title: Association between socioeconomic status and self-reported diabetes in India: a cross-sectional multilevel analysis.
abstract: OBJECTIVE
  To quantify the association between socioeconomic status (SES) and type 2 diabetes in India.
  
  
  METHODS
  Nationally representative cross-sectional household survey.
  
  
  METHODS
  Urban and rural areas across 29 states in India.
  
  
  METHODS
  168 135 survey respondents aged 18-49 years (women) and 18-54 years (men).
  
  
  METHODS
  Self-reported diabetes status.
  
  
  RESULTS
  Markers of SES were social caste, household wealth and education. The overall prevalence of self-reported diabetes was 1.5%; this increased to 1.9% and 2.5% for those with the highest levels of education and household wealth, respectively. In multilevel logistic regression models (adjusted for age, gender, religion, marital status and place of residence), education (OR 1.87 for higher education vs no education) and household wealth (OR 4.04 for richest quintile vs poorest) were positively related to self-reported diabetes (p<0.0001). In a fully adjusted model including all socioeconomic variables and body mass index, household wealth emerged as positive and statistically significant with an OR for self-reported diabetes of 2.58 (95% credible interval (CrI): 1.99 to 3.40) for the richest quintile of household wealth versus the poorest. Nationally in India, a one-quintile increase in household wealth was associated with an OR of 1.31 (95% CrI 1.20 to 1.42) for self-reported diabetes. This association was consistent across states with the relationship found to be positive in 97% of states (28 of 29) and statistically significant in 69% (20 of 29 states).
  
  
  CONCLUSIONS
  The authors found that the highest SES groups in India appear to be at greatest risk for type 2 diabetes. This raises important policy implications for addressing the disease burdens among the poor versus those among the non-poor in the context of India, where >40% of the population is living in poverty.
authors: Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors: Daniel J
authors: DJ
authors: Corsi
authors: S V
authors: SV
authors: Subramanian