Exploring spatial patterns of cardiovascular disease among women in India

Cardiovascular disease (CVD) has become a leading cause of mortality and morbidity in India, surpassing the global rate. While CVD is influenced by gender due to sex-specific risk factors in women, it remains underdiagnosed, and undertreated in women. WHO provides a list of ‘best buys’ which does not consider sex-specific risk factors. Hence, we assessed prevalence, unawareness and spatial variations of CVDs in women (15-49 years). We used NFHS (2019-20) WHO causal links between underlying drivers, behavioral risk factors, metabolic/physiological risk factors, and CVDs. We used ordinary kriging interpolation techniques to measure the spatial heterogeneity of CVD prevalence and spatial autocorrelation techniques using global Moran I statistic. Furthermore, ordinary least square were used to examine spatial predictors and geographically weighted regression and multiscale geographically weighted regression model were used to map the local spatial variations. CVDs prevalence in women is 11.7% [95%, CI: 0.117-0.118], its unawareness is 12% [95%, CI: 0.116-0.117] among women. Spatial regression analysis suggests observed geographical variation of CVDs significantly correlated with risk factors- metabolic (BMI), behavioral (tobacco consumption), and underlying (sex-specific - women's education as a proxy for autonomy and socioeconomic depriviation- household wealth). India has a high burden of CVDs in women, with state-level disparities and a lack of awareness about the disease. Women are not a target population for CVDs in SDG 3.4 and India's National Health policy, 2017; however, its rising epidemic burden on women demands a need for policy choices targeted at women. The study provides evidence to inform the policy choices in reducing CVDs burden in women. It suggests a need to develop gender-specific guidelines for CVD prevention and management in India. KEY MESSAGES: • The study provides evidence to inform the policy choices in reducing CVDs burden in women and suggests a need to develop gender-specific guidelines for CVD prevention and management in India. • India has high burden & unawareness of CVDs in women with risk factors- BMI, tobacco consumption, sex-specific - women's education as a proxy for autonomy; socioeconomic deprivation- household wealth.