Introduction
Non-communicable diseases (NCDs) accounted for more than 50 million deaths worldwide (equivalent to 70% of all deaths) in 2015 [1]. Since the past few decades, cardiovascular diseases have consistently ranked among the top causes of death worldwide [2]. More specifically, hypertension has been ranked as a leading risk factor for premature mortality and health loss, mostly from ischemic heart disease and stroke [3]. In the 20th century, NCDs such as cardiovascular diseases were mostly a concern in developed countries [4]. However, NCDs are now causing a large number of deaths worldwide, irrespective of whether the country is developed or developing. Cardiovascular disease (CVD) is identified as the predominant factor leading to mortality in women across developed and developing nations, among all NCDs. Several studies have indicated that women exhibit a higher propensity to manifest multiple metabolic risk factors, thereby contributing to a heightened prevalence of Non-Communicable Diseases (NCDs) among them. The presence of hypertension serves as well established, prevalent, and modifiable risk factor associated with cardiovascular diseases [3, 5-7].
In India, the prevalence of hypertension was reported to be close to 27% in both the sexes (which could be higher than some of the neighboring countries) [8, 9]. Furthermore, the risk of developing hypertension in India has been reported to be 6 to 8 times higher in elderly individuals and 2 to 3 times higher amongst those aged 35 to 59 years compared to those in the 20 to 34-year-old age group [9]. Also, hypertension and hemorrhage have been identified as leading causes of death among reproductive-agewomen in India [10]. Less than 10% of Indian men and women are aware of their hypertensive condition, while the majority remain unidentified. Among those with hypertension, more than half have been reported to actively seek treatment [9-11].Studies have also found that in India, almost a fifth of the women of reproductive age have undiagnosed hypertension with profound regional differences (e.g. 17% and 22% in rural andurban areas respectively [11]. Also, the contribution of pregnancy-induced hypertension to maternal mortality is likely underestimated [12].
Much of the research on hypertension prevalence, determinants, and prevention has focused on individuals in developed countries. Also, hypertension control programs predominantly target the elderly population, thus overlooking the early screening of other vulnerable groups like women, especially those of reproductive age [13-16]. In this study, we investigated the factors that affect hypertension-related treatment-seeking behavior among women in India. Also, we explored the variation in hypertension prevalence among women in the reproductive age group and its association with age groups and socioeconomic status. We utilized data from the 2019–2020 National Family Health Survey (NFHS-5), India focusing on women of reproductive age.
Methods
Ethical considerations
The study does not include any identifiable information about the participants involved in the survey since it utilizes secondary data. The dataset used in the study is readily accessible from the public domain for research purposes. Therefore, approval through an institutional review board is not required.
Study Design and Sampling
The study uses the secondary data derived from the NFHS-5 conducted in 2019–2020. The data was synchronized from the latest fifth NFHS survey in the series. It involves a representative sample of households throughout India. The NFHS was conducted first time in 1991. To date, a total of five rounds of NFHS have been conducted by the Government of India.
The survey provides vital data on populations, housing and socio-economic variables. It also shines a light on crucial indicators like infant and child mortality, fertility, family planning, anemia, nutrition, morbidity, women's empowerment, maternal and child health, and domestic violence. This information is provided for both the entire country and discretely for every State/Union Territory in India. In NFHS-4 (2015–2016), it was the first time that information on emerging health issues, and non-communicable diseases like hypertension and diabetes mellitus,