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Evidence globally and in India indicates intersecting gender inequalities in Non-Communicable Diseases (NCDs) risk factors. These are understudied in Kerala, which is at an advanced stage of an epidemiological transition. We estimated sex differences in self-reported prevalence and screening coverage of blood pressure (BP) and blood glucose (BG) grouped by the socio-economic status. A multistage cluster random sampling survey of 3398 women and 2982 men was conducted in 4 districts of Kerala from July to October 2019. Descriptive, Relative Concentration Index (RCI) for age, wealth and education and Population Attributed Fraction (PAF) for caste/tribal groups and religion were computed using Stata 12 and WHO's Health Equity Assessment Toolkit (HEAT) Plus. More women reported BP and BG screening than men (BP - W: 90.3%; 95%CI: (89.1, 91.4) vs M: 80.8%; 95%CI: (78.5, 82.9); BG- W: 86.2%; 95%CI: 84.9, 87.4 vs M: 78.3%; (95%CI: 75.9, 80.6)).BP prevalence was significantly higher among women than men (BP - W: 11.2%; 95%CI: (9.0, 13.9) vs M: 7.9%; 95%CI: (6.6, 9.6). BP screening was concentrated among less educated women (WRCI: -0.2: 95%CI: -0.2, -0.1), older (WRCI: 0.3: 95%CI: 0.2, 0.4; MRCI: 0.5: 95%CI: 0.4,0.7) and wealthier populations (WRCI: 0.1: 95%CI: 0.03, 0.2; MRCI: 0.3: 95%CI: 0.1, 0.4).High BP was concentrated among more educated women (WRCI: 0.9: 95%CI: 0.1, 1.6) and less educated men (MRCI: -1.6: 95%CI: -2.6, -0.6). High BG was concentrated among less educated women (WRCI: -1.6: 95%CI: -2.4, -0.8) and more educated men (MRCI: 0.9: 95%CI: -0.1, -1.6). Religion inequality in high BG among women was -19.1(95%CI:-28.0, -10.2).We found distinct patterns of sex related inequalities in NCD risk factors in Kerala. There is a need for greater screening among men but also sub populations of women who may be under-served by screening services. These patterns require further exploration to understand contexts and pathways to ensure program design leaves no one behind. Key messages Intersecting gender inequalities in prevalence and screening coverage of NCD risk factors in Kerala, India. NCD screening should reach all gender equitably despite of their social economic status.

Intersecting gender inequalities in non-communicable disease risk factors in Kerala: A primary study