Decomposing the rural–urban disparities in the prevalence of diabetes among older adults in India

Abstract Objectives The study aims to address the emerging issue of population ageing in India alongside the rising burden of non-communicable diseases, with a particular focus on the rural-urban differences in diabetes prevalence among older adults. Specifically, it seeks to measure the gap and identify the key socioeconomic and health determinants of this gap. Methods For the purpose of the analysis, self-reported data on diabetes diagnosis and management were used. The sample was drawn from LASI Wave 1 (2017-18) and comprised 28,199 respondents aged 60 years and above. Multivariable analysis, in conjunction with, the Fairlie decomposition method was employed to identify the significant predictors of the rural-urban gap in diabetes prevalence. Results The prevalence of diabetes was substantially higher in urban as compared to rural areas (24.2% and 9.0% respectively). Approximately 56% of the disparity was explained by observable factors with hypertension, education, obesity, and a family history, emerging as the most significant contributors. The remaining 44% of the disparity was unexplained, indicating differences in healthcare structure, awareness, and lifestyle contexts. Conclusions This study enhances the understanding of place-based health inequalities by integrating decomposition analysis with nationally representative aging data. It emphasizes the need for tailored strategies that address both individual-level and structural barriers, particularly in underserved rural areas. The study contributes to the broader literature on aging, health inequity, and the management of chronic diseases in lower-middle-income countries.