Exploring urban health inequities: the example of non-communicable disease prevention in Indore, India

Figures & data

Table 1. Summary Statistics of Stratification Measures.

Measure*	n	Mean	Min	Max
Individual Level (maximum n = 3070)
Gender (Male)*	3,070	36%	0	1
Education (average level)	3,062	1.56	0	3
Slum Dwellers	3,070	29%	0	1
Have Permanent Housing	3,070	71%	0	1
Average Wealth Index	3,020	3	1	5
Ward Level (Maximum n = 30)
Park Attribute Score	26	0.71	0.22	1
Tobacco Advertising per 1000-Meter Street Length	30	12.35	0.52	47.70

*Table presents data with no survey weights added. For all analysis, we applied age-gender weights to match the general age and gender breakdown of Indore City population.

Table 2. WHO 2025 NCD Risk Factor Indicators.

Harmful use of alcohol Age-standardized prevalence of heavy episodic drinking among adults, as appropriate, within the national context

Physical inactivity Prevalence of insufficiently physically active persons aged 18+ years (defined as less than 150 minutes of moderate-intensity activity per week, or equivalent)

Sodium intake* *In lieu of WHO measure, this is prevalence of respondents reporting that they often/always add salt right before eating

Tobacco use Prevalence of current tobacco use among persons aged 18+ years

Raised blood pressure Prevalence of raised blood pressure among persons aged 18+ years (defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg)

Diabetes (raised blood glucose) Prevalence of raised blood glucose/diabetes among persons aged 18+ years (defined as fasting plasma glucose concentration ≥ 7.0 mmol/l (126 mg/dl) or on medication)

Overweight and obesity Prevalence of overweight and obesity in persons aged 18+ years (defined as body mass index ≥ 25 kg/m2 for overweight and body mass index ≥ 30 kg/m2 for obesity)

Table 3. Analytical Techniques.

Technique	Outcome Measure	Dimension of Inequity	Reason for Inclusion
Bivariate Ratios	Relative occurrence of NCD risk factors	Gender, education, housing type, slum status	Easy to calculate and interpret, provides basic entry point for understanding of binary inequalities
Concentration Index	Actual vs. expected distribution of NCD risk factors	Wealth index	Provides a slightly more nuanced analysis of wealth inequality than the bivariate ratios; allows for controls on sociodemographic data
GIS Heat Mapping	Relative occurrence of NCD risk factors	Geographic location, environmental factors	Adds a visual description of an additional dimension of inequality
Multivariate Regression	Predicted probabilities of NCD risk	Gender, education, housing type, slum status, wealth index, sociodemographic factors, environmental factors	Allows consideration of multiple overlapping dimensions of inequity; enables controls on sociodemographic data to removed underlying, unavoidable differences by group.

Source: Adapted from Bonnefoy et al. (2011).

Table 4. All-Indore Prevalence Rates for NCD Risk Factors.

Indicator	Indore Mean Prevalence, 2018
Harmful use of alcohol	2%
Physical inactivity	24%
Sodium intake	22%
Tobacco use	21%
Raised blood pressure	25%
Diabetes (raised blood glucose)	12%
Overweight and obesity	41%

Figure 1. (a) NCD Risk Prevalence by Gender. (b). NCD Risk Prevalence by Education. (c) NCD Risk Prevalence by Slum Status. (d) NCD Risk Prevalence by Housing Type.

*The Education graphic compares Primary to College; No education and Secondary are left out of the graphic for visual brevity.

Table 5. Concentration Indices of Wealth, by NCD Risk Factor*.

	N	Concentration Index (CI)	Standard Error	P-value
Harmful use of alcohol	3011	−0.20256	0.098005	0.0388
Physical inactivity	3020	0.119506	0.0408	0.0066
Sodium intake	3020	−0.10375	0.021363	0
Tobacco use	3020	−0.19715	0.022814	0
Hypertension	2910	0.085334	0.019021	0
Raised blood sugar	3020	0.021747	0.027479	0.4288
Overweight	2897	0.119824	0.013431	0

*Concentration index ranges from −1 to 1, with 0 representing true equality.

Figure 2. Geographic Heat Mapping of Proximal NCD Risk Factors.

Figure 3. (a) Bivariate Map of Insufficient Physical Activity and Park Attribute Score. (b) Bivariate Map of Tobacco Use and Ward Average of Tobacco Advertising per 1000-Meter Street Length.

Table 6. Regression Results, by NCD Risk Factor.

Results of the Multilevel Regression Models (Coefficients are Odds Ratios)	Harmful Use of Alcohol	Insufficient Physical Activity	Excess Salt Intake	Tobacco Use	Hypertension	Raised Blood Sugar	Overweight and Obesity
n	967	2858	2858	2858	2810	2848	2848
Stratifiers
Gender (Male = 1)	1.00	0.95	1.36	11.32**	1.14	1.23	0.95
Gender*Education	0.80	1.17	0.88	1.63**	1.21*	0.90	1.04
Interaction between gender and education
Education (No education = 0)
Primary	2.65**	0.94	1.25	0.41**	0.78*	1.02	0.73**
Secondary	1.03	0.90	1.58**	0.11**	0.83	1.05	0.80
College and above	1.00	0.86	1.42	0.06**	0.61	1.23	0.63**
Housing Type (Permanent = 1)	1.82	1.88**	1.19	0.89	0.96	0.65**	0.53**
Slum Status (Slum = 1)	2.61**	1.30*	1.05	1.19	0.99	0.83	0.90
Wealth (Lowest quintile = 0)
Second	0.67	0.77	0.89	0.57*	0.82	1.17	1.57**
Middle	0.44	0.60**	0.83	0.56	1.06	1.33	2.53*
Fourth	0.15**	1.07	0.53**	0.40**	1.13	1.12	3.72**
Highest	0.88	1.01	0.54**	0.49*	1.16	1.08	5.35**
Sociodemographics
Marital Status (Ever married = 1)	2.28	0.55**	1.50	1.85	0.80	2.76*	1.95**
Religion (Other religions = 0)
Hinduism	18.99**	0.68	2.03	1.34	1.16	0.80	0.93
Islam	1.00	0.72	1.91	1.81	1.41	1.32	1.15
Social Group (General caste = 0)
Other disadvantaged castes	0.95	1.15	1.07	0.95	1.01	1.02	1.18
Scheduled caste or tribe	1.75	1.22	1.10	1.45	1.09	0.83	0.96
Age	1.01	1.02**	0.98**	1.00	1.06**	1.05**	1.03**
Lifestyle Factors
Weight (BMI score)	1.04	1.03**	0.99	0.99	1.11**	1.05**	N/A
Professional Advice (Ever received lifestyle advice from health professional = 1)	2.29*	1.07	1.07	0.97	1.52**	1.42	1.29**
Ever Screened (Ever measured for risk by a health professional = 1)	0.58	0.61	1.01	0.96	1.37*	1.53*	1.53**
Tobacco (Current tobacco user = 1)	N/A	N/A	N/A	N/A	1.04	1.10	0.95
Salt (Add extra salt before eating = 1)	N/A	N/A	N/A	N/A	1.11	0.66	0.82
Fruit and Vegetables (Does not meet min. daily consumption = 1)	N/A	N/A	N/A	N/A	0.92	0.76	0.70
Passive Smoke (Exposed to passive tobacco smoke at work or during travel = 1)	N/A	N/A	N/A	N/A	1.04	0.93	0.97
Constant	0.00	0.07	0.15	0.11	0.00	0.00	0.12
Ward-level Random Effects	1.03	1.11	0.39	0.22	0.04	0.18	0.00
Intra-cluster Correlation	0.24	0.25	0.10	0.06	0.02	0.05	0.00
F	7.27**	2.82**	2.09	20.39**	32.43**	16.75**	8.58**

*P values at 95% confidence or better

**P values at 90% −94% confidence

Table 7. Predicted Prevalence for Compounded Risk, by NCD Risk Factor.

	Harmful Use of Alcohol	Insufficient Physical Activity	Excess Salt Intake	Tobacco Use	Hypertension	Raised Blood Sugar	Overweight and Obesity
Men
Lowest education, wealth, housing, slum	4%	25%	28%	79%	30%	13%	38%
Highest education, wealth, housing, non-slum	1%	31%	12%	21%	40%	15%	57%
Women
Lowest education, wealth, housing, slum	3%	23%	18%	27%	31%	15%	43%
Highest education, wealth, housing, non-slum	2%	24%	14%	1%	27%	17%	57%

Figure 4. Equity Gap using Predicted Probabilities of NCD Risk Factor.

Bonnefoy, J., et al., 2011. Measuring the social determinants of health: theoretical and empirical challenges, in: improving equity in health by addressing social determinants. Geneva, Switzerland: WHO.

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Data Availability Statement

The data that support the findings will be available in The USAID development data library at https://data.usaid.gov/following a 1 month embargo from the date of first publication to allow for commercialization of research findings.