|Year : 2021 | Volume
| Issue : 2 | Page : 125-129
Prevalence and gender differences in risk factors for noncommunicable diseases in an urban village of Delhi, India: A community-based cross-sectional study
Anita Khokhar, Poornima Tiwari, Geeta Pardeshi, Shalini Smanla, Priyanka Sharma, Mohammad Rashid, Prateek Goyal
Department of Community Medicine, VMMC and Safdarjung Hospital, New Delhi, India
|Date of Submission||23-Mar-2021|
|Date of Acceptance||05-Oct-2021|
|Date of Web Publication||24-Dec-2021|
Dr. Priyanka Sharma
Department of Community Medicine, VMMC and Safdarjung Hospital, Room Number 517, Fifth Floor, College Building, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
Introduction: About 60% of all deaths in India occur due to noncommunicable diseases (NCDs) and their complications. Early screening for the risk factors can result in a significant reduction in morbidity & mortality. The study was conducted to assess the risk factors for common NCD in an urban village of Delhi, India.
Material & Methods: A house-to-house survey was conducted in the study area and risk assessment was done for apparently healthy individuals ≥30 years of age using Community-Based Assessment Checklist by the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke. Participants with a total risk score of more than four were categorized as being at risk of development of NCDs. Descriptive analysis was performed and Chi-square was used to find out gender-related differences in risk factor scores.
Results: A total of 478 adults participated in the study with a mean age of 40.3 ± 9.7 years and 54.6% were females. Majority (93.1%) of study participants had at least one risk factor. Approximately 17.2% of study participants had a total risk score of more than 4. There was a high prevalence of modifiable risk factors with more males being tobacco (P < 0.001) and alcohol users (P < 0.001) and more females being inactive (P = 0.007) and having abdominal obesity (P < 0.001).
Conclusion: One in six study participants with age ≥30 years was found to be at high risk of having NCDs. This calls for heightened screening activities in this age group along with gender-specific approaches to address the risk factors.
Keywords: Noncommunicable diseases, risk factors, screening, urban village
|How to cite this article:|
Khokhar A, Tiwari P, Pardeshi G, Smanla S, Sharma P, Rashid M, Goyal P. Prevalence and gender differences in risk factors for noncommunicable diseases in an urban village of Delhi, India: A community-based cross-sectional study. Indian J Community Fam Med 2021;7:125-9
|How to cite this URL:|
Khokhar A, Tiwari P, Pardeshi G, Smanla S, Sharma P, Rashid M, Goyal P. Prevalence and gender differences in risk factors for noncommunicable diseases in an urban village of Delhi, India: A community-based cross-sectional study. Indian J Community Fam Med [serial online] 2021 [cited 2022 Jul 4];7:125-9. Available from: https://www.ijcfm.org/text.asp?2021/7/2/125/333663
| Introduction|| |
Noncommunicable diseases (NCDs) account for 71% of all deaths globally, killing about 41 million people annually. They cause 15 million premature deaths among people between 30 and 69 years of age every year. More than three-fourth of total NCD deaths and 85% of premature deaths due to NCDs occur in low- and middle-income countries. In India, about 5.8 million or 60% of all the deaths occur due to NCDs which mainly includes coronary heart disease, stroke, hypertension, chronic respiratory diseases, cancers, and diabetes., There are about 25% chances for a 30-year old person dying from one of these major NCDs before the age of 70 years. NCDs contribute to about 50% of all cause-disability-adjusted life years in India, and this burden is equally contributed by males and females.
Rise in NCDs can impede the progress toward the achievement of sustainable development goals and pose challenges in poverty reduction initiatives by increasing health-care costs and out-of-pocket expenditures due to lengthy and expensive treatment. One of the most important ways to prevent and control NCDs is to reduce the modifiable risk factors which mainly include tobacco, alcohol, physical inactivity, and overweight or obesity. STEPwise approach to surveillance (STEPS) was therefore developed for NCD risk factor surveillance by the World Health Organization in response to control NCDs, as timely screening and intervention for risk factors associated with NCDs can significantly reduce the mortality and morbidity associated with them.
In India, under the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease, and Stroke (NPCDCS) which was launched in the year 2010, opportunistic screening for NCDs was initiated, which was later expanded into population-based screening of healthy men and women ≥30 years of age for NCD risk factors. A Community-Based Assessment Checklist (CBAC) for risk profiling of individuals was developed by NPCDCS to be used by frontline workers including accredited social health activists, auxiliary nurse midwives, and multipurpose workers and this information can be used to make people aware of consequences of unhealthy practices, motivate them to adopt healthy lifestyles as well as facilitate early diagnosis and management of NCDs.,
Due to rapid and haphazard urbanization, urban villages are emerging. They have high population densities, lower literacy rates and awareness levels, and are usually devoid of basic infrastructure including sanitation and piped water supply. There were about 135 urban villages in Delhi alone in 2011. Many studies have been conducted in past to study the risk factors of NCDs, but there is a paucity of literature for the same in urban villages. With this background, the present study was undertaken to ascertain the risk factors for common NCDs in a community-based setting in an urban village, find out at-risk individuals using CBAC for risk assessment and study the gender differences in risk factors.
| Material & Methods|| |
This was a cross-sectional community-based study conducted in an urbanized village of Delhi, India, which is the field practice area of authors' institution. The approximate population of this village is 6100, which is a mix of natives and migrants. The study duration was 3 months from October 2019 to December 2019.
The study was conducted among apparently healthy people of age 30 years or more, residing in the study area for at least 6 months. People with age <30 years or with a known history of diabetes, cancer, hypertension or other cardiovascular diseases, chronic respiratory diseases, and pregnant women were excluded from the study. People who were not available at the time of study and could not be contacted even after three consecutive visits to the household were also excluded.
The sample size for the study was calculated using the formula for proportions, i.e. N = (Z1−α/2)2 × p × (1 − p)/d2. Taking p as 0.82, found out in a previous study by Sarma et al. as the proportion of individuals who had at least one risk factor for NCDs, and d as absolute precision of 3.5%, we arrived at a sample size of 463. A nonresponse rate of 10% was added to get a final sample size of 510.
A house-to-house survey was conducted in the study area. All the members of each household were assessed for eligibility in the study. Eligible males and females were then invited to participate after explaining the nature and purpose of the study. Written informed consent was obtained from each participant before their inclusion. Households which were found locked or if the eligible participants were not present at the first visit, two more visits were paid to them to include in the study. Residents which could not be contacted even after three visits were excluded from the study. NPCDCS CBAC risk assessment checklist was used by field investigators to collect data on risk factors [Table 1]. Field investigators were trained over a period of 2 days on procedures to do the anthropometric measurements and collect the required information. Waist circumference was measured using nonstretchable tape. All screened individuals were then advised to visit Urban Health Training Centre (UHTC), located in the study area for further assessment, management, and counseling.
|Table 1: Risk assessment as per Community-Based Assessment Checklist, National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Disease, and Stroke|
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All the data were entered into MS Excel and analyzed using IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. The risk factors were scored as per CBAC scores [Table 1]. The total score can range from 0 to 11. Study participants with a total risk score of more than 4 were categorized as being at risk of developing NCDs. Descriptive analysis was performed. Frequencies and percentages were used to depict results wherever appropriate. Chi-square test was used to find out the association between gender and risk scores. P < 0.05 was considered significant.
The study was conducted within the boundaries of Helsinki Declaration. Written informed consent was obtained from each participant prior to inclusion in the study. Privacy and confidentiality of data was ensured. Participants with high-risk scores were referred to UHTC of the study area.
| Results|| |
A total of 478 residents participated in the study. The response rate was 93.7%. Out of 478 study participants, 217 (45.4%) were male and 261 (54.6%) were female. The mean age of the study participants was 40.3 ± 9.7 years (range: 30–80).
A total of 33 (6.9%) study participants did not have any risk factor and the rest 445 (93.1%) had at least one risk factor. None of the study participants had all the risk factors. The median risk score was 3 (0-8) and the mean score was 2.8 ± 1.7. Eighty two (17.1%) of study participants were ≥50 years and 87 (18.2%) had a positive family history of high blood pressure or heart disease or diabetes. Less than one-fifth (17.8%) of study participants were daily tobacco consumers. Eighty two (17.2%) study participants had a total risk score of more than 4, thereby putting them at high risk of NCDs [Table 2].
|Table 2: Distribution of study participants according to risk factors' scores (n=478)|
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A significantly higher percentage of males were found to be current daily users of tobacco (P < 0.001) and alcohol compared to females (P < 0.001). However, central obesity (P = 0.007) and physical inactivity (P < 0.001) were significantly higher among females as compared to males.
There was no significant difference in proportion of males and females at high risk of NCDs (P=0.394) [Table 3].
| Discussion|| |
India is undergoing through epidemiological as well as demographic transition resulting in increased burden of NCDs. Due to rapid and haphazard urbanization, the risk factors for NCDs are also on the rise. Primary preventive measures including early detection of risk factors in populations can be an important method to prevent morbidity and mortality associated with NCDs. The present study therefore attempted to do a community-based risk factor assessment for people ≥30 years in an urban village using NPCDCS CBAC form for risk assessment.
About half (54.4%) of the study participants were in the age group of 30–39 years. Family history of hypertension or heart disease or diabetes was found to be present among 18.2% of participants. This was lower as compared to another study conducted by Thakur et al. in Haryana in which 42.6% of study participants had a family history of hypertension. The possible reason for this could be they included participants with a known history of chronic diseases. Family history of NCDs has been identified as a significant risk factor for the development of NCDs in future. This could be attributed to common genetic makeup, similar behavioral characteristics, and identical environmental factors.
In the present study, it was found that 17.8% of the participants were current daily tobacco users and 8.8% were past users or used tobacco sometimes at present. This was similar to the findings of other studies conducted in the country and other parts of the world where the prevalence of current tobacco use ranged from 13.3% to 25%.,,,, However, this prevalence was lower as compared to studies conducted by Sajeev and Soman et al., Tushi et al., Bhattacherjee et al., and Srivastav et al.,,, The possible reasons for this difference could be different age composition as these studies included participants in the age group of 18–29 also and mostly were conducted among rural and tribal populations. However, the prevalence found in the present study was higher as compared to the study conducted in Kerala (7.9%) which included both urban and rural population of the state.
Waist circumference which is a proxy measure for abdominal obesity was found to be higher than the normal cutoffs among two-third of the study participants. Similar findings were reported by other authors.,, This prevalence was higher compared to other studies, where the prevalence of abdominal obesity was between 22.1% and 26.2%,, which could be explained by the fact that these studies were conducted specifically among rural tribal populations which have lower NCD rates than urban populations but are also slowly progressing toward high NCD burden.
About half of the study participants (41.4%) were found to be doing inadequate physical activity of <150 min/week. This was higher as compared to study findings of Thakur et al., Tushi et al., Aryal et al., and Pelzom et al.,,,, which reported prevalence of physical inactivity ranging from 3.4% to 26.2%. Most of these studies included participants with known chronic diseases. Already diagnosed participants might be more aware of the importance of physical activity for control of NCDs. In the present study, almost one-sixth of the participants (17.2%) were found to be at higher risk of NCDs based on a total risk factor score of more than 4.
A significantly higher percentage of males were found to be current alcohol and tobacco users compared to females. This was similar to the findings of other studies.,,,,, More of the women participants had abdominal obesity and were found to be doing <150 min/week of physical activity compared to men and this difference was also statistically significant. These findings were in line with previous studies.,,, However, the total risk score was not found to be significantly different among males and females.
Strengths and limitations
This study was a community-based study and used a standard tool for risk factor assessment, which is suitable for resource-limited settings in low and middle income countries. It is among the few studies conducted in urban villages that are rapidly increasing in number. It was exclusively done among apparently healthy individuals and its results can help in implementing primary preventive measures among disease-free population. The study was conducted in an urban village, so the findings cannot be generalized to other parts of the country. Family history of NCDs, physical activity, tobacco, and alcohol use were self-reported by study participants; therefore, information bias cannot be ruled out.
| Conclusion|| |
One in six study participants aged ≥30 years was found to be at high risk of having NCDs. This calls for heightened screening activities in this age group. A simple tool like NPCDCS CBAC form can be used by frontline workers in resource-limited settings to find out high-risk population at the community level and create awareness among individuals and persuade them to take on healthy practices. Both males and females had high prevalence of modifiable risk factors with more males being tobacco and alcohol users and more females being inactive and having abdominal obesity. These risk factors, therefore, should be targeted with gender-specific approaches.
The authors would like to thank Mr. P.P. Pathak, Ms. Rashmi Sharma, and Mrs. Kiran for their support in survey and data collection.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]