India’s Chronic Disease Burden Hits Women Harder, National Survey Analysis Reveals

Non-communicable diseases have quietly become the dominant force of mortality in India, now responsible for roughly two-thirds of all deaths in the country. While much of the public conversation about India’s health has historically centered on infectious disease, malnutrition, and maternal health, a new analysis of national survey data suggests that the chronic disease burden is not distributed evenly across the population. Among Indians aged 15 to 49, the working-age heart of the country’s demographic dividend, women consistently carry a heavier load of chronic illness than men, and the gap appears to have widened between 2015 and 2021. The finding comes from a study published in Discover Social Science and Health by geographers Soumitra Mandal, Nasrin Banu, and Arindam Roy of Aliah University in Kolkata, who mined two rounds of India’s National Family Health Survey to map who gets sick, where, and why.

The researchers drew on the Demographic and Health Surveys program, using round four of the National Family Health Survey, conducted in 2015-16, and round five, conducted in 2019-21. These surveys are among the largest standardized health data collection exercises in the world, and the study harnessed samples of 63,696 respondents from the earlier round and 57,693 from the later one, all aged between 15 and 49. Rather than treating chronic disease as a single undifferentiated category, the team constructed a chronic disease index using principal component analysis, a statistical technique that condenses multiple disease indicators into a single weighted measure. The index allowed them to compare the overall chronic disease burden between men and women across both survey rounds and to track how that burden shifted over the six-year interval.

The headline numbers are striking in their consistency. For men, the chronic disease index stood at 0.018 in 2015 and fell to 0.012 in 2021. For women, the corresponding values were 0.023 and 0.019. In other words, women’s chronic disease burden exceeded men’s in both periods, and while the burden declined for both sexes over time, the gender gap actually grew, from 0.005 in 2015 to 0.007 in 2021. That widening disparity is the study’s central puzzle. It suggests that whatever forces are driving down chronic disease prevalence among young and middle-aged Indian adults, whether improved diagnostics, health awareness campaigns, or genuine improvements in living conditions, they are not operating equally across genders, and women are being left behind relative to men.

To understand the geography of this burden, the researchers applied hot spot analysis, a spatial statistics method rooted in geographical information systems that identifies statistically significant clusters of high and low values across a map. The results revealed a pronounced regional pattern: people residing in the extreme southern and northern parts of India face higher chances of chronic disease prevalence than those in other regions. This kind of spatial clustering matters for policy because it indicates that chronic disease risk in India is not randomly scattered but concentrated in identifiable areas, likely reflecting combinations of dietary transitions, urbanization, aging population structures within the surveyed range, and state-level differences in health system capacity and reporting. Region-specific interventions, the authors argue, are therefore essential rather than optional.

Beyond geography, the study used binary logistic regression to estimate how individual and household characteristics predict the likelihood of developing the selected chronic conditions. Age emerged as the single strongest determinant, with an odds ratio of 5.14, meaning that the oldest groups within the 15 to 49 range faced more than five times the odds of chronic disease compared with the reference group. This is perhaps unsurprising, since conditions such as cardiovascular disease, chronic respiratory diseases, and diabetes accumulate with time, but the magnitude of the effect underscores how sharply risk rises even within what is conventionally considered a young population. Education was also significantly associated with chronic disease prevalence for both genders, though the direction and strength of the relationship reflect the complex ways in which schooling, occupation, income, and health awareness intertwine.

One of the most provocative findings concerns employment, and here the story diverges sharply by gender. Working women had a higher probability of facing chronic disease prevalence, with an odds ratio of 1.08 compared with non-working women. For men, the pattern ran in the opposite direction: working men had lower odds of chronic disease, at 0.93, than their non-working counterparts. The authors do not over-interpret this reversal, but it resonates with a substantial body of literature on the double burden faced by employed women in India, who often juggle formal work with the majority of household labor and caregiving responsibilities, potentially compounding stress and limiting time for rest and health care. Whatever the underlying mechanism, the finding challenges the assumption that labor force participation is uniformly protective for health.

Wealth, too, produced results that cut against intuition. Compared with the poorest women, the richest women had 69 percent higher probabilities of chronic disease prevalence, while among men the corresponding wealth gradient was 27 percent. In a country where poverty has traditionally been associated with worse health outcomes, the elevated risk among the affluent likely reflects the epidemiological transition now underway in India: as incomes rise, diets shift toward processed and energy-dense foods, physical activity declines, and sedentary lifestyles become the norm. The pattern also raises the possibility of detection bias, since wealthier households have greater access to health facilities and diagnostics, meaning conditions are more likely to be diagnosed and reported in surveys. Both interpretations carry implications, because they suggest that India’s emerging chronic disease epidemic is not confined to the poor and may in some respects be led by the better-off.

Dietary behavior featured prominently in the analysis as well. The consumption of fried food and aerated drinks was significantly associated with a higher likelihood of developing the selected chronic conditions, and the strength of these associations differed between men and women. These findings tie the survey-based statistical patterns to well-established physiological pathways: diets high in trans fats and refined sugars promote obesity, insulin resistance, dyslipidemia, and hypertension, which are the biological precursors of cardiovascular disease and type 2 diabetes. In a country where the market for packaged snacks and sugar-sweetened beverages has expanded rapidly over the past two decades, the gendered differences in consumption patterns identified by the study offer a concrete behavioral target for public health campaigns aimed at bending the curve of chronic disease before it overwhelms the health system.

The policy context makes these findings timely. India has adopted a series of measures to mitigate chronic disease, including the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease and Stroke, and the expansion of Ayushman Arogya Mandirs, the network of primary health and wellness centers intended to bring screening and preventive care closer to communities. The study’s authors argue, however, that these measures need to be sharpened along two axes revealed by their analysis: gender and geography. Because women aged 15 to 49 bear a consistently higher chronic disease burden, and because risk clusters in the country’s extreme south and north, a one-size-fits-all national strategy risks misallocating resources. Gender-sensitive, region-specific interventions, combined with lifestyle-focused public health strategies targeting diet and activity, form the core of the study’s recommendations.

What makes this research notable is not any single statistic but the convergence of evidence from a nationally representative dataset, a rigorous spatial method, and gender-disaggregated regression modeling, all pointing in the same direction. India’s demographic dividend, the economic promise of its enormous young and working-age population, depends on that population remaining healthy through its prime years. If chronic diseases are already carving a deeper groove into women’s health than men’s during these decades, and if wealth and urbanizing lifestyles are amplifying rather than buffering risk, then the country’s epidemiological transition is not a distant threat but a present reality. The study, published open access with the DOI 10.1007/s44155-026-00469-5, offers policymakers a data-driven map of where and among whom the next phase of India’s health challenge will unfold, and a reminder that the answers will need to be as differentiated as the disease burden itself.

Subject of Research: Gender differences in chronic disease prevalence and determinants among India's 15-49 year-old population

Article Title: Gender differences in the prevalence and determinants of selected chronic diseases among India’s 15–49 years aged population

Article References: Gender differences in the prevalence and determinants of selected chronic diseases among India’s 15–49 years aged population. (n.d.). https://doi.org/10.1007/s44155-026-00469-5

Image Credits: AI Generated

DOI: 10.1007/s44155-026-00469-5

Keywords: non-communicable diseases, chronic disease, gender differences, India, NFHS, epidemiological transition, binary logistic regression, hot spot analysis, public health, dietary patterns, socioeconomic status, women's health