Dynamics of chronic diseases in metro and non-metro regions of India: evidence from India Human Development Survey I and II

Shobhit Srivastava, Tarique Anwar, Ratna Patel, Shekhar Chauhan


Background: The growth of metropolitan cities had significantly contributed to the process of urbanization in India. About two-fifth of the urban population, out of total India’s urban population, live in 35 metropolitan cities. It is important to look into the disease dynamics in the population of metro and non-metro regions of India. The study aims to find the differences in the distribution of chronic diseases in metro and non-metro regions of India and depicts the contributions of background factors causing a change in the prevalence of chronic diseases in metro and non-metro regions of India.

Methods: Data from India Human Development Survey (IHDS) I and II conducted in 2004 and 2012 respectively have been used. Bivariate analysis has been performed to find the association between independent variables and chronic diseases, and logistic regression has been used to find the effect of predictor variables on chronic diseases by metro and non-metro regions. Fairlie decomposition technique has been used to find the contribution of each predictor variable accounting for differences in chronic diseases between metro and non-metro regions.  

Results: Age, sex, socio-economic status (education and wealth), alcohol consumption, tobacco consumption, and body mass index status are significantly associated with chronic conditions in metro regions of India. Age, wealth, and developed regions contributed most to the differences in chronic diseases between metro and non-metro areas.

Conclusions: Metro regions in India suffers from a massive burden of chronic conditions. Metro regions should be given a special focus to tackle the menace of chronic diseases.



Decomposition, Chronic condition, India, Metro regions

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Kumar D, Navodaya AR. Urbanization process, trend, pattern and its consequences in India. Neo Geographia. 2014;3.

Bhagat RB, Mohanty S. Emerging pattern of urbanization and the contribution of migration in urban growth in India. Asian Population Studies. 2009;5(1):5-20.

Srivastava S, Khan A. Globalization and Development in Contemporary India: Cultural Perspective. Int J Soc Sci Stud. 2016;4:18.

Godfrey R, Julien M. Urbanisation and health. Clin Med. 2005;5(2):137.

Singh PN. Chronic disease burden in rural India attributable to diet, obesity, and tobacco use. J Postgraduate Med. 2011;57(1):1.

Reddy KS, Shah B, Varghese C, Ramadoss A. Responding to the threat of chronic diseases in India. Lancet. 2005;366 (9498):1744-9.

Campbell T, Campbell A. Emerging disease burdens and the poor in cities of the developing world. J Urban Health. 2007;84(1):54-64.

Gowda MJ, Bhojani U, Devadasan N, Beerenahally TS. The rising burden of chronic conditions among urban poor: a three years follow-up survey in Bengaluru, India. BMC Health Services Res. 2015;15(1):330.

Agarwal S. The state of urban health in India; comparing the poorest quartile to the rest of the urban population in selected states and cities. Environment Urbanization. 2011;23(1):13-28.

Galea S, Vlahov D. Urban health: evidence, challenges, and directions. Annu Rev Public Health. 2005;26:341-65.

Jenkins KR, Ofstedal MB. The association between socioeconomic status and cardiovascular risk factors among middle-aged and older men and women. Women Health. 2014;54(1):15-34.

Vlahov D, Gibble E, Freudenberg N, Galea S. Cities and health: history, approaches, and key questions. Academic Med. 2004;79(12):1133-8.

Steyn K, Damasceno A. Lifestyle and related risk factors for chronic diseases. Disease Mortality Sub-Saharan Africa. 2006;2:247-65.

Australian Institute of Health. Australia's health 2012: the thirteenth biennial health report of the Australian Institute of Health and Welfare. AIHW; 2012.

Bovet P, Ross AG, Gervasoni JP, Mkamba M, Mtasiwa DM, Lengeler C, et al. Distribution of blood pressure, body mass index and smoking habits in the urban population of Dar es Salaam, Tanzania, and associations with socioeconomic status. Int J Epidemiology. 2002;31(1):240-7.

Desai S, Vanneman R. National Council of Applied Economic Research, New Delhi. India Human Development Survey (IHDS), 2005. Ann Arbor, MI: Inter-university Consortium for Political and Social Research (distributor); 2018:8.

Parmar MC, Saikia N. Chronic morbidity and reported disability among older persons from the India Human Development Survey. BMC Geriatrics. 2018;18(1):299.

Oxaca R. Male-Female wage differentials in urban labour markets. Int Economic Review. 1973;14(3):693-709.

Fairlie RW. An extension of the Blinder-Oaxaca decomposition technique to logit and probit models. Journal of economic and social measurement. 2005;30(4):305-16.

Kumar S, Pradhan MR, Singh AK. Chronic Diseases and their Association with Disability among the Elderly in India. Social Sci Spectrum. 2017;3(1):27-37.

Halter JB, Musi N, Horne FM, Crandall JP, Goldberg A, Harkless L, et al. Diabetes and cardiovascular disease in older adults: current status and future directions. Diabetes. 2014;63(8):2578-89.

Prieto CD, Saez PM, Fernandez BC. Social isolation and multiple chronic diseases after age 50: a European macro-regional analysis. PloS one. 2018;13(10).

Lennep RJE, Westerveld HT, Erkelens DW, Wall VEE. Risk factors for coronary heart disease: implications of gender. Cardiovascular Res. 2002;53(3):538-49.

Paulsen MS, Andersen M, Munck AP, Larsen PV, Hansen DG, Jacobsen IA, et al. Socio-economic status influences blood pressure control despite equal access to care. Family Practice. 2012;29(5):503-10.

Psaltopoulou T, Hatzis G, Papageorgiou N, Androulakis E, Briasoulis A, Tousoulis D. Socioeconomic status and risk factors for cardiovascular disease: impact of dietary mediators. Hellenic J Cardiology. 2017;58(1):32-42.

Tareque MI, Koshio A, Tiedt AD, Hasegawa T. Are the rates of hypertension and diabetes higher in people from lower socioeconomic status in Bangladesh? Results from a nationally representative survey. PloS one. 2015;10(5).

Indian Council of Medical Research, Public Health Foundation of India, I. for H. M. and E India: Health of the Nation’s States: The India State-Level Disease Burden Initiative. Govt Report; 2017:27-31.

Nethan S, Sinha D, Mehrotra R. Non communicable disease risk factors and their trends in India. Asian Pacific J Cancer Prevention: APJCP. 2017;18(7):2005.

Vellakkal S, Subramanian SV, Millett C, Basu S, Stuckler D, Ebrahim S. Socio-economic inequalities in non-communicable diseases prevalence in India: disparities between self-reported diagnoses and standardized measures. PloS one. 2013;8(7).

Fagard RH. Smoking amplifies cardiovascular risk in patients with hypertension and diabetes. Diabetes Care. 2009;32(2):429-31.

Primatesta P, Falaschetti E, Gupta S, Marmot MG, Poulter NR. Association between smoking and blood pressure: evidence from the health survey for England. Hypertension. 2001;37(2):187-93.

Puddey IB, Vandongen R, Beilino LJ, English DR, Ukich AW. The effect of stopping smoking on blood pressure: a controlled trial. J Chronic Diseases. 1985;38(6):483-93.

Maheswaran R, Gill JS, Davies P, Beevers DG. High blood pressure due to alcohol. A rapidly reversible effect. Hypertension. 1991;17(6-1):787-92.

Carlsson S, Hammar N, Grill V, Kaprio J. Alcohol consumption and the incidence of type-2 diabetes: a 20 years follow-up of the Finnish twin cohort study. Diabetes Care. 2003;26(10):2785-90.

Knott C, Bell S, Britton A. Alcohol consumption and the risk of type-2 diabetes: a systematic review and dose-response meta-analysis of more than 1.9 million individuals from 38 observational studies. Diabetes Care. 2015;38(9):1804-12.

Pearson TA. Alcohol and heart disease. Circulation. 1996;94(11):3023-5.

Puddey IB, Beilin LJ. Alcohol is bad for blood pressure. Clinical Experimental Pharmacol Physiology. 2006;33(9):847-52.

Khan MZ. Mechanism linking diabetes mellitus and obesity. Diabetes Metab Syndr Obes. 2014:587-91.

Narkiewicz K. Obesity and hypertension the issue is more complex than we thought. Nephrology Dialysis Transplantation. 2006;21(2):264-7.

Rao M, Barten F, Blackshaw N, Lapitan J, Galea G, Jacoby E, et al. Urban planning, development and non-communicable diseases. Planning Practice Res. 2011;26(4):373-91.