Comparing socioeconomic inequalities across hypertension and diabetes care cascades in Bangladesh: a cross-sectional analysis of the 2022 Bangladesh Demographic and Health Survey

Background: Hypertension and diabetes are major public health challenges in Bangladesh, placing significant strain on the health system. This study used the care cascade framework to compare health system performance for both conditions and assess associated socioeconomic disparities. Methods: This cross-sectional study analysed data from the Bangladesh Demographic and Health Survey 2022, including adults aged ≥18 years with biomarker measurements (n=14,296 for hypertension; n=13,980 for diabetes). Five-stage care cascades (prevalence, screening, diagnosis, treatment, control) were constructed for each condition. Survey-weighted descriptive and multivariable logistic regression were performed. Results: The weighted prevalence estimates were 22.1% for hypertension and 16.9% for diabetes. Both cascades revealed substantial attrition, but at different stages. For hypertension, screening was relatively high (78.3%), yet only 57.7% were diagnosed. Among diagnosed adults, 71.4% were receiving treatment, and among treated adults, 43.3% achieved blood pressure control. For diabetes, the main gap occurred at the initial stage of care: only 33.6% of adults had ever undergone blood glucose measurement, 33.5% of adults with diabetes had been diagnosed, 73.7% of diagnosed individuals received treatment, and 21.7% of treated individuals achieved glycaemic control. Socioeconomic disparities were evident, particularly for diabetes. Compared with the poorest, the richest had higher odds of diabetes screening (aOR 3.2, 95% CI: 2.7-3.9), diagnosis (aOR 3.0, 95% CI: 1.8–4.8), and treatment (aOR 5.0, 95% CI: 2.2–11.4), as well as hypertension screening (aOR 2.2, 95% CI: 1.7–3.0). Higher education was associated with a twofold increase in blood pressure control compared with no education, and improved screening and diagnosis for both conditions. Conclusion: Hypertension and diabetes care in Bangladesh show different system gaps, indicating that a uniform approach to non-communicable disease care is inadequate. Hypertension care is constrained mainly after screening, while diabetes care is limited by low screening and diagnosis. Both cascades show socioeconomic inequalities, particularly affecting poorer and less educated adults. Policies should prioritise disease-specific primary care strategies, integrated and targeted screening, affordable diagnostics and medicines, pro-poor financing, and targeted outreach for disadvantaged groups. Trial registration: Not applicable.