A study reveals that hypertension among Muslim women in India doesn’t follow simple poverty patterns—and the geographic clustering is intensifying.
Summary
A comprehensive analysis of India’s National Family Health Surveys reveals that hypertension among Muslim women is rising and socially patterned in unexpected ways. The study, conducted by researchers at IIT Bombay, examined data from over 90,000 Muslim women across two survey rounds.
Hypertension prevalence increased from 12.11% in 2015-16 to 12.52% in 2019-21 among Muslim women. The age gradient is striking: women aged 40-49 face roughly nine times higher odds than those aged 15-19. By 2021, women in the wealthiest quintile showed 37% higher odds of hypertension than the poorest—a reversal of the typical pattern.
Education emerged as protective, with higher education linked to 35% lower odds. Spatial analysis revealed intensifying geographic clustering, with Moran’s I increasing from 0.111 to 0.210—meaning hypertension hotspots among Muslim women are becoming more concentrated.
The findings challenge assumptions that hypertension is purely a disease of poverty. Instead, they suggest India’s epidemiological transition is creating complex risk patterns where economic advancement may bring new cardiovascular vulnerabilities. The study calls for screening strategies that account for minority status, age, and substantial subnational spatial inequality.
The Silent Crisis Nobody Is Talking About
When researchers Zeenat Hashmi and Ashish Singh from IIT Bombay dove into India’s National Family Health Survey data, they uncovered a troubling pattern. Hypertension among Muslim women isn’t just increasing—it’s becoming more geographically concentrated and socially complex .
The numbers tell a stark story. Among Muslim women aged 15-49, hypertension prevalence crept up from 12.11% to 12.52% between 2015 and 2021. But that modest national increase masks far more dramatic patterns beneath the surface .
Age: The Unavoidable Risk Factor
The age gradient is undeniable. Women aged 40-49 faced adjusted odds of hypertension that were nine times higher than women aged 15-19 in 2015 (OR=9.19), dropping only slightly to 8.33 times higher by 2021 .
This age-related risk aligns with broader Indian hypertension patterns. The overall prevalence in India stands at 22.6%, with rates climbing to 48.4% among those aged 60 and above .
The Wealth Paradox: When Affluence Brings Risk
Perhaps the most counterintuitive finding involves wealth. By 2021, women in the fourth wealth quintile showed 51% higher odds of hypertension than the poorest quintile. The richest quintile followed closely with 37% higher odds .
This pattern suggests India is in an early stage of epidemiological transition. During this phase, lifestyle-related risks often appear first among wealthier populations, who are more likely to work in sedentary occupations, consume energy-dense diets, and live in urban environments. Better access to healthcare and screening among advantaged groups can further amplify observed prevalence .
The Education Protection Effect
Education appears to offer real protection. In 2021, Muslim women with higher education had 35% lower odds of hypertension than those without formal schooling (OR=0.65, 95% CI: 0.50-0.84) .
This finding aligns with broader research showing higher education correlates with lower hypertension likelihood across India’s population .
Employment and Marital Status: Complex Associations
Among employed Muslim women, hypertension prevalence increased from 13.08% to 15.41% between survey rounds, compared with non-employed women who saw a modest rise from 11.51% to 11.98% .
However, researchers caution against simplistic interpretations. The NFHS employment variable doesn’t distinguish between formal salaried work, casual labor, agricultural work, self-employment, or unpaid family work. These forms differ substantially in income security, autonomy, physical demand, and time pressure .
Marital status tells a similarly complex story. Formerly married women showed the highest prevalence among marital-status groups, increasing from 20.14% to 24.17% between rounds .
The Geography of Risk: Clustering Intensifies
The spatial analysis reveals something deeply concerning. District-level clustering among Muslim women intensified significantly between survey rounds, with Moran’s I increasing from 0.111 to 0.210 (p<0.001) .
Coastal districts in the peninsular region and parts of northeastern India show the highest prevalence of elevated blood pressure. Meanwhile, parts of Gujarat, Rajasthan, and Jammu and Kashmir demonstrate relatively lower prevalence .
This geographic patterning reflects uneven development trajectories, differences in urbanization, labor markets, infrastructure, and state capacity. Areas experiencing earlier economic growth may be exposed sooner to transition-related risks, while simultaneously benefiting from better diagnostic capacity .
Minority Status and Health Disparities
Muslims constitute India’s largest religious minority and have historically experienced disadvantages in education, employment, housing, and access to public services .
For Muslim women, these disadvantages intersect with gendered constraints on mobility, labor force participation, household decision-making, and healthcare access. The study conceptualizes minority status as a structural social location that may shape exposure to socioeconomic, gendered, and spatial conditions associated with cardiometabolic risk .
However, researchers emphasize that religion itself isn’t a direct biological or cultural determinant of hypertension. Instead, the socioeconomic patterning among Muslim women may be shaped by unequal exposure to education, wealth, employment, marital status, residential context, and health-system access .
Beyond Numbers: What These Patterns Mean
The findings challenge several assumptions. First, hypertension among Muslim women cannot be understood solely as a disease of poverty. The emergence of elevated risk among relatively better-off groups suggests screening strategies should not be limited to economically deprived women alone .
Second, socioeconomic gradients are dynamic rather than fixed. The Concentration Index remained positive for several subgroups, including secondary-educated women (0.104 to 0.125) and employed women (0.042 to 0.123), indicating hypertension continued concentrating among relatively better-off groups .
Third, spatial clustering suggests prevention strategies must account for subnational heterogeneity. Districts and regions with persistent clustering may require stronger screening, referral, and follow-up systems .
Policy Implications: A Call for Targeted Action
The study’s recommendations are clear. Screening strategies must account for age, education, wealth, marital status, employment, and regional context .
Healthcare systems need to ensure minority women aren’t overlooked in non-communicable disease prevention. This means culturally sensitive outreach, improved access to primary care, and better integration of hypertension screening into routine reproductive and child health services .
Community-level interventions could help educate women about health-promoting and health-risk behaviors. Strengthening health-services delivery at the community level could facilitate effective hypertension management among marginalized women .
Future Research Directions
The study opens several research avenues. Future work with richer measures of work conditions, household resources, healthcare access, and local institutional capacity would help explain the mechanisms behind these patterns .
Inter-religious comparative designs and longitudinal data would help test whether socioeconomic gradients in hypertension differ across religious groups and how these gradients evolve over the life course. Small-area estimation or Empirical Bayes smoothing could improve the stability of district-level estimates in sparse populations .
Conclusion: A Different Kind of Development Challenge
India is in the midst of an epidemiological transition where chronic diseases increasingly coexist with persistent undernutrition, infectious disease burdens, and socioeconomic inequality .
The findings from Hashmi and Singh’s study reveal that hypertension among Muslim women is not following a simple trajectory. Age-related risk persists, wealth gradients are shifting, and geographic clustering is intensifying .
This isn’t just a medical problem—it’s a development challenge. As India’s economy grows and populations urbanize, the burden of non-communicable diseases is shifting in complex ways. Understanding these patterns within religious minority populations is essential for designing effective, equitable public health strategies.
The researchers conclude that hypertension screening and prevention must account for socioeconomic position, minority status, and substantial spatial inequality. Without targeted, disaggregated approaches, India’s progress in controlling hypertension may leave vulnerable populations behind .
Reference: Hashmi Z and Singh A (2026) Trends and socioeconomic-spatial inequalities in hypertension among Muslim women in India, 2015–2021: evidence from the National Family Health Surveys. Front. Public Health 14:1828079. doi: 10.3389/fpubh.2026.1828079
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