India is witnessing a rapid epidemiological transition. While infectious diseases remain important, non-communicable diseases (NCDs) such as diabetes, hypertension, cardiovascular diseases, cancer, and chronic respiratory diseases are now responsible for a growing share of morbidity and mortality. The recently released NFHS-6 (2023–24) data provide valuable insights into the prevalence of key NCD indicators and their risk factors across the country.
The findings reveal significant differences by gender and geography, highlighting the need for region-specific prevention and control strategies.
Men Carry a Higher Burden of Diabetes and Hypertension
Nationally, men aged 15 years and above have a higher prevalence of elevated blood sugar levels or are taking medication for diabetes (20.9%) compared to women (17.8%).
Similarly, hypertension appears more common among men. About 22.1% of men report taking medication to control blood pressure compared with 19.4% of women. Men also show higher levels of mildly elevated blood pressure (12.4%) than women (9.4%).
These findings indicate a substantial burden of cardiometabolic diseases among Indian men and underscore the need for early screening and lifestyle interventions.
Obesity Is Emerging as a Major Concern Among Women
Unlike diabetes and hypertension, overweight and obesity are more prevalent among women.
According to NFHS-6, 30.7% of women are overweight or obese (BMI ≥25 kg/m²) compared to 27.3% of men.
This trend is important because obesity increases the risk of diabetes, hypertension, cardiovascular disease, and several cancers, including breast and endometrial cancer. The findings suggest that preventive strategies targeting nutrition and physical activity among women deserve greater attention.
Tobacco and Alcohol Use Remain Predominantly Male Behaviors
The survey highlights a stark gender difference in behavioral risk factors.
Nationally:
- Tobacco use: 36.3% among men versus 8.4% among women
- Alcohol consumption: 18.9% among men versus 1.1% among women
These behaviors continue to be major contributors to cardiovascular disease, stroke, chronic respiratory disease, and cancers. Strong tobacco and alcohol control policies remain essential components of India’s NCD prevention strategy.
Regional Variations: A Tale of Two Indias
NFHS-6 reveals striking geographical differences in NCD burden and risk factors.
Southern states such as Kerala and Goa continue to report some of the highest levels of diabetes and hypertension, whereas several North-Eastern states show comparatively lower metabolic disease burden but much higher prevalence of tobacco and alcohol use.
Ranking of States/UTs with Highest and Lowest Prevalence of Selected NCD Indicators
| Indicator | Highest Prevalence (State/UT) | Least Prevalence (State/UT) |
|---|---|---|
| High Blood Sugar | Goa (32.1% among men) and Kerala (28.9% among women) | Meghalaya (6.8% among men; 7.1% among women) |
| Hypertension (Taking Medication) | Kerala (36.6% among men; 31.9% among women) | Jharkhand (17.0% among men; 13.0% among women) |
| Tobacco Use | Meghalaya (73.6% among men) | Punjab (0.5% among women) |
| Alcohol Consumption | Arunachal Pradesh (50.5% among men) | Haryana (0.2% among women) |
Southern and Western India: The Metabolic Disease Hotspot
Kerala, Goa, and Puducherry emerge as important hotspots for diabetes and hypertension. These regions have undergone rapid demographic and nutritional transitions, characterized by aging populations, urbanization, sedentary lifestyles, and dietary changes.
The high prevalence may also reflect better awareness, diagnosis, and treatment availability compared with several other states.
North-East India: High Risk Behaviors, Lower Metabolic Burden
A different pattern is observed in the North-East.
Meghalaya records the highest prevalence of tobacco use among men (73.6%), while Arunachal Pradesh reports the highest prevalence of alcohol consumption among men (50.5%).
Although current diabetes and hypertension prevalence remain relatively lower, the widespread use of tobacco and alcohol raises concerns about future increases in cardiovascular diseases, cancers, and chronic respiratory illnesses.
Central and Northern India: Potential Hidden Burden
States such as Bihar and Jharkhand report lower levels of hypertension treatment and elevated blood sugar compared with national averages.
However, lower prevalence may not necessarily indicate lower disease burden. Limited screening, underdiagnosis, and reduced healthcare access may contribute to these observations. Expanding community-based screening programs remains a priority in these regions.
The Missing Piece: Cancer Screening
Cancer is increasingly recognized as a major contributor to India’s NCD burden. However, the NFHS-6 fact sheets do not include indicators related to screening for cervical, breast, or oral cancers among the 101 key indicators released.
Given India’s substantial burden of these cancers and the importance of early detection, future surveys should consider incorporating cancer screening indicators to better guide national prevention strategies, even if the rates are same as the previous surveys.
Public Health Implications
The NFHS-6 findings reinforce several important messages:
- Men experience higher rates of diabetes, hypertension, tobacco use, and alcohol consumption.
- Women have a higher prevalence of overweight and obesity.
- Southern states bear a greater burden of metabolic diseases.
- North-Eastern states face disproportionately high behavioral risk factors.
- Significant regional inequalities exist in diagnosis, treatment, and risk exposure.
Conclusion
India’s NCD epidemic is no longer a future threat—it is a present reality. NFHS-6 demonstrates that the burden of diabetes, hypertension, obesity, tobacco use, and alcohol consumption varies substantially across gender and geography. These variations call for targeted, region-specific interventions rather than a one-size-fits-all approach.
As India strives to achieve its Sustainable Development Goal targets and reduce premature mortality from NCDs, strengthening prevention, early detection, treatment, and risk-factor reduction must become a national priority. The NFHS-6 findings offer a valuable roadmap; translating these data into action will determine the nation’s future health trajectory.
I
