Sugar and Status: Glycaemic Risk and Social Stratification Among Women in India

The wealthiest women show roughly double the diabetes prevalence of the poorest (6.2% vs 2.6%), the opposite of the affluence-protective pattern seen in many countries. The apparent urban-rural gap (5.6% vs 3.0%) largely disappears once wealth, BMI, and age are controlled for - urbanisation itself isn't the causal driver. Age and BMI are the strongest predictors: women aged 45–49 have 3.9× the odds of the youngest cohort. Religious disparities persist even after adjustment, with Muslim women showing elevated odds (OR = 1.237), suggesting community-specific factors beyond socioeconomic status. Education's apparent protective effect disappears once wealth and urbanisation are controlled for - a case of confounding, not real protection. Using ordered logistic regression that preserves clinical staging, the study surfaces a "wealth reversal" effect and highlights undiagnosed prediabetes (7.1% prevalence) as the real intervention target. It recommends targeting specific high-risk demographic groups, rejecting an affluence-only risk narrative, and designing culturally tailored interventions.