Prevalence of non-communicable disease risk factors and chronic conditions among middle-aged and older adults in extreme poverty: a nationally representative cross-sectional study in India

Background Evidence on non-communicable disease (NCD) prevalence among adults in extreme poverty is sparse. We aimed to determine the national and subnational prevalence of NCD risk factors and chronic conditions among middle-aged and older adults in extreme poverty in India, where a large share of the global population in extreme poverty in this age group lives. Methods In this cross-sectional study, we analysed baseline data (2017–19) from the Longitudinal Ageing Study in India using the World Bank's international poverty line set at $1·90 in 2011 purchasing power parity dollars to define extreme poverty. Outcomes included metabolic (eg, hypertension) and behavioural (eg, tobacco use) risk factors, and chronic conditions (eg, depression). We conducted weighted descriptive analyses to obtain prevalence estimates and multivariable Poisson regression to estimate differences in the relative risk of all outcomes by sex and residence among participants in extreme poverty (n=11 243). We also estimated the relative risk of all outcomes by poverty levels by categorising all participants (n=66 617) into mutually exclusive groups based on the three World Bank poverty line cutoffs (≤$1·90, $1·91–3·20, and $3·21–5·50 versus >$5·50). Findings In this nationally representative sample of 66 617 adults aged 45 years and older, 53·4% were male, 46·6% were female, and 39·2% were aged 45–54 years. Among participants in extreme poverty (11 243 [18·1%]), the most prevalent risk factors and chronic conditions were tobacco use (40·3% [95% CI 39·2–41·5]), frailty (39·0% [37·9–40·2]), and hypertension (28·7% [27·7–29·8]). The prevalence of specific outcomes varied across states and territories, and the relative risk differed by residence, sex, and poverty levels. Interpretation Middle-aged and older adults in extreme poverty in India have a high prevalence of some NCD risk factors and chronic conditions than those not in extreme poverty, but prevalence varies substantially across states and territories and subgroups, calling for more targeted public health policies for specific geographical areas and subgroups.