Unequal health outcomes: Wealth-based inequalities in major non-communicable diseases among reproductive-age women in North India
India’s non-communicable disease burden has increased rapidly, but chronic conditions remain unevenly distributed across socioeconomic groups. This study examines wealth-related disparities in four major outcomes: anaemia, diabetes, thyroid disorder, and high blood pressure among women aged 15–49 years in six North Indian states: Uttar Pradesh, Uttarakhand, Himachal Pradesh, Haryana, Punjab, and Rajasthan. Using nationally representative data from the National Family Health Survey (NFHS)-4 (2015–2016) and NFHS-5 (2019–2021), women are grouped into low, middle, and high wealth categories based on the NFHS wealth index. Multivariable logistic regression models are used to estimate the relationship between socioeconomic position and disease outcomes. Wealth-related inequality is clearly condition-specific and varies across states. Anaemia remains concentrated among women in the Poor wealth category and predominantly rural women, pointing to persistent nutritional and health-service deficits. By contrast, diabetes and high blood pressure are more common among older and relatively better-off women, with some urban concentration. Thyroid disorder shows a more mixed wealth gradient. Overall, the evidence points to a continuing double burden in which deprivation-related and cardiometabolic risks coexist among women in North India. The study highlights the need for state-specific and equity-sensitive strategies that combine nutrition interventions with early detection and long-term management of chronic conditions.
Bashir, K., Qurieshi, M. A., & Haq, I. (2025). Features of Goiter and Links with Iodine Deficiency: Indian Perspectives. In Handbook of Public Health Nutrition (pp. 1–21). Springer, Cham. https://doi.org/10.1007/978-3-031-32047-7_128-1
Bauer, G. R. (2014). Incorporating intersectionality theory into population health research methodology: Challenges and the potential to advance health equity. Social Science and Medicine, 110, 10–17. https://doi.org/10.1016/j.socscimed.2014.03.022
Belwal, E., Pandey, S., & Sarkar, S. (2021). Anemia Prevalence in India Over Two Decades: Evidence from National Family Health Survey (NFHS). International Journal of Science and Healthcare Research, 6, 335–340. https://doi.org/10.52403/ijshr.20211046
Christensen, V. T., & Carpiano, R. M. (2014). Social class differences in BMI among Danish women: Applying Cockerham’s health lifestyles approach and Bourdieu’s theory of lifestyle. Social Science and Medicine, 112, 12–21. https://doi.org/10.1016/j.socscimed.2014.04.017
Cockerham, W. C. (2005). Health Lifestyle Theory and the Convergence of Agency and Structure. Journal of Health and Social Behavior, 46(1), 51–67. https://doi.org/10.1177/002214650504600105
Cockerham, W. C., D. Wolfe, J., & Bauldry, S. (2019). Health Lifestyles in Late Middle Age. Research on Aging, 42(1), 34–46. https://doi.org/10.1177/0164027519884760
Daar, A. S., Singer, P. A., Persad, D. L., Pramming, S. K., Matthews, D. R., Beaglehole, R., Bernstein, A., Borysiewicz, L. K., Colagiuri, S., Ganguly, N., Glass, R. I., Finegood, D. T., Koplan, J., Nabel, E. G., Sarna, G., Sarrafzadegan, N., Smith, R., Yach, D., & Bell, J. (2007). Grand challenges in chronic non-communicable diseases. Nature, 450(7169), 494–496. https://doi.org/10.1038/450494a
Details of Anemia Mukt Bharat | Ministry of Health and Family Welfare | GOI. (n.d.). Retrieved January 15, 2026, from https://www.mohfw.gov.in/?q=en/pressrelease-8
Dinsa, G. D., Goryakin, Y., Fumagalli, E., & Suhrcke, M. (2012). Obesity and socioeconomic status in developing countries: A systematic review. Obesity Reviews, 13(11), 1067–1079. https://doi.org/10.1111/j.1467-789X.2012.01017.x
Fatima, S., & Mahmood, S. (2021). Combatting a silent killer – the importance of self-screening of blood pressure from an early age. EXCLI Journal, 20, 1326–1327. https://doi.org/10.17179/excli2021-4140
Giridharan, S., Bhandari, Y., Halder, P., Sharma, D., Gupta, M., & Kiran, T. (2025). Asset-based wealth inequalities in maternal anaemia prevalence across Indian states: A decomposition analysis of nationally representative data. Journal of Health, Population, and Nutrition, 44(1), 406. https://doi.org/10.1186/s41043-025-00939-7
Goryakin, Y., Rocco, L., & Suhrcke, M. (2017). The contribution of urbanization to non-communicable diseases: Evidence from 173 countries from 1980 to 2008. Economics and Human Biology, 26, 151–163. https://doi.org/10.1016/j.ehb.2017.03.004
Green, M. A., Evans, C. R., & Subramanian, S. V. (2017). Can intersectionality theory enrich population health research? Social Science & Medicine, 178, 214–216. https://doi.org/10.1016/j.socscimed.2017.02.029
India State-Level Disease Burden Initiative Diabetes Collaborators. (2018). The increasing burden of diabetes and variations among the states of India: The Global Burden of Disease Study 1990-2016. The Lancet. Global Health, 6(12), e1352–e1362. https://doi.org/10.1016/S2214-109X(18)30387-5
Jeevan, J., Karun, K. M., Puranik, A., Deepa, C., MK, L., & Barvaliya, M. (2025). Prevalence of anemia in India: A systematic review, meta-analysis and geospatial analysis. BMC Public Health, 25(1), 1270. https://doi.org/10.1186/s12889-025-22439-3
Kakwani, N., Wagstaff, A., & van Doorslaer, E. (1997). Socioeconomic inequalities in health: Measurement, computation, and statistical inference. Journal of Econometrics, 77(1), 87–103. https://doi.org/10.1016/S0304-4076(96)01807-6
Kulothungan, V., Ramamoorthy, T., Mohan, R., & Mathur, P. (2024). Assessing progress of India in reduction of premature mortality due to four noncommunicable diseases towards achieving the WHO 25×25 goal and the sustainable development goals. Sustainable Development, 32(3), 2020– 2030. https://doi.org/10.1002/sd.2761
Kumar, T., Taneja, S., Yajnik, C. S., Bhandari, N., Strand, T. A., & Study Group. (2014). Prevalence and predictors of anemia in a population of North Indian children. Nutrition (Burbank, Los Angeles County, Calif.), 30(5), 531–537. https://doi.org/10.1016/j.nut.2013.09.015
Link, B. G., & Phelan, J. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, Spec No, 80–94.
Mackenbach, J. P., Kulhánová, I., Bopp, M., Deboosere, P., Eikemo, T. A., Hoffmann, R., Kulik, M. C., Leinsalu, M., Martikainen, P., Menvielle, G., Regidor, E., Wojtyniak, B., Östergren, O., & Lundberg, O. (2015). Variations in the relation between education and cause-specific mortality in 19 European populations: A test of the “fundamental causes” theory of social inequalities in health. Social Science & Medicine, Special Issue: Educational Attainment and Adult Health: Contextualizing Causality, 127, 51–62. https://doi.org/10.1016/j.socscimed.2014.05.021
Masters, R. K., Link, B. G., & Phelan, J. C. (2015). Trends in education gradients of “preventable” mortality: A test of fundamental cause theory. Social Science and Medicine, 127, 19–28. https://doi.org/10.1016/j.socscimed.2014.10.023
Neff, R. A., Palmer, A. M., Mckenzie, S. E., & Lawrence, R. S. (2009). Food Systems and Public Health Disparities. Journal of Hunger & Environmental Nutrition, 4(3–4), 282–314. https://doi.org/10.1080/19320240903337041
Perkins, J. M., Lee, H., James, K. S., Oh, J., Krishna, A., Heo, J., Lee, J., & Subramanian, S. V. (2016). Marital status, widowhood duration, gender and health outcomes: A cross-sectional study among older adults in India. BMC Public Health, 16, 1032. https://doi.org/10.1186/s12889-016-3682-9
Phelan, J. C., Link, B. G., Diez-Roux, A., Kawachi, I., & Levin, B. (2004). “Fundamental causes” of social inequalities in mortality: A test of the theory. Journal of Health and Social Behavior, 45(3), 265–285. https://doi.org/10.1177/002214650404500303
Popkin, B. M., & Ng, S. W. (2022). The nutrition transition to a stage of high obesity and noncommunicable disease prevalence dominated by ultra-processed foods is not inevitable. Obesity Reviews, 23(1), e13366. https://doi.org/10.1111/obr.13366
Pradeepa, R., & Mohan, V. (2021). Epidemiology of type 2 diabetes in India. Indian Journal of Ophthalmology, 69(11), 2932–2938. https://doi.org/10.4103/ijo.IJO_1627_21
Ramesh, S., & Kosalram, K. (2023). The burden of non-communicable diseases: A scoping review focus on the context of India. Journal of Education and Health Promotion, 12, 41. https://doi.org/10.4103/jehp.jehp_1113_22
Rydland, H. T., Solheim, E. F., & Eikemo, T. A. (2020). Educational inequalities in high- vs. low-preventable health conditions: Exploring the fundamental cause theory. Social Science and Medicine, 267, 113145. https://doi.org/10.1016/j.socscimed.2020.113145
Safiri, S., Kolahi, A.-A., Noori, M., Nejadghaderi, S. A., Karamzad, N., Bragazzi, N. L., Sullman, M. J. M., Abdollahi, M., Collins, G. S., Kaufman, J. S., & Grieger, J. A. (2021). Burden of anemia and its underlying causes in 204 countries and territories, 1990–2019: Results from the Global Burden of Disease Study 2019. Journal of Hematology & Oncology, 14(1), 185. https://doi.org/10.1186/s13045-021-01202-2
Shah, D., Yadav, V., Singh, U. P., Sinha, A., Dumka, N., Banerjee, R., Shah, R., Unni, J., & Manneni, V. R. (2024). Prevalence of non-communicable chronic diseases in rural India amongst peri- and post-menopausal women: Can artificial intelligence help in early identification? Maturitas, 186, 108029. https://doi.org/10.1016/j.maturitas.2024.108029
Siddiqui, Z., & Donato, R. (2020). The dramatic rise in the prevalence of overweight and obesity in India: Obesity transition and the looming health care crisis. World Development, 134, 105050. https://doi.org/10.1016/j.worlddev.2020.105050
Solar, O., & Irwin, A. (2010). A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion Paper 2 (Policy and Practice) https://www.who.int/publications/i/item/9789241500852
Subramanian, S., Perkins, J. M., Özaltin, E., & Davey Smith, G. (2011). Weight of nations: A socioeconomic analysis of women in low- to middle-income countries. The American Journal of Clinical Nutrition, 93(2), 413–421. https://doi.org/10.3945/ajcn.110.004820
Thakur, J. S., Paika, R., & Singh, S. (2020). Burden of noncommunicable diseases and implementation challenges of National NCD Programmes in India. Medical Journal Armed Forces India, 76(3), 261–267. https://doi.org/10.1016/j.mjafi.2020.03.002
Veenstra, G. (2013). Race, gender, class, sexuality (RGCS) and hypertension. Social Science and Medicine, 89, 16–24. https://doi.org/10.1016/j.socscimed.2013.04.014
Veenstra, G., & Patterson, A. C. (2016). South Asian-White health inequalities in Canada: Intersections with gender and immigrant status. Ethnicity and Health, 21(6), 639–648. https://doi.org/10.1080/13557858.2016.1179725
Viruell-Fuentes, E. A., Miranda, P. Y., & Abdulrahim, S. (2012). More than culture: Structural racism, intersectionality theory, and immigrant health. Social Science and Medicine, 75(12), 2099–2106. https://doi.org/10.1016/j.socscimed.2011.12.037
Wetzel, S., Geldsetzer, P., Mani, S. S., Gupta, A., Singh, K., Ali, M. K., Prabhakaran, D., Tandon, N., & Sudharsanan, N. (2023). Changing socioeconomic and geographic gradients in cardiovascular disease risk factors among Indians aged 15–49 years – evidence from nationally representative household surveys. The Lancet Regional Health - Southeast Asia, 12, 100188. https://doi.org/10.1016/j.lansea.2023.100188
WHO (Ed.). (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. World Health Organization. https://digitallibrary.un.org/ record/645415
Zhang, L. (2021). A latent class analysis of health lifestyles and health outcomes among Chinese older adults. Ageing and Society, 41(2), 313–338. https://doi.org/10.1017/S0144686X20001063
Zhang, X., Wang, X., Hu, H., Qu, H., Xu, Y., & Li, Q. (2023). Prevalence and Trends of Thyroid Disease Among Adults, 1999-2018. Endocrine Practice, 29(11), 875–880. https://doi.org/10.1016/j.eprac.2023.08.006