Social inequities in clustering of modifiable non-communicable disease risk factors among adults in a low-income urban community: A cross-sectional study
1
Community Medicine, B.J. Government Medical College and Sassoon General Hospital, Pune, India
Popul. Med. 2026;8(Supplement Supplement 1):A2886
ABSTRACT
INTRODUCTION:
Non-communicable diseases (NCDs) are rising rapidly in low- and middle-income countries, with modifiable risk factors disproportionately concentrated among socioeconomically disadvantaged urban population. Evidence on how multiple modifiable risk factors cluster within low-income urban communities remains limited. This study assessed the distribution and social patterning of clustered NCD risk factors in an urban low-income community.
METHODS:
A community-based, cross-sectional study enrolled 400 adults from an urban low-income field practice area. Nine NCD risk factors were assessed: overweight/obesity (BMI ≥25; obesity ≥30), central obesity (waist circumference ≥90 cm men/≥80 cm women), raised blood pressure (systolic ≥140, diastolic ≥90 mmHg, or hypertension), dysglycemia (HbA1c ≥5.7%), tobacco use, alcohol use, insufficient physical activity (<150 min/week), uninterrupted sitting (≥120 min/day), and short sleep (<7 hours). Clustering was defined as ≥3 concurrent risk factors. Socioeconomic inequities were examined across education, occupation, socioeconomic class (Kuppuswamy), and economic status (ration card). Among working adults, shift work and commuting time were assessed as structural barriers.
RESULTS:
Participants (mean age 45.5 (SD 14.0) years; 52% male) had risk factor prevalence: overweight/obesity 34.8%, central obesity 36.0%, raised blood pressure 42.5%, dysglycemia 30.0%, tobacco use 5.8%, alcohol use 7.0%. Insufficient physical activity (59.8%), uninterrupted sitting (25.8%), and short sleep (28.3%) were common. Overall, 44.5% had ≥3 risk factors; 30.8% had ≥4. Clustering showed social gradients: 81.3% in illiterate/primary education versus 21.8% in graduate+ education (p<0.001); 54.1% in upper lower versus 21.2% in upper middle class (p<0.001). Among working adults (n=209), clustering was 62.5% in shift workers versus 32.0% in day workers (p<0.001).
CONCLUSIONS:
Clustering of modifiable NCD risk factors was frequent with social gradients, addressing an evidence gap in low-income urban communities. These findings support equity-oriented prevention strategies: strengthened surveillance (WHO STEPS), evidence-based prevention packages (WHO PEN), and community interventions targeting physical activity, sedentary behaviour, and cardiometabolic screening in disadvantaged populations.
Non-communicable diseases (NCDs) are rising rapidly in low- and middle-income countries, with modifiable risk factors disproportionately concentrated among socioeconomically disadvantaged urban population. Evidence on how multiple modifiable risk factors cluster within low-income urban communities remains limited. This study assessed the distribution and social patterning of clustered NCD risk factors in an urban low-income community.
METHODS:
A community-based, cross-sectional study enrolled 400 adults from an urban low-income field practice area. Nine NCD risk factors were assessed: overweight/obesity (BMI ≥25; obesity ≥30), central obesity (waist circumference ≥90 cm men/≥80 cm women), raised blood pressure (systolic ≥140, diastolic ≥90 mmHg, or hypertension), dysglycemia (HbA1c ≥5.7%), tobacco use, alcohol use, insufficient physical activity (<150 min/week), uninterrupted sitting (≥120 min/day), and short sleep (<7 hours). Clustering was defined as ≥3 concurrent risk factors. Socioeconomic inequities were examined across education, occupation, socioeconomic class (Kuppuswamy), and economic status (ration card). Among working adults, shift work and commuting time were assessed as structural barriers.
RESULTS:
Participants (mean age 45.5 (SD 14.0) years; 52% male) had risk factor prevalence: overweight/obesity 34.8%, central obesity 36.0%, raised blood pressure 42.5%, dysglycemia 30.0%, tobacco use 5.8%, alcohol use 7.0%. Insufficient physical activity (59.8%), uninterrupted sitting (25.8%), and short sleep (28.3%) were common. Overall, 44.5% had ≥3 risk factors; 30.8% had ≥4. Clustering showed social gradients: 81.3% in illiterate/primary education versus 21.8% in graduate+ education (p<0.001); 54.1% in upper lower versus 21.2% in upper middle class (p<0.001). Among working adults (n=209), clustering was 62.5% in shift workers versus 32.0% in day workers (p<0.001).
CONCLUSIONS:
Clustering of modifiable NCD risk factors was frequent with social gradients, addressing an evidence gap in low-income urban communities. These findings support equity-oriented prevention strategies: strengthened surveillance (WHO STEPS), evidence-based prevention packages (WHO PEN), and community interventions targeting physical activity, sedentary behaviour, and cardiometabolic screening in disadvantaged populations.
| eISSN: | 2654-1459 |
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