|Year : 2015 | Volume
| Issue : 2 | Page : 101-104
Prevalence of Risk Factors for Noncommunicable Diseases in Working Population
Sumita Sandhu1, Raman Chauhan2, SR Mazta2
1 Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
2 Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
|Date of Web Publication||1-Jun-2015|
Dr. Sumita Sandhu
Room No. 26, Lok Nayak Resident Doctors Hostel, Maulana Azad Medical College, New Delhi
Source of Support: None, Conflict of Interest: None
Objectives: Noncommunicable diseases (NCDs) are the leading causes of death globally, killing more people each year than all other causes combined. NCDs are caused to a large extent by four behavioral risk factors that are pervasive aspects of economic transition, rapid urbanization, and 21 st century lifestyles: Tobacco use, unhealthy diet, insufficient physical activity, and the harmful use of alcohol. The aim was to find out the prevalence of risk factors for NCDs in working population. Materials and Methods: A cross sectional study was conducted in working population aged 18 years and above in 10 public institutions. World Health Organization STEPS approach was used to find the prevalence of risk factors. The study sample was randomly selected by using random number generator. Results: A total of 350 participants were included in the study. The overall prevalence of tobacco use was 23.4%. The prevalence of alcohol consumption was 36%. Thirty three percent of the participants was consuming more than five servings of fruits and vegetables per day. Physical inactivity was seen in 51%. 33.1% of the participants were overweight, 6% were obese and 32.6%, 5.8% were hypertensive and diabetic, respectively. Conclusions: This study shows the high burden of risk factors for NCDs in the working population. Action should be oriented toward curbing the NCD risk factors and promoting healthier lifestyles to reduce NCD incidence rates and delay the age of NCD onset.
Keywords: Non communicable diseases, World Health Organization STEPS, Risk factors
|How to cite this article:|
Sandhu S, Chauhan R, Mazta S R. Prevalence of Risk Factors for Noncommunicable Diseases in Working Population. MAMC J Med Sci 2015;1:101-4
|How to cite this URL:|
Sandhu S, Chauhan R, Mazta S R. Prevalence of Risk Factors for Noncommunicable Diseases in Working Population. MAMC J Med Sci [serial online] 2015 [cited 2020 Sep 28];1:101-4. Available from: http://www.mamcjms.in/text.asp?2015/1/2/101/157926
| Introduction|| |
A healthy society is one of the requirements for sustainable human development in every country. The sociodemographic transition has brought major changes in the health behaviors and health profile of developing countries. A "risk factor" refers to any attribute, characteristic, or exposure of an individual, which increases the likelihood of developing a disease. The major (modifiable) behavioral risk factors identified in the World Health Report 2002, are tobacco use, harmful alcohol use, unhealthy diet (low fruit and vegetable consumption), and physical inactivity. On the other hand, the major biological risk factors identified are overweight and obesity, raised blood pressure, raised blood glucose, and raised total cholesterol.
Noncommunicable diseases (NCDs) are the leading cause of death in the world, responsible for 63% of the 57 million deaths that occurred in 2008. The majority of these deaths, 36 million were attributed to cardiovascular diseases and diabetes, cancers, and chronic respiratory diseases.  In most middle- and high-income countries, NCDs were responsible for more deaths than all other causes of death combined, with almost all high-income countries reporting the proportion of NCD deaths to total deaths to be more than 70%.  Common preventable risk factors underlie most NCDs. These risk factors are a leading cause of the death and disability burden in nearly all countries, regardless of economic development. The leading risk factor globally for mortality is raised blood pressure (responsible for 13% of deaths globally), followed by tobacco use (9%), raised blood glucose (6%), physical inactivity (6%), and overweight and obesity (5%). 
It is important to note that all these risk factors are amenable to modification through lifestyle changes. For instance, World Health Organization (WHO) estimates that positive changes in health behaviors (mainly, not smoking, eating a healthy diet, maintaining normal weight, and being physically active), can reduce the risk of coronary heart disease, stroke, and diabetes by about three quarters and cancers by one third. 
The rise of NCDs among younger populations may jeopardize many countries' "demographic dividend," including the economic benefits expected to be generated during the period when a relatively larger part of the population is of working age. Instead, these countries will have to contend with the costs associated with populations that are living with longer episodes of ill health. A growing number of young adults are being affected, prompting the conclusion that the country could lose the next generation to chronic disease.  Attempts to "treat the way out" of NCDs will not be affordable for most middle- and low-income countries. Action should be oriented toward curbing the NCD risk factors and promoting healthier lifestyles to reduce NCD incidence rates and push back the age of NCD onset. 
The purpose of this study is to identify the major risk factors for NCDs. As the disease burden has also shifted from the older age group to the more productive middle age group. Workplaces having productive populations need special attention owing to their higher vulnerability for NCDs. Number of studies has been conducted to see the prevalence of individual NCD, but very few studies have been done to see the prevalence of risk factors for NCDs in totality.
| Materials and Methods|| |
The study was conducted in 10 public sector institutions of Boileauganj, urban field practice area of Department of Community Medicine, Indira Gandhi Medical College, Shimla. The adult population (18 years and above) working in public sector institutions were included in the study. Due to unavailability of data on risk factors for NCDs, the sample size of convenience was taken. Subjects were randomly selected for the study by using random number generator. To conduct this study prior permission was taken from the head of each institution. A written consent of selected employees was also taken before the start of actual study and were interviewed using a WHO STEPS questionnaire and screened at their workplaces.
The interview was taken in three steps. In Step 1, the participants were interviewed to determine the socioeconomic and behavioral risk profile by using WHO STEPS questionnaire. It consists of core items including age, sex, literacy, education in years, tobacco use, alcohol consumption, fruits, and vegetables intake and physical activity. In Step 2, Anthropometric measurements including weight, height, waist circumference, and hip circumference and blood pressure were taken at their workplaces. Height and weight measurements were taken to calculate the body mass index (BMI) that is used to determine the overweight and obesity. BMI was calculated as weight in kg/height in m 2 . Then in Step 3, biochemical estimation of the "at risk" individuals was performed. The subjects having more than 3 behavioral and/or anthropometric risk factors from step 1 to 2 were identified as being "at risk."
Analysis was performed using Epi info 7, Openepi save software (Atlanta, Georgia, USA). Chi-square test was applied to find the association between these risk factors and sociodemographic factors. A P value < 0.05 was considered as statistically significant.
| Results|| |
Total 350 participants were included in the study. The mean age of participants was 45.3 ± 10 years and the mean age of female participants 46.2 ± 9.8 years. Distribution of study participants according to age group and educational status is shown in [Table 1] and [Table 2], respectively. Thirty four percent of the study population was educated up to graduation. The maximum numbers of participants were from the clerical group (46.3%) followed by professional/executive/manager (23.43%) and unskilled group (16.6%). The prevalence of tobacco use was 23.4% and mainly used as smoking. The prevalence of cigarette smoking was higher (63.1%) than bidi smoking (50.1%) among daily smokers. The mean age of initiation of smoking in males was 27.6 ± 9.78 years. The mean number of bidi (10 ± 4.5) smoked per day was higher than the mean number of cigarette (6.97 ± 4.6). Only 3.1% of participants were smokeless tobacco users. Tobacco use was highest (23%) in 35-44 years and was significantly higher among males.
|Table 2: Distribution of study population according to the educational status |
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The overall prevalence of alcohol consumption in the study population was 36% and consumption within past 12 months was 93.6% and among those 8.5% were daily drinkers. The daily fruits and vegetable consumption was 1.4% and 16.6%, respectively. None of the participants had reported having more than five serving of fruits and vegetables per day as five servings are recommended by WHO. Half of the participants were indulging in travel related physical activity. 15.7% participants were doing regular yoga and vigorous activity was reported by only 1.43%. The mean time spent in travel-related activities (walking/cycling) was 29.04 ± 12.5 min. Fifty one percent of the participants were having a low level of physical activity followed by 47% in moderate physical activity according to WHO Global Physical Activity Questionnaire. 
About 33.1% of the participants were overweight and 6% were obese according to the WHO classification. Only 4.3% were underweight. The mean BMI of the participants was 24.09 ± 3.6 kg/m 2 and in males, it was 24 ± 3.3 kg/m 2 and 24.3 ± 4.3 kg/m 2 in females. Central obesity (>90 cm in men and >80 cm in women)  was found in 40.5% male and 66.3% of female participants. The high waist-hip ratio (>1 for men and >0.85 for women)  was found in 15.5% males and 71% females.
History of raised blood pressure and diabetes mellitus and lifestyle modification is shown in [Table 3]. Joint National Committee guidelines for the management and treatment of Hypertension. Forty six percent were prehypertensive and among them 48.1% were males and 38.4% were females. Twenty nine percent of the participants were in Stage-1 hypertension, and only 3.7% were in Stage-2 hypertension raised blood pressure was significantly high among males (37.1%) than females (18.6%). The prevalence was highest (46.2%) in > 55 years of age group. There was a steep rise in the prevalence after 34-44 years of age. It was significantly (P = 0.001) high among males (37.8%) than females (18.6%).
|Table 3: History of raised BP/diabetes, treatment, and lifestyle modification |
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According to the WHO/International Diabetes Federation recommendations on the diagnosis of diabetes mellitus and impaired fasting blood sugar, raised blood sugar level was found in 5.8%. The mean blood sugar was 93.63 ± 17.37 mg/dl and it was slightly higher among males than females. Impaired fasting blood sugar was seen in 3.6% of the participants. The prevalence of diabetes was more among males (6.7%) than females (4.2%). Highest (9.5%) prevalence was seen in >55 years of age group.
According to the national cholesterol education program Adult Treatment Panel III Guidelines,  high serum cholesterol levels were seen in 12.4% of the participants. High serum cholesterol levels were seen among females.
| Discussion|| |
The present study shows the prevalence of tobacco use was 23.4% and tobacco smoking was 21.4%. In a study in Jordan,  tobacco smoking was found to be 29%. Smokeless tobacco was consumed by only 3.1% participants, which was low as compared to the other studies. The prevalence of smokeless tobacco was higher (20%) in a study  and 7.1% in study  conducted in Haryana. This difference could be due to ban on gutkha, khaini, and other chewing tobacco product in Shimla.
The overall alcohol consumption was 36% and was 93.6% among those who had consumed alcohol within past 12 months in the present study. Daily drinking and heavy drinking was reported by 8.5% and 21.4% of study participants. A study  conducted in Vietnam found that the ever alcohol consumption was 87.2% and within past 12 months, it was 80.9%.
Though fruits and vegetable consumption reduces the risk of NCDs, the present study showed larger proportion of population consumed significantly less (P = 0.003) amount of fruits and vegetables (i.e., <5 servings of fruits and vegetables per day). Daily fruits and vegetables were consumed by 1.4% and 16.6%, respectively. Similar finding was seen in a study  in which daily fruit consumption was 1% and vegetable consumption was 16.8%.
Physical inactivity is a major risk factor in promoting obesity, which itself is a risk factor for the other chronic diseases. The present study shows that the majority (51%) of participants had a low level of physical activity and remaining 47% and 2% were seen with moderate and high levels of physical activity. A study conducted in 9 Asian sites including India, found 51.7% males and 54.2% females with low level of physical activity. 
Hypertension is an important determinant of the risk of cardiovascular diseases. The prevalence of hypertension was 32.6% in the present study. It was significantly (P = 0.001) more among males (37.8%) than females (18.6%), which could be due to less number of female participants in the study as well as less behavioral risk factors among females. A study  in Kerala showed that 34.9% were hypertensive and among them 36.2% were males and 33.6% were females. High prevalence of hypertension was seen in 55-64 years of age group in a study performed in Haryana. 
Over the past few decades, the country has experienced major transitions that had an impact on health. Profound changes have occurred in economic development, nutritional status, fertility, and mortality rates and consequently, the disease profile has undergone considerable change. Although substantial progress has been achieved in controlling communicable diseases, they still contribute significantly to the national disease burden. Declines in morbidity and mortality from communicable diseases have been accompanied by a gradual shift to, and accelerated increase the prevalence of, chronic NCDs.
| Conclusions|| |
The present study shows the high burden of major risk factors. Lifestyle modification is the chief nonpharmacological method for prevention and control of NCDs and their risk factors.
Balanced diet and daily intake of seasonal and fresh fruits and vegetables should be encouraged. The school-based health promotion programs using population approach should be designed to prevent the emergence of the risk factors. The program should target the whole school community including parents, students, staff, teachers, and the school environment. There is a relatively long time gap between exposure to a risk factor and development of NCD. Therefore, community should be screened for the detection of risk factors at an early stage to reduce the mortality, morbidity, and disability.
| Acknowledgment|| |
Department of Community Medicine, Indira Gandhi Medical College, Shimla, Delhi.
| References|| |
Alwan A, Maclean DR, Riley LM, d′Espaignet ET, Mathers CD, Stevens GA, et al.
Monitoring and surveillance of chronic non-communicable diseases: Progress and capacity in high-burden countries. Lancet 2010;376:1861-8.
World Health Organization. Global Status Report on Non-Communicable Diseases 2010. Geneva: World Health Organization; 2011.
World Health Organization. Global health risks: Mortality and burden of disease attributable to selected major risks. Geneva: World Health Organization; 2009.
Beaglehole R, Magnus P. The search for new risk factors for coronary heart disease: Occupational therapy for epidemiologists? Int J Epidemiol 2002;31:1117-22.
World Bank. What Underlies Ukraine′s Mortality Crisis? Washington, DC: World Bank; 2010.
Adeyi O, Smith O, Robles S. Public Policy and the Challenge of Chronic Non Communicable Diseases. Washington, DC: World Bank; 2007.
Global Physical Activity Questionnaire (GPAQ), Analysis Guide. Available from: http://www.who.int/chp/steps
. [Last accessed on 2013 Jul 03].
Waist Circumference and Waist Hip Ratio: Report of a WHO expert Consultation, Geneva. WHO Document Production Services; 2008. p. 15-22.
Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Final Report. AHA 2002;106:3143-421.
Ahmed SM, Hadi A, Razzaque A, Ashraf A, Juvekar S, Ng N, et al
. Clustering of chronic non-communicable disease risk factors among selected Asian populations: Levels and determinants. Glob Health Action 2009;2:68-75.
Kinra S, Bowen LJ, Lyngdoh T, Prabhakaran D, Reddy KS, Ramakrishnan L, et al.
Sociodemographic patterning of non-communicable disease risk factors in rural India: A cross sectional study. BMJ 2010;341:c4974.
Krishnan A, Shah B, Lal V, Shukla DK, Paul E, Kapoor SK. Prevalence of risk factors for non-communicable disease in a rural area of Faridabad district of Haryana. Indian J Public Health 2008;52:117-24.
Pham LH, Au TB, Blizzard L, Truong NB, Schmidt MD, Granger RH, et al.
Prevalence of risk factors for non-communicable diseases in the Mekong Delta, Vietnam: Results from a STEPS survey. BMC Public Health 2009;9:291.
Laskar A, Sharma N, Bhagat N. Lifestyle disease risk factors in a north Indian community in delhi. Indian J Community Med 2010;35:426-8.
Thankappan KR, Shah B, Mathur P, Sarma PS, Srinivas G, Mini GK, et al.
Risk factor profile for chronic non-communicable diseases: Results of a community-based study in Kerala, India. Indian J Med Res 2010;131:53-63.
[Table 1], [Table 2], [Table 3]