Social patterning of anemia, excess adiposity, and high blood pressure among nonpregnant women aged 20–49 years in Nepal: a cross-sectional analysis of the 2022 demographic and health survey

Abstract Background Nepal is experiencing simultaneous burdens of anemia and cardiometabolic disease, but these conditions may not share the same social distribution. We compared anemia, excess adiposity, and high blood pressure within a common analytical framework using contemporary national data. Methods We conducted a cross-sectional secondary analysis of the nationally representative 2022 Nepal Demographic and Health Survey. The primary population was nonpregnant women aged 20–49 years. Outcomes were anemia (altitude- and smoking-adjusted hemoglobin < 12.0 g/dL), excess adiposity (body mass index ≥ 25.0 kg/m²), and high blood pressure (systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or current antihypertensive medication). We estimated survey-weighted prevalence. The main comparative presentation used model-standardized prevalence from outcome-specific survey-weighted logistic models containing the same seven sociodemographic covariates. Survey-weighted quasi-Poisson models provided adjusted prevalence ratios in supplementary analyses. Cross-outcome heterogeneity was tested in a stacked common-sample model. Results Among 5,762 nonpregnant women, outcome-specific eligible samples were 5,692 for anemia, 5,654 for excess adiposity, and 3,088 for high blood pressure; corresponding complete-case model samples were 5,682, 5,644, and 3,082. Weighted prevalence was 32.7% (95% confidence interval [CI], 30.8–34.6) for anemia, 34.5% (32.6–36.4) for excess adiposity, and 11.2% (9.8–12.5) for high blood pressure. Standardized prevalence showed a strong positive age and wealth pattern for excess adiposity and a steep age pattern for high blood pressure, whereas anemia varied most clearly by ethnicity and province. In a common complete-case sample of 3,023 women, overall outcome-by-covariate heterogeneity was detected ( P < 0.001); heterogeneity was detected for age, wealth, ethnicity, province, and marital status, but not for education or residence. Among 3,029 women with all three outcomes measured, 15.4% had at least two conditions and 1.8% had all three. Conclusions Applying consistent definitions and a common covariate set showed that several social and geographic patterns differed across anemia, excess adiposity, and high blood pressure, although education and residence patterns were not statistically distinguishable across outcomes. These conditional associations should not be interpreted causally, and hemoglobin measurement alone cannot establish anemia etiology. Public health planning should avoid assuming that one targeting strategy will identify women with all three conditions. Trial registration Not applicable. This study is a secondary analysis of cross-sectional survey data and does not report results from a health care intervention on human participants.