Household Clustering of Hypertension and Diabetes Drives India's NCD Burden, Finds NFHS-5 Study

While India has seen a rising prevalence of non-communicable diseases (NCDs) like hypertension and diabetes, little was known about how these conditions might affect multiple members within the same household. This research aimed to fill that gap by analyzing data from the fifth round of the National Family Health Survey (NFHS-5, 2019–21), covering individuals aged 15 years and older across all 707 Indian districts. In this context, “clustering” was defined as having two or more household members diagnosed with the same condition.

The following were the key findings of the study:

• 14.9% of Indian households exhibited clustering of hypertension, contributing to about 50% of the country’s total hypertension cases.
• 7.7% of households showed clustering of diabetes, accounting for nearly 39.3% of total diabetes cases.
• Clustering was more common in wealthier, urban households.
• Households with a larger number of older members or individuals who were overweight or obese had higher clustering rates.
• Higher consumption of fried foods and fish was associated with an increased likelihood of clustering.
• Multi-level analysis indicated that community-level factors had the strongest influence on clustering.
• Certain districts demonstrated particularly high levels of clustering, highlighting the need for targeted and district-specific interventions.

Despite the study’s robust dataset, there were some limitations. Diabetes diagnosis relies on random blood glucose measurements, which are less reliable than HbA1c or fasting blood glucose levels. Additionally, BMI data were only available for women, and dietary intake information was self-reported, potentially introducing recall bias.

Still, the study’s results carry significant implications for India’s health policies. The authors stress the value of household-focused screening and management interventions to improve the detection and treatment of these NCDs. Such strategies could be critical for advancing toward Sustainable Development Goal (SDG) 3.4, which focuses on reducing premature mortality from NCDs.

Furthermore, the research team recommends improvements to future NFHS surveys, including the collection of more comprehensive data on diet, physical activity, and the timing of disease onset. The study also offers a model for other low- and middle-income countries to better understand how NCDs cluster within families and communities.

The authors concluded, "By identifying key risk factors and regional patterns, this work provides actionable insights for more effective public health interventions and policy design aimed at tackling the growing burden of hypertension and diabetes in India."

Reference:

Pedgaonkar SP, Kumar K, Meitei WB, Kumar S, Upadhyay AK, Maurer J, et al. (2025) Clustering of hypertension and clustering of diabetes within households across districts of India: A cross-sectional analysis using a nationally representative household survey. PLOS Glob Public Health 5(6): e0004648. https://doi.org/10.1371/journal.pgph.0004648