The study traced how non-communicable diseases (NCDs) and risk factors have spread among India’s poorest middle-aged and older adults. Among older people in extreme poverty in Andhra Pradesh, 28.6 percent have diabetes. In Telangana, 28.7 percent consume alcohol.
Published Oct 17, 2025 | 7:00 AM ⚊ Updated Oct 17, 2025 | 7:00 AM
Southern states, despite higher incomes and better health infrastructure, show a heavier burden of metabolic diseases.
Synopsis: India’s poorest adults are increasingly affected by chronic diseases once associated with wealth, according to a new study. In Andhra Pradesh, 28.6 per cent of older adults living in extreme poverty have been diagnosed with diabetes, while 28.7 per cent of their counterparts in Telangana consume alcohol. Researchers warn that poverty no longer protects against lifestyle-related illness, highlighting high rates of hypertension, frailty, tobacco use and metabolic risk factors across rural and southern states.
The poorest families in Andhra Pradesh survive on less than $1.90 per day (₹165), stretching that meagre income for food, shelter, and medicine. Yet, one in four older people in these families has been diagnosed with diabetes – the highest recorded in the country.
In neighbouring Telangana, one in four of the poorest older people consumed alcohol in the previous three months. These figures, from a new study published in The Lancet Global Health, challenge long-held ideas about poverty and disease. The findings overturn the old belief that poverty protects people from illnesses once associated with wealth.
The study traced how non-communicable diseases (NCDs) and risk factors have spread among India’s poorest middle-aged and older adults. Among older people in extreme poverty in Andhra Pradesh, 28.6 percent have diabetes. In Telangana, 28.7 percent consume alcohol.
The research, conducted by Stanford University, the University of Southern California, the University of Michigan, and India’s International Institute for Population Sciences, analysed data from more than 66,000 adults aged 45 and above.
Using the World Bank’s poverty line of ₹165 per day (equivalent to $1.90 in 2011 purchasing power), the researchers estimated that about 46 million people—roughly 4.6 crore Indians—live in extreme poverty.
Among this group, 40.3 percent use tobacco, 39 percent experience frailty, 28.7 percent live with hypertension, 10.4 percent have diabetes, and 10.5 percent consume alcohol.
The study notes: “We found that people in extreme poverty in India have a high prevalence of hypertension (28.7 percent), tobacco use (40.3 percent), and frailty (39.0 percent).”
Researchers estimate that approximately 1.9 crore people in extreme poverty use tobacco, 1.8 crore are frail, and about 1.3 crore live with hypertension.
The data reveal a clear regional divide. Southern states, despite higher incomes and better health infrastructure, show a heavier burden of metabolic diseases. Central and eastern states struggle more with alcohol and tobacco use.
They call for stronger enforcement of bans, particularly in rural areas where smokeless tobacco dominates.
“Socioeconomically developed states in the south and north need to address the high prevalence of diabetes and obesity,” the researchers write.
Kerala and Tamil Nadu also report high metabolic risks. The pattern suggests that poverty no longer protects against lifestyle-related illness. Even in poor households, changing diets and reduced physical labour appear to increase the risk of diabetes and hypertension.
Tobacco remains the most widespread behavioural risk factor among India’s poor. Despite the National Tobacco Control Programme, 40.3 percent of adults in extreme poverty continue to use tobacco.
The study’s authors observe: “Tobacco taxation is a powerful policy tool but has thus far been under-utilised. Raising taxes on tobacco products could be especially effective in curbing use among those in poverty as this population is highly price-sensitive.”
For decades, public health planning in India assumed that the poor mainly face infectious diseases and undernutrition. This study challenges that view.
“As people move out of extreme poverty, their risk of metabolic risk factors approaches the risk in those not in poverty,” the authors observe.
Poverty now coexists with chronic illness. The researchers estimate that about 13 lakh people in extreme poverty live with diabetes, and similar numbers consume alcohol. The combined burden pushes families into debt and loss of income.
Hypertension prevalence exceeded 25 percent in most states, reaching 64.2 percent in Sikkim. Tobacco use surpassed 25 percent in 26 states and territories, reaching 76.3 percent in Mizoram and 69.2 percent in Tripura.
Alcohol use was highest in Dadra and Nagar Haveli (41.7 percent) and Daman and Diu (35.9 percent), followed by several eastern and southern states, including Telangana (28.7 percent).
Women in extreme poverty face different risks. They are more likely to have hypertension and frailty, and less likely to use tobacco or alcohol.
“Females had a higher risk of hypertension and general obesity, and a lower risk of alcohol and tobacco use,” the study reports.
Frailty among poor women stands at 39 percent. Depression affects 8.8 percent of adults in extreme poverty, though the researchers note that social stigma leads to under-reporting.
“The higher risk of chronic conditions among females could be addressed by integrating screening for depression and eye diseases into women’s health services,” the authors suggest.
In rural India, limited access to screening and care compounds these risks. The study found that “rural residents had a higher risk of alcohol use (1.37 times), tobacco use (1.20 times), and frailty (1.24 times) than urban residents.”
In Andhra Pradesh, the 28.6 percent diabetes prevalence among adults in extreme poverty far exceeds the national average of 10.4 percent. Researchers link this to changing diets and reduced physical activity, a trend visible even in low-income households.
In Telangana, 28.7 percent alcohol use points to social stressors that accompany poverty. The authors note that “eastern and central states, such as Jharkhand and Chhattisgarh, could consider prioritising alcohol prevention efforts, whereas more socioeconomically developed states in the south and north need to address the high prevalence of diabetes and obesity.”
For Telangana, this means prevention and de-addiction campaigns must reach rural communities. For Andhra Pradesh, it calls for scaling up diabetes screening and counselling through primary health centres.
Frailty emerges as one of the strongest predictors of disability and mortality. Nearly four in ten adults in extreme poverty are frail.
The study notes: “Participants at all poverty levels had a higher risk of frailty compared with those not in poverty.”
The burden is higher among women and rural residents. Researchers point to Tamil Nadu’s eye-care outreach as a model: “Community-based outreach programmes have been successful in reducing inequities in access to eye care in Tamil Nadu and could serve as a model for other states.”
Similar community models, they suggest, can identify frail adults early and link them to basic services and nutrition support.
India’s Ayushman Bharat Health and Wellness Centres—now Ayushman Arogya Mandirs—include NCD management within their service package. But gaps persist.
The researchers flag “shortage of testing supplies, lack of knowledge among health workers, and poor referral mechanisms” as barriers. These issues limit diagnosis and follow-up, especially in remote areas.
The authors add: “India’s health policy framework must reflect intracountry variations to maximise efficiency. Urban residents in extreme poverty had a higher risk of metabolic risk factors, whereas rural residents had a higher risk of behavioural risk factors.”
Among those in extreme poverty, 44 percent belong to other backward classes and 28 percent to scheduled castes or tribes. About 78 percent lack any form of health insurance, and more than half have never attended school.
“The majority of participants were male, had completed no schooling, were illiterate, currently working, married, rural residents, and did not have health insurance,” the study records.
Older adults form a large share – nearly one-third are aged 65 years or more. Chronic pain affects 12.3 percent, and vision impairment 4.9 percent. The combined effect is long-term disability and financial strain.
The authors summarise the larger pattern: “The poorest are living longer – but with illnesses that threaten to push them deeper into destitution.”
The study urges state-specific strategies. For Andhra Pradesh, the focus should be on managing metabolic diseases. For Telangana, efforts must curb alcohol use. For both states, community-level screening through health and wellness centres and outreach camps should be expanded.
“There were substantial geographical variations in the prevalence of NCD risk factors and chronic conditions, which highlights the need for state-specific policies,” the authors write.
The message is simple but urgent: the poorest Indians now face the same diseases as the rich, without the same care or cushion.
“This study is one of the first to estimate the prevalence of a wide range of NCD risk factors and chronic conditions in a nationally representative sample of adults in extreme poverty. Our subnational estimates can guide state-level planning and resource allocation decisions.”
(Edited by Dese Gowda)
