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Background <p>Ambient fine particulate matter (PM<sub>2.5</sub>) exposure is a leading risk factor for non-communicable diseases (NCDs) globally. Yet gaps remain in understanding the disparities in PM<sub>2.5</sub>-related NCD burdens across population subgroups, especially in low- and middle-income countries like India.</p> Objective <p>The main aim of this work is to address this gap by examining how the ambient PM<sub>2.5</sub>-attributable burden of three NCDs (diabetes, high blood pressure, and heart disease) varied across demographic subgroups in India, where people are exposed to some of the highest PM<sub>2.5</sub> levels.</p> Methods <p>Using nationally representative socio-demographic and health information from the National Family Health Survey (NFHS-4 and NFHS-5), covering approximately 1.49 million individuals aged 15–49 years, we employed a hierarchical logistic mixed-effects model to estimate associations between satellite-derived ambient PM<sub>2.5</sub> exposure and the odds of diabetes, high blood pressure, and heart disease, stratified by gender, wealth, and caste-based subgroups, and adjusted for relevant covariates, using data from the National Family Health Survey. These subgroup-specific risk estimates were then used to assess disparities in ambient PM<sub>2.5</sub>-attributable NCD burden.</p> Results <p>The associations between PM<sub>2.5</sub> exposure and the three NCDs were stronger in males (Odds Ratio, OR: 1.047, 95% confidence intervals: 1.041–1.053) than in females (OR: 1.033, 1.027–1.039) and in other backward classes (OBC) (OR: 1.079, 1.075–1.083) than in their demographic counterparts. While the richest subgroup was most vulnerable to PM<sub>2.5</sub>-related diabetes risk (OR: 1.063, 1.056–1.07), with risk decreasing across lower wealth-index categories, the pattern was reversed for heart disease and high blood pressure. The morbidity burden attributable to PM<sub>2.5</sub> was higher among males, OBC, and disadvantaged subgroups (2.04–11.8 million) than among their demographic counterparts.</p> Significance <p>Our findings underscore the need for equity-focused policies targeting vulnerable subgroups to reduce disparities in environmental health burdens in India.</p> Impact <p><UnorderedList Mark="Bullet"> <ItemContent> <p>This study quantifies socio-demographic disparities in ambient PM<sub>2.5</sub>-attributable burden of diabetes, high blood pressure, and heart disease across India using nationally representative socio-demographic and health database. The findings identify population subgroups disproportionately affected by air pollution, providing policy-relevant evidence to guide equitable clean-air strategies. Because NFHS health measurements were limited to adults aged 15–49 years, the estimated disparities likely represent a conservative assessment of the true population-level burden.</p> </ItemContent> </UnorderedList></p>

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Disparity in non-communicable disease burden attributable to ambient PM2.5 exposure among adult population subgroups in India

  • 期刊论文

  • 发表日期：

    2026年5月29日

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  • Debajit Sarkar,
  • Alok Kumar,
  • Fahad Imam,
  • Santu Ghosh,
  • Sagnik Dey

摘要

Background

Ambient fine particulate matter (PM2.5) exposure is a leading risk factor for non-communicable diseases (NCDs) globally. Yet gaps remain in understanding the disparities in PM2.5-related NCD burdens across population subgroups, especially in low- and middle-income countries like India.

Objective

The main aim of this work is to address this gap by examining how the ambient PM2.5-attributable burden of three NCDs (diabetes, high blood pressure, and heart disease) varied across demographic subgroups in India, where people are exposed to some of the highest PM2.5 levels.

Methods

Using nationally representative socio-demographic and health information from the National Family Health Survey (NFHS-4 and NFHS-5), covering approximately 1.49 million individuals aged 15–49 years, we employed a hierarchical logistic mixed-effects model to estimate associations between satellite-derived ambient PM2.5 exposure and the odds of diabetes, high blood pressure, and heart disease, stratified by gender, wealth, and caste-based subgroups, and adjusted for relevant covariates, using data from the National Family Health Survey. These subgroup-specific risk estimates were then used to assess disparities in ambient PM2.5-attributable NCD burden.

Results

The associations between PM2.5 exposure and the three NCDs were stronger in males (Odds Ratio, OR: 1.047, 95% confidence intervals: 1.041–1.053) than in females (OR: 1.033, 1.027–1.039) and in other backward classes (OBC) (OR: 1.079, 1.075–1.083) than in their demographic counterparts. While the richest subgroup was most vulnerable to PM2.5-related diabetes risk (OR: 1.063, 1.056–1.07), with risk decreasing across lower wealth-index categories, the pattern was reversed for heart disease and high blood pressure. The morbidity burden attributable to PM2.5 was higher among males, OBC, and disadvantaged subgroups (2.04–11.8 million) than among their demographic counterparts.

Significance

Our findings underscore the need for equity-focused policies targeting vulnerable subgroups to reduce disparities in environmental health burdens in India.

Impact

This study quantifies socio-demographic disparities in ambient PM2.5-attributable burden of diabetes, high blood pressure, and heart disease across India using nationally representative socio-demographic and health database. The findings identify population subgroups disproportionately affected by air pollution, providing policy-relevant evidence to guide equitable clean-air strategies. Because NFHS health measurements were limited to adults aged 15–49 years, the estimated disparities likely represent a conservative assessment of the true population-level burden.