Decomposing socioeconomic inequality in lean diabetes among middle-aged adults and elderly in India

Background: Lean diabetes is a subtype of diabetes (BMI < 18.5 Kg/m 2) with severe microvascular complications. Unlike diabetes, the prevalence of lean diabetes is higher among poor and marginalised populations. We decompose the socioeconomic inequalities in lean diabetes among middle-aged adults and elderly (45+ years) using nationally representative data from India. Methods: The Longitudinal Ageing Study in India (LASI) wave-1 microdata with a complete case analytic sample size of 58,824 individuals (45+) were utilised. We combined self-reported medically diagnosed diabetic conditions with BMI and identified the lean diabetic cases. Descriptive statistics and multivariable logistic regression were used to examine the prevalence and predictors of lean diabetes. Erreygers’ concentration index (ECI) and decomposition analyses were used to examine the contribution of socioeconomic factors in lean diabetes. Results: The prevalence of lean diabetes among older adults 45+ was 0.8% (95% CI: 0.7%, 0.9%); ranging from 1.1% (95% CI: 0.7%, 1.6%) among the poorest MPCE quintile to 0.5% (95% CI: 0.3%,0.6%) among richest MPCE quintile. A negative ECI (-.006) suggests pro-poor inequality in lean diabetes. The decomposition shows that the economic condition of households measured by monthly per capita consumption expenditure explains the largest variation in socio-economic inequality of lean diabetes (72%) followed by the place of residence (24%) and education (20%). Conclusion: The health care system in India needs to pay attention to the high burden of lean diabetes among the socially and economically disadvantaged populations in the diabetes care cascade.