Validity of self-reported hypertension in India: evidence from nationally representative survey of adult population over 45 years

Self-reported measures of health, in the context of developed countries, are well-researched and commonly regarded as reliable predictors of the underlying health of the population. However, the validity of these measures is under-researched and questionable in the context of low- and middle-income countries. The authors used Longitudinal Ageing Study in India (LASI) survey data from India to compare self-reported hypertension with biometrically-measured hypertension. The results are reported in terms of sensitivity, specificity, and kappa as a measure of agreement. Logistic regression was undertaken to examine the characteristics of those who were unaware of their hypertensive status. Our analysis showed a low sensitivity of 56% and a high specificity of 90.5%. Agreement between self-reported data and biometric measurement of hypertension was observed to be moderate (κ = 0.48). Large variations were observed among states and sub-groups. The odds of false negative reporting of hypertension were lower in the individuals with higher age, high education, and greater wealth status. The authors conclude that self-reported hypertension has important limitations and may be a source of systematic bias. It is recommended that planning and policy-making in India be based more on an objective assessment of hypertension.