-value = 0.001), indicating strong spatial autocorrelation, while local analysis revealed high-high clusters in the east and low-low clusters in western and hilly areas. It is important to note that this index captures potential future vulnerability based on current structural, environmental, and behavioural risk conditions, rather than reflecting actual current disease burden. This index provides a valuable framework for pinpointing and addressing CVD vulnerabilities at the local level, underscoring the imperative for tailored public health strategies and interventions by policymakers and researchers.