# Clustering of hypertension and clustering of diabetes at the household level and variations in disease awareness within households in India: findings from a nationally representative household survey

## TL;DR

This study finds that hypertension and diabetes often cluster within Indian households, with many cases undiagnosed, suggesting a need for household-level health interventions.

## Contribution

The study provides novel evidence on the clustering patterns of hypertension and diabetes within Indian households and their awareness levels.

## Key findings

- 14.9% of households had two or more members with hypertension, contributing to nearly half of all hypertension cases in India.
- Households with diabetes clustering accounted for 39.3% of total diabetes cases, with spouses being the most common affected dyad.
- Over 40% of households with clustered hypertension or diabetes had all affected members unaware of their condition.

## Abstract

Despite rising prevalence, very limited evidence is available on the clustering of hypertension and clustering of diabetes at household level in India. This study examines the clustering of hypertension and clustering of diabetes at household level among members aged 15 years and above in India.

Clustering of hypertension is defined as two or more members of the household having hypertension. Clustering of diabetes is defined as two or more members of the household having diabetes. Clustering was examined in 636 699 households interviewed in the fifth round of the National Family Health Survey 2019–2021. The relationship dyads of clustering and awareness of the diseases within households were also examined.

Two or more members suffered from hypertension in 14.9% households, which contributed to 49.8% of total hypertension cases in India. Diabetes was clustered in 7.7% of households which contributed to 39.3% of total diabetes cases in India. Among households with two diagnosed members, the most common relationship dyad was spouses (53.6% for hypertension and 53.8% diabetes), followed by parent–child (29.8% for hypertension and 28.8% for diabetes). In households with three diagnosed members, the most common dyad was parent–child (44.3% for hypertension and 42.5% for diabetes). Among households with clustering, all the members with disease were unaware in 42.5% of the households for hypertension and 55.5% for diabetes, and mixed awareness was seen in 37.9% and 31.4% households for hypertension and diabetes, respectively.

Given the disproportionate amount of India’s total case burden of hypertension and diabetes concentrated within clustered households, our findings underscore the importance of targeting households for interventions of hypertension and diabetes management in addition to interventions targeting individuals. Our findings may equip health systems with information on patterns of concentrated pockets of undiagnosed disease burden within households and may help in designing intensified interventions for rapid progress towards Sustainable Development Goal V.3.4.