Prevalence and detecting spatial clustering of diabetes at the district level in India



Diabetes is increasingly becoming a prevalent disease in developing countries such as India. This has raised great concern among public health practitioners, researchers and policy makers. The present study aims to examine the geographical variations in the prevalence of diabetes and its contextual risk factors including production and consumption of different food groups in the districts of India.


We used state- and district-level data from multiple sources. These include National Family Health Survey-4 (2015–2016), socio-economic data from the census of India (2011), per capita crop production from the Ministry of Agriculture and Farmers and consumption of different food groups from the 68th round of the National Sample Survey. The study adopted advanced spatial statistical analysis including the Moran index and spatial regression to fulfil the objectives of the article.


The study reveals the remarkable geographical variations in diabetes risk in the districts of India. Districts from the coastal area have more diabetes prevalence. Per capita calorie consumption, calorie intake from sugar and production of sugar crops in districts are significantly positively related to diabetes prevalence. On the other hand, protein intake and calorie consumption from pulses and nuts and milk and dairy products reduce the risk of diabetes.


The study recommends that public health programmes target hot-spot districts with high prevalence of diabetes and encourage people to increase consumption of protein-rich diets including pulses, nuts and milk products to reduce diabetes prevalence.

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Data availability

This article used state/district-level data from multiple sources. State/district factsheets of National Family Health Survey-4 (2015–2016) can be downloaded from the website “”. Socio-economic indicators for all districts were compiled from (census of India, 2011). Furthermore, the article used per capita crop production from the website of the Ministry of Agriculture and Farmers (, and consumption of different food groups at the state-level was compiled from the National Sample Survey Office (NSS Report no. 560).


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This research received no specific grant from any funding agency, commercial entity or not-for-profit organisation. We thank the reviewers from the journal for giving their useful comments for the improvement of this article.

Author information




Conceived and designed the experiments: KG, PD. Compiled the data: KG. Analysed the data: KG. Writing-original draft: KG, PD. Writing-review and editing: PD, GA.

Corresponding author

Correspondence to Preeti Dhillon.

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Competing interests

We declare that no competing interests exist.

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The authors declare that they have no conflict of interest.

Ethical statement

The authors assert that all procedures contributing to this work fulfil the ethical standards of the National Family Health Survey. The protocol for the NFHS-4 survey, including the content of all the survey questionnaires, was approved by the IIPS Institutional Review Board and the ICF Institutional Review Board. The protocol was also reviewed by the US Centers for Disease Control and Prevention (CDC).

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Ghosh, K., Dhillon, P. & Agrawal, G. Prevalence and detecting spatial clustering of diabetes at the district level in India. J Public Health (Berl.) 28, 535–545 (2020).

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  • Diabetes
  • Spatial
  • Dietary groups
  • India
  • Districts