Objective: This study aims at understanding the important correlates of child undernutrition in India using a quantile regression approach. Design: Cross-sectional study. Data Source: The study utilizes the secondary data from the latest round of the National Family Health Survey (2019–2021) to assess the individual, maternal and household-level determinants of under-nutrition among Indian children aged 0–5 years. Participants: The unit of analysis is children under the age of 5 years and the sample size is 224, 218. Outcome Variable: The outcome measures of this study are stunting, wasting and underweight. Results: Results from our study show that birth order and size of the child at birth have a statistically significant association with stunting, wasting and underweight. While currently breastfeeding is negatively associated with HAZ scores (below 50th quantile), maternal height is positively associated with HAZ, WAZ and WHZ scores in all quantiles. Mother’s age, body mass index and education level have significantly stronger association with HAZ and WHZ scores. Furthermore, children from richer and richest households are likely to have higher HAZ, WAZ, and WHZ scores compared to the children from poorest households. For instance, the WHZ scores increased from 0.15 in the 10th quantile among the poorest to 0.43 among the richest at the same quantile. Moreover, at the 90th percentile, this coefficient increased from 0.11 among the poorest to 0.46 among the richest. Conclusion: It is crucial to acknowledge that to have healthy babies, we must have healthy mothers. Thus, interventions to address child nutrition in India should also focus on maternal health, education, increasing the women’s agency and women empowerment. The findings of the study suggest that concerted efforts addressing the manifold determinants of children’s nutritional status from the government, non-governmental organisations and civil societies will ensure bolstered nutritional outcomes for children in India.

Intimate Partner Violence (IPV) is not only confined to impacting women’s physical, mental and sexual health but also imposes adverse health outcomes on growing fetus with higher rates of unwanted pregnancy outcomes and induced abortions. The present study aims to investigate the association between self-reported experience of IPV and pregnancy termination among Indian women based on the analysis of data from the fifth round of the Indian demographic and health surveys. IPV was measured using physical, sexual and emotional violence questions from state module of NFHS-5. To address the objectives, Logistic regression was employed to examine the association between IPV and adverse pregnancy outcomes. Further, Propensity Score Matching analysis was applied to understand the impact of IPV on adverse pregnancy outcomes. It was found that prevalence of pregnancy termination was around 20%, 23% and 20% among women experiencing physical violence, sexual violence and emotional violence respectively. Those experiencing IPV were more likely to have pregnancy termination [OR: 1.43, 95% CI:1.37–1.50 in unadjusted model, and OR: 1.4, 95% CI:1.34–1.47 in adjusted model]. Results also indicated that experience of IPV increases the risk of pregnancy termination by 5.9 percent compared to the matched control group. To conclude, this study confirms an association between induced abortions, pregnancy loss, and intimate partner abuse. The widespread prevalence of IPV in the country can have substantial implications on the prevalence of unintended pregnancy outcomes. Thus, it is important to have policies aimed at reducing IPV and improving contraception usage which can lower the unintended pregnancy outcomes.

Women with disabilities in India face higher levels of emotional, physical, and sexual violence compared to women without disabilities. The findings highlight the need for the prevention of violence accounting for disability and extend support services for women with disabilities. (PsycInfo Database Record (c) 2026 APA, all rights reserved) Objective: Women with disabilities have a disproportionate risk of intimate partner violence (IPV) in India and global level, compared to “nondisabled women.” This study examines the physical, sexual, and emotional violence gap perpetrated by intimate partners on ever-married women with and without disabilities. Method: This study has used the information of 62,573 ever-married women from the fifth round of the nationally representative survey, that is, National Family Health Survey (2019–2021). Descriptive statistics were used to identify gaps in physical, emotional, and sexual IPV experienced ever and in the last 12 months, by disability status. Results: Lifetime IPV prevalence among women with disabilities was 10% points higher than women without disabilities, with the largest disparity observed for emotional violence (11.54% points), which is nearly double that of physical violence (5.76% points). Recent experiences of IPV followed similar patterns, where the prevalence of emotional and physical violence was 8.96% and 2.12% points higher among women with disabilities. Notably, emotional violence gaps were highest among urban, educated, working women with disabilities, challenging conventional vulnerability assumptions. Sexual violence showed the smallest gap (1.03%). Conclusion: These findings reveal emotional abuse as the predominant but overlooked form of IPV against women with disabilities in India. Current violence prevention programs focusing primarily on physical abuse should be expanded to include women with disabilities. Also, standard measurement tools, effective prevention strategies, and intervention programs are needed globally to address this hidden epidemic. (PsycInfo Database Record (c) 2026 APA, all rights reserved)

Background Sleep disturbances are increasingly recognized as important determinants of cognitive functioning, yet evidence from large population-based studies in India remains limited. Understanding how specific sleep problems relate to different cognitive domains across age groups is essential for informing healthy ageing policies. Objective This study aims to analyse the association between sleep quality such as being unrested, trouble having sleep, night-time/early morning awakening and cognitive performance across domains such as memory, arithmetic ability, orientation, executive functioning, and object naming among Indian adults. Methods This study analysed data from 62,479 adults aged 18 years and older from the Longitudinal Ageing Study in India (2017-18). Mean cognition scores were compared across categories of sleep disturbances and across three age groups (18-44, 45-59, and ≥60 years). Propensity score matching (PSM) was employed to estimate the effect of various sleep problems on cognitive functioning. Results Individuals reporting sleep problems had lower mean cognitive scores. Age differences were prominent, with adults aged ≥60 years consistently showing the lowest scores. Two-way analyses confirmed strong main effects of age and sleep problems. Middle-aged adults (45-59years) with sleep problems showed deficits in orientation and arithmetic performance while among younger adults, sleep problems largely affected memory and orientation. Among young adults, daytime napping increased the memory scores by 0.45 points while feeling unrested despite adequate sleep duration decreased the orientation scores by 0.11 points. Conclusion Sleep disturbances are strongly associated with poorer cognitive functioning across multiple domains, with the greatest impact observed among older adults. These findings highlight sleep health as a potentially modifiable determinant of cognitive functioning in a rapidly ageing population.

India has been on the brink of rapid socio-economic changes and these changes have manifested themselves through improvements in health and overall living standards of the general population. Although several health strategies and policies have addressed the equitable distribution of health care in India, not many studies have been undertaken on this topic, especially among formerly married older adults. The aim of this paper is to evaluate income related-inequalities in healthcare utilization among formerly married older population in India. This study utilizes individual level data from the first wave of the Longitudinal Ageing Study in India. Logistic regression was employed to examine the effect of the socio-economic characteristics on the health seeking behavior of the formerly married older adult population. The magnitude of socio-economic inequity in health care utilization was quantified using Wagstaff decomposition analysis. The regression results revealed that with higher levels of education, the odds of getting inpatient health care utilization decreased. For instance, the health care utilization was 32 % less among individuals with 10+ years of schooling than those who did not have any formal level of education [OR: 0.68; 95 % C.I.:0.52–0.88]. The odds of inpatient health care utilization was higher among those who had morbidity [one morbidity, OR:1.98; 95 % C.I.:1.68–2.36 & multimorbidity OR: 2.68; 95 % C.I.:2.25–3.20]. Additionally, presence of multi-morbidity (83 %) and geographical regions (50 %) were two of the largest contributors to inequality in healthcare utilization. Findings from the current study point towards the need for having improved social security systems in place to protect the households from distress financing and reducing inequalities.

Background: Oral health is a fundamental component of overall health and mental well-being. However, due to social and economic factors impacting health care access, older people have limited resources and opportunities to meet their ongoing oral health care needs. With an increase in the proportion of aged population and increased life expectancy, early onset of edentulism is a growing public health problem. This study aimed to measure and determine oral health status and its implications on self-reported health among adults aged 50 years and over, in India. Method: This study utilizes the data from a prospective longitudinal survey of national survey data from WHO-SAGE Wave 1 (2007). Study samples in India (n = 6555) were conditioned on self-reported health. The main predictor variable is edentulism. The methods were multinomial logistic regression, chi-squared tests, and the relative risk ratios. Results: Nationally, about 30.5% had good, 47.1% had moderate, and 22.4% reported their health as bad. Among edentulous, the prevalence of good, moderate, and bad health is 27.2%, 45.4%, and 27.4%, respectively. It was found that elderly who had edentulism had were significantly less likely to have “Good” and “Moderate” health status. Adjusted relative risk ratios showed a significant association between self rated health and covariates such as education, wealth, eating less, and feeling hungry. Conclusion: Findings indicate that the reporting of good health among Indian edentulous adults are inadmissibly low. Since, edentulism has never been paid enough attention despite its toll on quality of life of an individual, policies and programs should be aimed towards oral care especially for older adults. There is a need to improve the health literacy of the older adults through community health education and making use of activity opportunities that can improve their self-rated health.

Leishmaniasis, a vector-borne disease, remains one of the most significant parasitic disease with potential outbreak and high mortality. Despite improvements in living standards and health infrastructure, there has been a territorial expansion in the incidence and lethality of the disease. However, evidence regarding its control, prevention, and eradication remains limited. Given an understanding of the present status of the disease, this study assesses the trends and patterns in the incidence and mortality of this endemic in India from 1990 to 2019. This study obtained Visceral Leishmaniasis (VL) incidence and mortality data (1990–2019) from the Global Burden of Disease (GBD) study 2019, provided by the Institute for Health Metrics and Evaluation (IHME). To capture the overall changes and sex-specific changes in ASIRs and ASMRs of VL, joinpoint regression analysis was employed for all ages by using joinpoint regression programme version 4.5.0.1. Age-period-cohort analysis is used to estimate the net age, period, and cohort effects on the incidence and mortality of VL from observed age-specific incidence and mortality rates. The APC model was implemented using Stata 16.0, and its fit was assessed using Akaike’s Information Criterion (AIC) and Bayesian Information Criterion (BIC). Findings indicate a significant decline in the age-specific incidence and mortality rates for both sex. The highest annual percentage decline in VL incidence and mortality was observed during 2011–2016 for both males and females. (Table 1). Results from the age effect show that the risk of VL incidence and mortality among both genders decreased sharply with advancing age. Period effect indicated a sharp decline in incidence and mortality risk from the period 1990–94 to 2000–04. The cohorts effect showed that compared to earlier birth cohort (1900–04),, the relative risk (RR) of VL incidence increased by 1.5 in male and 1.7 times in females in more recent birth cohort (2015–19), whereas mortality risk decreased by 48% among females. Findings highlight a notable reduction in VL incidence and mortality in the country. The age pattern in the incidence and mortality rates indicates the need for age-specific attention while performing preventive measures and comprehensive strategies. Moreover, strengthening large-scale screening, vector control measures, and public health education is essential to sustain VL elimination efforts.

Objective: This study evaluates the trends in tuberculosis (TB) incidence, prevalence, mortality, and disability-adjusted life years (DALYs) in India over a 30-year period, from 1990 to 2019. Data and methods: This study leverages data from the Global Burden of Disease Study 2019. We employed Joinpoint regression analysis to determine the average annual percent changes (AAPCs) and their corresponding confidence intervals for age-standardized rates. Result: Our findings reveal a significant reduction in the overall TB burden, with incidence declining from 390.22 to 223.01, prevalence from 707.94 to 390.03, mortality decreasing from 121.72 to 36.11 per 100,000, and DALYs reducing at an average annual rate of 4.01%. In stark contrast, multidrug-resistant TB (MDR-TB) exhibited substantial increases across all indicators, with an AAPC of 14.27% for incidence, 14.05% for prevalence, 11.06% for mortality, and 11.16% for DALYs. Conclusion: Our findings indicate that TB metrics consistently remain higher among males compared to females across all subtypes. The ongoing increase in multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB), coupled with the growing threat of antimicrobial resistance (AMR), underscores the urgent need for advancements in diagnostic capabilities, broader access to effective treatment, and enhanced public health awareness. AMR complicates TB management by limiting the efficacy of existing drugs, making it even more critical to address resistant strains with innovative solutions. Joint modeling efforts for TB and AMR are necessary to better understand their interactions, predict future trends, and develop integrated strategies for effective control. To achieve the ambitious target of eliminating TB by 2025, as set by India's National Tuberculosis Elimination Programme, such intensified and focused efforts are crucial. Strengthening early detection, optimizing treatment strategies, and raising community awareness will be essential to curb the spread and impact of resistant TB forms, while mitigating the broader implications of AMR.

Introduction: Depression is a prevalent and debilitating mental health condition globally, particularly affecting older adults. Disasters, both natural and man-made, are significant contributors to depressive symptoms. This study aims to fill this gap by examining the impact of disasters on the development of depressive symptoms among older adults in India. Methods: This study utilized data from the Longitudinal Ageing Study in India (LASI) Wave-1, which includes individual aged 45 and older. Logistic regression analysis was conducted to examine the relationship between health impacts of disaster and depressive symptoms. The impact of disasters on depressive symptoms was assessed using the propensity score matching (PSM). Results: Around, 4.1% of older adults reported that their health was affected by either natural or man-made disasters. The odds of depressive symptoms were higher among older adults whose health was affected by any disaster [AOR 2.7, CI 1.9, 3.9] while in the unadjusted model, the likelihood of having depressive symptoms increased by 3.5 times [UOR 3.5, 95% CI: 2.4, 4.9] compared to older adults whose health was not affected by disaster exposure. Results from PSM indicated that, on an average, individuals whose health was affected by disaster have 9.7% higher chance of experiencing depressive symptoms compared to those individuals whose health was not affected by disaster. Conclusion: Findings indicate that older adults whose health was affected by disasters exhibited a higher likelihood of having depressive symptoms. Policies that prioritize mental health care for older adults in disaster preparedness plans are crucial. Strengthening community networks before disasters could enhance the communal resilience and provide better support structures for older adults.

Introduction: Much research on the association between childhood status and adult health has been focussed on high income countries and, hence, these findings cannot be generalised for all developing economies. Therefore, this study is an attempt to systematically examine the impact of multiple domains of early disadvantage on nutrition status during old age in India, while testing for potential mediation by adult health, socio-economic status and lifestyle. Methods: The study uses data from the first wave of the Longitudinal Ageing Study in India (LASI), 2017-18. Binary logistic regression was used to assess the adjusted association of childhood and adulthood conditions with nutrition status. Two separate models were run for underweight and overweight. We used the structural equation modelling (SEM) approach to construct latent variables and structural models to test our hypothetical model. Results: The SEM explained 78% of the variance in underweight. The direct effect of education and childhood conditions on underweight was significant. The SEM explained 68% of the variance in overweight. Results shows that the direct effect of education and working status on overweight was significant. The indirect and total effect of childhood conditions on overweight was significant. Conclusion: The study underscores the importance of considering both direct and indirect effects in understanding the pathways through which early life experiences influence nutritional status in old age. The unexpected finding regarding the direct effect of childhood conditions on overweight in the Indian context raises important questions about the complexities of nutrition and health in this population.

Introduction: Generating unbiased and accurate assessments of sexual behavior among unmarried individuals is a major challenge, as it is governed by many social, moral, legal conventions and restrictions. These estimates are particularly susceptible to Fieldworker-induced social desirability bias. Accurate estimation of pre-marital sexual behavior is crucial for evaluating many aspects of sexual and reproductive health. The National Family Health Survey (NFHS) is the only reliable source of information on pre-marital sexual behavior in India, especially in the absence of any other comparative large-scale survey. This study provides us with an opportunity to understand the Fieldworker-level bias in the reporting of pre-marital sex among unmarried men and women. Data and methods: This study uses nationally representative data from the fifth round of the National Family Health Survey (NFHS-5). The analysis included 2950 female and 2073 male fieldworkers, as well as all unmarried women and men of reproductive age. Bayesian cross-classified multilevel modelling was performed to examine the Fieldworker’s effect on the reporting of premarital sex among unmarried respondents. Additionally, Multivariate decomposition analysis was used to quantify the effect of various fieldworker characteristics in reporting pre-marital sex. Results: The fieldworker effect accounted for around 31.7% of total variation in the reporting of intimate partner violence for females and 24.6% for IPV reporting among males. Results from the decomposition analysis indicated that age and residence of fieldworker were associated with a 2.4% increase and 1.3% decrease in the likelihood of reporting pre-marital sexual activity, respectively. After adjusting fieldworker and individual-level characteristics, an association between an age difference of greater than ten years and higher reporting of ever having had sexual intercourse was observed for both sexes. Conclusion: Although we believe that NFHS surveys are a potentially valuable source of information on pre-marital sexual behavior, especially in the absence of proven alternatives, the evidence from this study suggests that fieldworker effects may bias reporting of ever-had sexual intercourse. Therefore, estimates from these surveys should be evaluated carefully and interpreted in the context of other available information, given their wide use in policy formulation and monitoring in India.

Background: The inclusion of adolescent fertility in the Sustainable Development Goals demonstrates the widespread recognition of the possible health hazards as well as social and economic disadvantages encountered by young women and their infants. Moreover, adolescents are in a precarious situation due to their socioeconomic vulnerability coupled with the responsibility of motherhood at an early age. The present study has been conducted to examine factors associated with adolescent fertility in India and to understand the socioeconomic inequality in teenage pregnancy utilizing data from the National Family Health Survey-5 (NFHS-5). Methods: Binary logistic regression and marginal effects are applied to determine the association between teenage childbearing and other independent variables. The socioeconomic inequality in teenage pregnancy is assessed by Errygers decomposition. Results: Around one-fifth of the respondents aged 19 years reported being pregnant in their teenage (21%). The risk of teen pregnancy was negatively associated with increasing educational attainment, improving wealth index, and working status. The risk of teenage pregnancy was 46% lower among individuals with family planning mass media exposure (OR: 0.54***0.4–0.75). Marginal effects showed that with secondary and higher educational attainment, the probability of having teenage pregnancy reduced by three and eight percent points in comparison to women without education. Results from Erregyers decomposition indicated that variables such as rural place of residence (47%), attempt to delay pregnancy (25%), no exposure to mass media related to family planning (13%), incorrect knowledge of ovulatory cycle (4%) were positive contributors to inequality attributable to wealth quintile in teenage pregnancy. Conclusions: Promoting formal, institutional sources of knowledge regarding sexual and reproductive health, availability of contraception and their effective usage can enable adolescents to understand the negative repercussions of adolescent pregnancy. Moreover, work participation, higher schooling and access to family planning can also positively contribute to the reduction of teenage pregnancies.

Objective: Universal health coverage and maternal health outcomes have become a part of the global health agenda in low and middle-income countries including India. To achieve the sustainable development goals (SDG-3), maternal healthcare services utilization is a significant intervention in decreasing maternal mortality and morbidity. This study aims to assess the potential association between health insurance coverage (HIC) and maternal healthcare services utilization in India. Methods: Data was obtained from the fifth round of the National Family Health Survey (NFHS-5), conducted during 2019–21. Bivariate, spatial analysis and logistic regression models have been used to assess association between utilization of maternal healthcare services and HIC combined with other background factors in India. Results: HIC among women was found to be 24%. Approximately 59%, 90% and 46% of women had full antenatal care (ANC) visits, skilled birth attendant (SBA) and post-natal care (PNC), respectively. The study results suggested that individuals with HIC were more likely to have ANC visits (OR = 1.28; 95% CI 1.25–1.31), SBA (OR = 1.41; 95% CI 1.36–1.46) and PNC (OR = 1.16; 95% CI 1.13–1.18) services, respectively. Moreover, socioeconomic characteristics and other predictor variables were significantly associated with maternal healthcare service utilization in India. Conclusion: The study concludes that HIC is a significant predictor for the maternal and child healthcare services in India, and women with HIC were more likely to have full ANC visits, SBA and PNC. Overall, to accelerate the progress towards achieving SDGs related to maternal and child health, the government should expand and strengthen the existing policies to increase coverage of health insurance.

Background: Depression is a major public health concern among Indian adolescents. Pre- and post-natal depression can often alter fetal development and have negative consequences on the physical and mental health of the mother. This paper aims to draw attention to the prevalence of depression and its correlates among currently married, ever-pregnant adolescents from two Indian States, i.e. Uttar Pradesh and Bihar. Methods: This study utilizes data from a subsample (n = 3116) of the prospective cohort study Understanding the Lives of Adolescents and Young Adults (UDAYA) among 10 to 19 year-old adolescents. Bivariate analysis was performed to assess the prevalence of depression by sociodemographic and behavioral characteristics. To further access the predictors associated with depression a logistic regression model was applied. Results: Around one-tenth (9%) of pregnant adolescents had depression. Regression analysis indicated that substance use, religion, autonomy, considering attempting suicide, premarital relationship, violence, dowry, adverse pregnancy outcome, menstrual problem, and parental pressure for the child immediately after marriage were significantly associated with depression. Conclusions: This study confirms the pre‑existing annotation that teen pregnancy is linked with depression. Findings indicate that Adolescent mothers experiencing violence, and a history of adverse pregnancy outcomes are at increased risk of developing depression. These study findings call for an urgent need to address depression among adolescent mothers.

Background Understanding chronic disease prevalence, patterns, and co-occurrence is pivotal for effective health care planning and disease prevention strategies. In this paper, we aimed to identify the clustering of major non-communicable diseases among Indian adults aged ≥50 years based on their self-reported diagnosed non-communicable disease status and to find the risk factors that heighten the risk of developing the identified disease clusters. Methods We utilised data from the nationally representative survey Study on Global AGEing and Adult Health (SAGE Wave-2). The eligible sample size was 6298 adults aged ≥50 years. We conducted the latent class analysis to uncover latent subgroups of multimorbidity and the multinomial logistic regression to identify the factors linked to observed latent class membership. Results The latent class analysis grouped our sample of men and women?>49 years old into three groups – mild multimorbidity risk (41%), moderate multimorbidity risk (30%), and severe multimorbidity risk (29%). In the mild multimorbidity risk group, the most prevalent diseases were asthma and arthritis, and the major prevalent disease in the moderate multimorbidity risk group was low near/distance vision, followed by depression, asthma, and lung disease. Angina, diabetes, hypertension, and stroke were the major diseases in the severe multimorbidity risk category. Individuals with higher ages had an 18% and 15% higher risk of having moderate multimorbidity and severe multimorbidity compared to those in the mild multimorbidity category. Females were more likely to have a moderate risk (3.36 times) and 2.82 times more likely to have severe multimorbidity risk. Conclusions The clustering of diseases highlights the importance of integrated disease management in primary care settings and improving the health care system to accommodate the individual’s needs. Implementing preventive measures and tailored interventions, strengthening the health and wellness centres, and delivering comprehensive primary health care services for secondary and tertiary level hospitalisation may cater to the needs of multimorbid patients.

Aim: This study aims to identify the disaster-related health impact on endemic diseases among middle-aged individuals in India. Data & Methods: This study utilizes data from the first wave of the Longitudinal Ageing Survey of India, 2017-18 with an eligible sample of 66,606 individuals aged 45 years and above. Binary logistic regression analysis and the Fairlie decomposition technique were used to understand the factors affecting endemic disease and to predict the factors contributing to rural-urban inequality in endemic disease prevalence. Results: The prevalence of endemic disease was 48 % among individuals whose health was affected by the disaster and 25 % among those whose health was not affected by the disaster. The Odds Ratio (ORs) of having endemic disease among disaster-affected individuals was found to be uniformly higher in rural areas [OR: 2.6 (95% CI: 2.2,3.0)] than in urban areas [OR: 1.84 (95% CI: 1.4,2.5)]. In the adjusted model, the risk of endemic disease among disaster-affected individuals was 2.17 times and 1.42 times higher in rural and urban areas respectively in comparison to individuals without any health impact from a disaster. Conclusion: Efforts aimed at education on hygiene, and provisions of safe water and sanitation will significantly reduce the burden. Preparedness in disaster-prone areas, training the health and local community, efficient resource allocation, and identifying and managing the particular disease will help to minimize disease transmission.

In the midst of rapid urbanization and economic shifts, the global landscape witnesses a surge in overweight and obese individuals, even as child malnutrition persists as a formidable public health challenge in low- and middle-income countries (LMICs). This study seeks to unravel the prevalence of the double burden of malnutrition (DBM) within the context of India and delve into the associated disparities rooted in wealth. This study leverages data from the fifth wave of the National Family and Health Survey (NFHS-5), a nationally representative survey conducted in the year 2019–21 in India. This study focuses on mother–child dyads with children under the age of 3 years. Descriptive, bivariate and logistic regression analysis is used to decipher the intricate web of DBM’s prevalence and risk factors, as underscored by socio-demographic attributes. Wagstaff decomposition analysis is applied to quantify the contribution of each inequality in the social determinants on the observed income-related inequality in the DBM. Result from bivariate and logistic regression indicated a heightened risk of DBM within households marked by C-section births, affluence, ongoing breastfeeding practices, advanced maternal age, and larger household sizes. Additionally, households harbouring women with abdominal obesity emerge as hotspots for elevated DBM risk. Notably, the interplay of abdominal obesity and geographical disparities looms large as drivers of substantial inequality in DBM prevalence, whereas other factors exert a comparably milder influence. As India grapples with the burgeoning burden of DBM, a conspicuous imbalance in its prevalence pervades, albeit inadequately addressed. This juncture warrants the formulation of dual-purpose strategies, and a slew of innovative actions to deftly navigate the complex challenges poised by the dual burden of malnutrition. Amidst these exigencies, the imperative to forge a holistic approach that encompasses both sides of the malnutrition spectrum remains a beacon guiding the quest for equitable health and nutrition outcomes.

Background: Monitoring the transmission patterns of human immunodeficiency virus (HIV) in a population is fundamental for identifying the key population and designing prevention interventions. In the present study, we aimed to estimate the gender disparities in HIV incidence and the age, period, and cohort effects on the incidence of HIV in India for identifying the predictors that might have led to changes in the last three decades. Data and methods: This study utilizes data from the Global Burden of Disease Study for the period 1990–2019. The joinpoint regression analysis was employed to identify the magnitude of the changes in age-standardized incidence rates (ASIRs) of HIV. The average annual percentage changes in the incidence were computed, and the age–period–cohort analysis was performed. Results: A decreasing trend in the overall estimates of age-standardized HIV incidence rates were observed in the period 1990–2019. The joinpoint regression analysis showed that the age-standardized incidence significantly declined from its peak in 1997 to 2019 (38.0 and 27.6 among males and females per 100,000 in 1997 to 5.4 and 4.6, respectively, in 2019). The APC was estimated to be 2.12 among males and 1.24 among females for the period 1990–2019. In recent years, although the gender gap in HIV incidence has reduced, females were observed to bear a proportionately higher burden of HIV incidence. Age effect showed a decline in HIV incidence by 91.1 and 70.1% among males and females aged between 15–19 years and 75–79 years. During the entire period from 1990–1994 to 2015–2019, the RR of HIV incidence decreased by 36.2 and 33.7% among males and females, respectively. Conclusion: India is experiencing a decline in new HIV infections in recent years. However, the decline is steeper for males than for females. Findings highlight the necessity of providing older women and young women at risk with effective HIV prevention. This study emphasizes the need for large-scale HIV primary prevention efforts for teenage girls and young women.

Sustainable development is the need of present and future generations to ensure human growth and balance in earth biodiversity. Nutrition, a development indicator, is linked to all sustainable development goals set by the United Nations, and thus it remains the most important factor of all time. On the other hand, a lack of sufficient nutrition in children, can lead to developmental difficulties, illness, and mortality, as well as a threat to human multidimensional growth. Undernutrition, a condition characterised by a lack of proper nutrition, manifests as stunting, wasting, and being underweight and has long-term consequences such as impaired health, lower school and educational performance, reduced cognitive ability and development, poor socioeconomic skills, lower economic productivity, and loss of human capital and household income. The presence of more than one type of undernutrition among children increases the risk of death in children by a 4–12-fold. As a result, reducing levels of undernutrition is crucial to reaching the SDG of reducing child mortality. Using a Bayesian geo-additive regression approach, this study examines the risk variables, including spatial variability, related to the co-existence of stunting, wasting, and underweight among Indian children. Data from the National Family and Health Survey (NFHS)-V, available from www.dhsprogram.com, were used for this purpose. The goal of using a Bayesian geo-additive regression method is to model the linear, nonlinear, and spatial impacts of various risk factors on a unified platform, thereby exploring the possible uneven effects of some risk factors and spatial variability of the study variable caused by unobserved socio-environmental and cultural factors. The findings of this study should give insight on the significant factors and impact-behavior of metric covariates on the coexistence of undernutrition. Furthermore, results on spatial effects on the study variable would aid in identifying geographical areas in India that lagged behind in SDGs developmental indicators related to child nutrition.

Objective: To determine the prevalence and predictors of combined BMI-WC disease risk categories among Indian adults. Methods: The study utilizes data from Longitudinal Ageing Study in India (LASI Wave 1) with an eligible sample of 66, 859 individuals. Bivariate analysis was done to get the proportion of individuals in different BMI-WC risk categories. Multinomial logistic regression was used to identify the predictors of BMI-WC risk categories. Results: Poor self-rated health, female sex, urban place of residence, higher educational status, increasing MPCE quintile, and cardio-vascular disease increased with increasing BMI-WC disease risk level while increasing age, tobacco consumption, and engagement in physical activities was negatively associated with BMI-WC disease risk. Conclusion: Elderly persons in India have a considerable higher prevalence of BMI-WC disease risk categories which make them vulnerable to developing several disease. Findings emphasize the need of using combined BMI categories and waist circumference to assess the prevalence of obesity and associated disease risk. Finally, we recommend that intervention programs with an emphasis on urbanites wealthy women and those with a higher BMI-WC risk categories be implemented.

Given the significance of household food security on well-being, this chapter assesses the dietary diversity and food security among the rural population and its implication on child health. This study is based on primary data collected from 85 rural households in Jharkhand. Household food insecurity access and Household Diet Diversity Score (HDDS) were measured using items from the household food security developed by Food and Nutrition Technical Assistance Project (FANTA). The study found that tribal people were more food secure as compared to non-tribal populations. Children who had less diverse diets were more likely to be malnourished. The findings of this chapter recommend a need for an ambitious programme of food security which not only meets effective demand but also ensures superior diet quality.

Reproductive health and well-being of a woman are associated with factors such as menarche, first marriage, first sex, first birth, and menopause. The beginning of these events also brings about significant changes in women's lives. Despite marrying early being acknowledged as a detrimental and discriminatory socio-cultural global practice, a huge proportion of girls are being married at an early age, often detrimental to maternal and child health. Adding to the current national debate for the revision of the minimum age at marriage for girls from 18 to 21 years it becomes important to understand the past scenario and current situation of age at marriage in India. In this study, first five rounds of the National Family Health Survey (NFHS) have been used as a data source. Cox Proportional Hazard Model, Multiple Classification Analysis (MCA), Kaplan Meier Curve, Life table survival analysis, hierarchical clustered heat map, Multivariate Decomposition Analysis (MDA), and geospatial mapping were used to fulfill the objective of the study. The results showed that almost 65.9% of women got married before reaching the age of 18 years in the year 1992–93 which reduced to 23.2% among women aged 20–24 years in 2019–21. Region, respondent's level of education, caste, religion, wealth, and mass media exposure were significantly associated with the age at first marriage. The hazard of age at marriage declined significantly with higher educational attainment [higher education- AHR:0.37; CI:0.36 to 0.37], improving household wealth [richest wealth- AHR:0.91; CI:0.90 to 0.91], and mass media exposure [AHR:0.96; CI:0.95 to 0.96]. Since, the age at marriage has a substantial impact on fertility pattern and has a strong association with maternal & child health, policies regarding improving the age at marriage and better enforcement of the concerned laws are required to meet the SDG targets.

Pregnancy during adolescence is a major risk factor for adverse pregnancy outcomes. Further, Motherhood during the adolescent period is identified as a major global health burden. Considering the widely known importance of the negative impact of adolescent pregnancy, motherhood at an early age, and adverse pregnancy outcomes, this paper aims to provide insight into correlates of teen pregnancy, adolescent motherhood and adverse pregnancy outcome. This study utilizes the data from UDAYA survey conducted in Uttar Pradesh and Bihar. The eligible sample size for the study was 4897 married adolescent girls between the ages of 15 and 19 years. Bivariate analysis with a chi-square test of association and Multivariable logistic regression analysis was performed to fulfill the aim of the study. Our study shows that a major proportion of married adolescents (61%) got pregnant before the age of 20 years and around 42% of all adolescent married women gave birth to a child before reaching the age of 20 years. Adolescents who married before the age of 18 years were 1.79 times more likely to experience pregnancy (OR: 1.79; CI: 1.39–2.30) and 3.21 times more likely to experience motherhood (OR: 3.21; CI: 2.33–4.43). In the present study, women who experienced physical violence were at higher risk for having an adverse pregnancy outcome (OR: 1.41; CI: 1.08–1.84) than those who did not experience physical violence. To conclude, regional and national level efforts focused on improving early marriage, education and empowering women and girls can be beneficial.

In recent years, developing and developed countries are witnessing delayed childbearing among women contributing to the overall decline in fertility rates. The age at which a woman has her last child impacts maternal and child health, especially in a country with high maternal and perinatal mortality rates. This study aims to investigate the trends of age at the last birth among Indian women and to identify the potential factors contributing towards higher maternal age. The present study uses the data from five consecutive rounds (1992–1993, 1998–1999, 2004–2005, 2015–2016, and 2019–2021) of the National Family Health Survey (NFHS). We have used descriptive statistics, bivariate, Cox proportional hazard regression analysis, multiple classification analysis (MCA), Kaplan–Meier curve, life table survival analysis, hierarchical clustered heat map, multivariate decomposition analysis (MDA) and geospatial mapping to fulfill the objective of the study. Results show that the proportion of women with age at last birth before reaching the age of 30 years was less than half (nearly 35%) during NFHS-I while during NFHS-V proportion becomes more than half and reaches 64.3% among 40–49 years women. Within three decades (1992–2021) there has been a decline of 15.8% in median age at last birth among women aged 40–49 years. Additionally, the highest percentage decline in predicted mean age at last birth was noted among individuals from rural area (10.7%, 3.3 years), Hindu religion (10.8%, 3.3 years), poor wealth quantile (12.5%, 4.0 years) and those with mass media exposure (10.6%, 3.2 years) from NFHS-I (1992–1993) to NFHS-V (2019–2021). Although there exists the need to delay age at first childbirth, the age at last childbirth also plays an important role in women’s and child health status. Hence, it is important to address the healthcare needs of those delaying their childbirth.

This study investigates the socio-demographic correlates of HIV discrimination among individuals aged 15–49 years. This study also aims to assess the change in discriminatory attitudes towards PLHIV in high HIV prevalence states from 2016 to 2021 using data from the national Demographic Health Survey (4th and 5th). To identify factors associated with discriminatory attitudes, a multivariable logistic regression analysis was performed. Further, predicted probabilities and average marginal effects were computed, and the difference in discriminatory attitudes across both rounds was examined using a non-linear Fairlie decomposition. Mass media exposure, improved wealth index, and comprehensive knowledge significantly reduced the discriminatory attitudes towards PLHIV. Fairlie decomposition indicated that comprehensive knowledge, knowledge of mother-to-child transmission, and mass media exposure was significant contributor to the differences observed in the discriminatory attitude towards PLHIV across survey rounds. This study emphasizes the importance of spreading accurate information about HIV transmission modes and reinforces existing programmes and policies aimed at reducing stigma and discrimination against PLHIV. These programmes' efficiency and effectiveness can be ensured by linking them with community-level programmes and activities organized by Self Help Groups (SHGs), which have resulted in a paradigm shift in empowering women in India.

Keeping in view the cascade of disturbances caused by the co-existence of multi-morbidity and depression among aged population, this study aims to ascertain the independent impact of multi-morbidity as a risk factor for the development of depressive symptoms among adults living in India. The present study utilizes data from the nationally representative survey “Longitudinal Ageing Study in India” (LASI, Wave-1, 2017–2018). The eligible sample size was 62,244 adults aged 45 years and above. Descriptive statistics along with bivariate analysis was used to understand the prevalence of depressive symptoms. Further, binary logistic regression and Propensity Score Matching (PSM) methods were applied to examine the independent effect of multi-morbidity on depressive symptoms while controlling the selected background characteristics. Overall, around one-third respondents had at least one chronic disease and one-fifth had multi-morbidity. The most prevalent chronic disease reported in the sampled population was hypertension followed by diabetes and joint disease. It is observed that older adults with multiple chronic diseases had 77% higher odds of having depressive symptoms as compared to those without a history of chronic disease in the multivariable logistic regression model. Results obtained from PSM indicate that the risk of having depressive symptoms was 3.7% higher for adults with multi- morbidity. Depressive symptom was identified to be associated with a wider range of multiple physical health problems and people with multi-morbidity are at a higher risk of having depressive symptoms. It is imperative that multi-morbidity can be used as a screener for identifying people with depressive symptoms.

Background: One in three women from lower and middle-income countries are subjected to physical and/or sexual intimate partner violence (IPV) in their life span. Prior studies have highlighted a range of adverse health impacts of sexual IPV. However, less is known about the link between multiple high-risk fertility behaviours and sexual intimate partner violence. The present study examines the statistical association between multiple high-risk fertility behaviours and sexual intimate partner violence among women in India. Methods: The present study used a nationally representative dataset, the National Family Health Survey (NFHS-4) 2015–16. A total of 23,597 women were included in the study; a subsample of married women of reproductive age who have had at least one child 5 years prior to the survey and who had valid information about sexual IPV. Logistic regression models were employed alongside descriptive statistics. Results: Approximately 7% of women who are or had been married face sexual IPV. The prevalence of sexual violence was higher among women who had short birth intervals and women who had given birth more than three times (12%). Around 11% of women who had experienced any high-risk fertility behaviours also experienced sexual violence. The unadjusted association suggested that multiple high-risk fertility behaviours were 32% (UORs = 1.32, 95% CI: 1.16–1.50) higher for those women who experienced sexual violence. After adjusting for other sociodemographic variables, except for women’s education and wealth quantile, the odds of multiple high-risk fertility behaviours were 16% (AOR = 1.16; 95% CI: 1.02–1.34) higher among women who faced sexual violence. The inclusion of women’s educational attainment and wealth status in the model made the association between sexual IPV and high-risk fertility behaviours insignificant. Conclusion: Sexual intimate partner violence is statistically associated with high-risk fertility behaviours among women in India. Programs and strategies designed to improve women’s reproductive health should investigate the different dimensions of sexual IPV in India.

The original publication of this article [1] contained an error in the P-values in table 1 and 2, “<0.000” should be “<0.001”. This does not affect the conclusions/results of the article. The original article has been updated.

Background: Cervical cancer is the fourth most common cancer that occurs to women worldwide. This study aims to assess trends in incidence and mortality of cervical cancer in India and its states over past three decades for tracking the progress of strategies for the prevention and control of cervical cancer. Methods: Data on cervical cancer incidence and mortality from 1990 to 2019 for India and its states were extracted from Global Burden of Disease study and were utilized for the analysis. Spatial and rank map has been used to see the changes in incidence and mortality of cervical cancer in different Indian states. Further, joinpoint regression analysis is applied to determine the magnitude of the time trends in the age standardized incidence and mortality rates of cervical cancer. We obtained the average annual percent change (AAPC) and corresponding 95% confidence intervals (CI) for each state. Results: Overall, from 1990 to 2019 Jharkhand (Incidence: -50.22%; Mortality: -56.16%) recorded the highest percentage decrement in cervical cancer incidence and mortality followed by the Himachal Pradesh (Incidence: -48.34%; Mortality: -53.37%). Tamilnadu (1st rank), Jammu & Kashmir and Ladakh (32nd rank) maintained the same rank over the period of three decade for age standardized cervical cancer incidence and mortality. The regression model showed a significant declining trend in India between 1990 and 2019 for age standardized incidence rate (AAPC: −0.82; 95%CI: −1.39 to −0.25; p < 0.05) with highest decline in the period 1998-2005 (AAPC: −3.22; 95%CI: −3.83 to −2.59; p < 0.05). Similarly, a significant declining trend was observed in the age standardized mortality rate of India between 1990 and 2019(AAPC: −1.35; 95%CI: −1.96 to −0.75; p < 0.05) with highest decline in the period 1998-2005 (AAPC: −3.52; 95%CI: −4.17 to −2.86; p < 0.05). Conclusion: Though the incidence and mortality of cervical cancer declined over past three decades but it is still a major public health problem in India. Information, education and communication activities for girls, boys, parents and community for the prevention and control of cervical cancer should be provided throughout the country.

Background and aims: Hypertension (HTN) is associated with significant morbidity and mortality, especially among women. Literature suggests an association between height and hypertension. We did this study to ascertain an association between hypertension and height and explore their determinants among Indian women of reproductive age group (15–49 years). Methods: We did a secondary data analysis of the National Family Health Survey-4 (2015–16) and included 5,36,093 women between 20 and 49 years. Blood pressure and height were measured using the standard procedures. Weighted analysis was done to depict the association between the two variables. Results: Overall prevalence of HTN was 13.49%. We observed an inverse association between height and mean blood pressure of the women, and shorter women had a higher prevalence of HTN. The height of women was found to be associated with lower systolic blood pressure but not with diastolic blood pressure. Women's height depicted significant associations with age and other socio-economic and geographical parameters. Prevalence of HTN depicted a significant association with height and across other subgroups stratified by these parameters. Conclusion: We observed a positive association between the systolic BP and the height of the female. Height is one of the most convenient forms of identifying target groups that should not be missed during screening women for NCDs, especially during pregnancy to prevent premature morbidity and mortality. We recommend disseminating this concept to our primary health care workers, who are also the point of first contact for early screening and halt the burden of disease.

Background: Human immunodeficiency virus (HIV) infection remains an important public health concern in many countries. It is fuelled by gender inequality and disparity, which has resulted in a fundamental violation of women’s human rights. This study aims to find out the association of intimate partner violence (IPV) and other risk factors with the prevalence of HIV infection among married women in India. Methods: This study is based on data from the India National Family Health Survey (2015–16). Bivariate analysis has been performed to estimate the prevalence of HIV. Logistic regression analysis is conducted to find out the association between IPV, factors such as having alcoholic husband and lifetime partner, and HIV infection among currently married women. Results: Married women who had faced physical, sexual, and emotional violence from their husbands/partners were almost twice more likely to have tested HIV positive compared to married women who did not face violence [OR: 2.14, CI: 1.08–4.50]. The odds of testing for HIV positive was significantly higher among the married women experiencing IPV and having alcoholic husband [OR: 4.48, CI: 1.87–10.70] than those who did not experience IPV and had non-alcoholic husband. The use of condom did not show any significant association with HIV infection. Again, having more than one lifetime partner had a positive association with HIV infection compared to those with one partner [OR: 2.45, CI: 1.21–4.16]. Conclusions: The study revealed that factors such as experiencing all types of IPV, having an alcoholic husband, increased number of lifetime partners, being sexually inactive, belonging to vulnerable social groups, and urban place of residence are important risk factors of HIV infection among married women in India. The results also suggest that gender-based violence and an alcoholic husband may represent a significant factor of HIV infection among married women and interventions should on focus such vulnerable populations.

Background: Primary Health Centers (PHCs) are crucial in providing primary and secondary level healthcare services in rural India. Despite immense efforts and huge funding, a very small proportion of deliveries are carried out at PHCs. The present study aims to explore the availability of facilities at PHCs and its association with likelihood of delivering the child at PHC. Methods: We extracted PHC level health infrastructure data from Health Management and Information system (HMIS) and created ‘Facility Index’ using exploratory factor analysis. We merged the ‘Facility Index’ with data of the 4th National Family Health Survey (NFHS-4) to explore the relationship between availability of facilities and healthcare-seeking behavior. Bivariate analysis and multilevel logistic regressions were employed to analyze the association between Facility Index and the likelihood of delivering the child at PHC. Results: Availability of facilities (Facility Index) was found to be positively associated with utilization of PHC for childbirth but up to only a certain level of Facility Index. Women living in districts with ‘good’ Facility index were having 2.45 (OR = 2.45; 95% CI: 2.12–2.84) times higher odds of delivering the child at PHC compared to women living in districts with ‘very poor’ Facility Index; however, the odds ratio decreased to 2.11 (95% CI: 1.83–2.43) for ‘Very Good’ Facility Index. The regression line and predicted probabilities also exhibited similar results. Conclusion: Based on the findings, we conclude that improvement in availability and quality of facilities might help in improving healthcare utilization from PHCs up to a certain level.

Widowhood is a catastrophic event at any stage of life for the surviving partner particularly in old age, with serious repercussions on their physical, economic, and emotional well-being. This study investigates the association of marital status and living arrangement with depression among older adults. Additionally, the study aims to evaluate the effects of factors such as socio-economic conditions and other health problems contributing to the risk of depression among older adults in India. This study utilizes data from the nationally representative Longitudinal Ageing Study in India (LASI-2017–18). The effective sample size was 30,639 older adults aged 60 years and above. Descriptive statistics and bivariate analysis have been performed to determine the prevalence of depression. Further, binary logistic regression analysis was conducted to study the association between marital status and living arrangement on depression among older adults in India. Overall, around nine percent of the older adults suffered from depression. 10.3% of the widowed (currently married: 7.8%) and 13.6% of the older adults who were living alone suffered from depression. Further, 8.4% of the respondents who were co-residing with someone were suffering from depression. Widowed older adults were 34% more likely to be depressed than currently married counterparts [AOR: 1.34, CI 1.2–1.49]. Similarly, respondents who lived alone were 16% more likely to be depressed compared to their counterparts [AOR: 1.16; CI 1.02, 1.40]. Older adults who were widowed and living alone were 56% more likely to suffer from depression [AOR: 1.56; CI 1.28, 1.91] in reference to older adults who were currently married and co-residing. The study shows vulnerability of widowed older adults who are living alone and among those who had lack of socio-economic resources and face poor health status. The study can be used to target outreach programs and service delivery for the older adults who are living alone or widowed and suffering from depression.

Background: Food Insecurity (FI) is a crucial social determinant of health, independent of other socioeconomic factors, as inadequate food resources create a threat to physical and mental health especially among older person. The present study explores the associations between FI and cognitive ability among the aged population in India. Methods: To measure the cognitive functioning we have used two proxies, word recall and computational problem. Descriptive analysis and multivariable logistic regression was used to understand the prevalence of word recall and computational problem by food security and some selected sociodemographic parameters. All the results were reported at 95% confidence interval. Results: We have used the data from the first wave of longitudinal ageing study of India (LASI), with a sample of 31,464 older persons 60 years and above. The study identified that 17 and 5% of the older population in India experiencing computational and word recall problem, respectively. It was found that respondents from food secure households were 14% less likely to have word recall problems [AOR:0.86, 95% CI:0.31–0.98], and 55% likely to have computational problems [AOR:0.45, 95% CI:0.29–0.70]. We also found poor cognitive functioning among those experiencing disability, severe ADL, and IADL. Further, factors such as age, education, marital status, working status, health related factors were the major contributors to the cognitive functioning in older adults. Conclusion: This study suggest that food insecurity is associated with a lower level of cognition among the elderly in India, which highlight the need of food policy and interventional strategies to address food insecurity, especially among the individuals belonging to lower wealth quintiles. Furthermore, increasing the coverage of food distribution may also help to decrease the burden of disease for the at most risk population. Also, there is a need for specific programs and policies that improve the availability of nutritious food among elderly.

The references have been updated. The original article has been corrected.

Introduction: Globally, a metabolic disorder like Diabetes is considered as one of the largest global health issues, as it accounts for the majority of the disease burden and happens to be one of the leading causes of mortality as well as reduced life expectancy across the world. As in 2019, India is home to the second-largest number (77 million) of Diabetic adults and the number of people affected has been increasing rapidly over the years. Termed as “the diabetes capital of the world,” with every fifth diabetic in the world being an Indian, there is an urgent need to address many critically significant challenges posed by Diabetes in India, like, increasing prevalence among young people in urban areas, less awareness among people, high cost of disease management, limited healthcare facilities, suboptimal diabetes control etc. In Indian context, not enough attempts have been made to observe and understand the long-term pattern of diabetes incidence and mortality. This study aims to provide deep insights into the recent trends of diabetes incidence and mortality in India from 1990 to 2019. Materials and methods: This is an observational study based on the most recent data from the Global Burden of Disease (GBD) Study 2019. We extracted numbers, age-specific and age-standardized incidence and mortality rates of diabetes (from 1990 to 2019) from the Global Health Data Exchange. The average annual percentage changes in incidence and mortality were analysed by joinpoint regression analysis; the net age, period, and cohort effects on the incidence and mortality were estimated by age-period-cohort analysis. Results: During the study period, age-standardized incidence and mortality rates of diabetes in India experienced an upsurge in numbers, the incidence rate increased from 199.14 to 317.02, and consequently, mortality increased from 22.30 to 27.35 per 100,000 population. The joinpoint regression analysis showed that the age-standardized incidence significantly rose by 1.63 % (95 % CI: 1.57 %, 1.69 %) in Indian males and 1.56 % in Indian females (95 % CI: 1.49 %, 1.63 %) from 1990 to 2019. On the other hand, the age-standardized mortality rates rose by 0.77 % (95 % CI: 0.24 %, 1.31 %) in Indian males and 0.57 % (95 % CI: -0.54 %, 1.70 %) in Indian females. For age-specific rates, incidence increased in most age groups, with exception of age groups 5–9, 70–74, 75–79 and 80–84 in male, and age groups 5–9, 75–79 and 80–84 in female. Mortality in male saw a decreasing trend till age group 20–24, whereas in female, the rate decreased till age group 35–39. The age effect on incidence showed no obvious changes with advancing age, but the mortality significantly increased with advancing age; period effect showed that both incidence and mortality increased with advancing time period; cohort effect on diabetes incidence and mortality decreased from earlier birth cohorts to more recent birth cohorts, while incidence showed no material changes from 1975 to 1979 to 2000–2004 birth cohort. Conclusions: Mortality of diabetes decreased in younger age groups but increased in older age groups; however, Incidence increased in most age groups for both male and female. The net age or period effect showed an unfavourable trend while the net cohort effect presented a favourable trend. Aging was likely to drive a continued increase in the mortality of diabetes. Timely population-level interventions aiming for health education, lifestyle modification with special emphasis on the promotion of physical activity and healthy diet should be conducted, especially for male and earlier birth cohorts at high risk of diabetes.

Background: Tuberculosis, as a communicable disease, is an ongoing global epidemic that accounts for high burden of global mortality and morbidity. Globally, with an estimated 10 million new cases and around 1.4 million deaths, TB has emerged as one of the top 10 causes of morbidity and mortality in 2019. Worst hit 8 countries account for two thirds of the new TB cases in 2019, with India leading the count. Despite India's engagement in various TB control activities since its first recognition through the resolution passed in the All-India Sanitary Conference in 1912 and launch of first National Tuberculosis Control Programme in 1962, it has remained a major public health challenge to overcome. To accelerate progress towards the goal of ending TB by 2025, 5 years ahead of the global SDG target, it is imperative to outline the incidence and mortality trends of tuberculosis in India. This study aims to provide deep insights into the recent trends of TB incidence and mortality in India from 1990 to 2019. Methods: This is an observational study based on the most recent data from the Global Burden of Disease (GBD) Study 2019. We extracted numbers, age-specific and age-standardized incidence and mortality rates of Tuberculosis for the period 1990–2019 from the Global Health Data Exchange. The average annual percent change (AAPC) along with 95% Confidence Interval (CI) in incidence and mortality were derived by joinpoint regression analysis; the net age, period, and cohort effects on the incidence and mortality rates were estimated by using Age–Period–Cohort model. Results: During the study period, age-standardized incidence and mortality rates of TB in India declines from 390.22 to 223.01 and from 121.72 to 36.11 per 100,000 population respectively. The Joinpoint regression analysis showed a significant decreasing pattern in incidence rates in India between 1990 and 2019 for both male and female; but larger decline was observed in case of females (AAPC: − 2.21; 95% CI: − 2.29 to − 2.12; p < 0.001) as compared to males (AAPC: − 1.63; 95% CI: − 1.71 to − 1.54; p < 0.001). Similar pattern was observed for mortality where the declining trend was sharper for females (AAPC: − 4.35; 95% CI: − 5.12 to − 3.57; p < 0.001) as compared to males (AAPC: − 3.88; 95% CI: − 4.63 to − 3.11; p < 0.001). For age-specific rates, incidence and mortality rates of TB decreased for both male and female across all ages during this period. The age effect showed that both incidence and mortality significantly increased with advancing age; period effect showed that both incidence and mortality decreased with advancing time period; cohort effect on TB incidence and mortality also decreased from earlier birth cohorts to more recent birth cohorts. Conclusion: Mortality and Incidence of TB decreased across all age groups for both male and female over the period 1990–2019. The incidence as well as mortality was higher among males as compared to females. The net age effect showed an unfavourable trend while the net period effect and cohort effect presented a favourable trend. Aging was likely to drive a continued increase in the mortality of TB. Though the incidence and mortality of tuberculosis significantly decreased from 1990 to 2019, the annual rate of reduction is not sufficient enough to achieve the aim of India’s National Strategic plan 2017–2025. Approximately six decades since the launch of the National Tuberculosis Control Programme, TB still remains a major public health problem in India. Government needs to strengthen four strategic pillars “Detect–Treat–Prevent–Build” (DTPB) in order to achieve TB free India as envisaged in the National Tuberculosis Elimination Programme (2020).