Abstract
Objective: Cardio-vascular Diseases (CVDs) are a leading cause of death and disease burden across the world, and the burden is only expected to increase as the population ages. The objective of this paper is to explore the patterns of CVD risk factors among women in the late reproductive ages (35-49 years) across 640 districts in India, and investigate the association between area-level socioeconomic factors and CVD risk patterns., using a nationally representative sample of 239,729 women aged 35–49 years from all 36 States/UTs under NFHS-4 (2015–16). Methods: Age-standardized prevalence of CVDs have been calculated, along with 95% CI among women in their late reproductive ages (35–49 years) in India. The spatial dependence and clustering of CVD burden has been examined by Moran's I indices, bivariate Local Indicator of Spatial Autocorrelation (LISA) cluster and significance maps. Ordinary Least Square (OLS) regression has been employed with CVD prevalence as the outcome variable. To consider for spatial dependence, Spatial Autoregressive (SAR) models have been fitted to the data. Diagnostic tests for spatial dependence have also been carried out to identify the best fit model. Results: Higher values of Moran's I imply high spatial autocorrelation in CVD among districts of India. Smoking, alcohol consumption, hailing from a Scheduled Caste background, more than 10 years of schooling, as well as urban places of residence appeared as significant correlates of CVD prevalence in the country. The spatial error model and the spatial lag model are a marked improvement over the OLS model; among the two, the spatial error model emerging to be the most improved of the lot. Conclusions: A broader course of policy action relating to social determinants can be a particularly effective way of CVD risk addressal. Social policy interventions related to health like reduction in inequalities in factors like education, poverty, unemployment, access to health-promoting physical or built-environments are crucial in tackling the long-term effects of CVD inequalities between geographical areas.