European Journal of Cardiovascular Medicine

Non-communicable diseases represent a major public health challenge globally and are responsible for a substantial proportion of premature mortality, particularly in low- and middle-income countries. Cardiovascular diseases, diabetes mellitus, cancers, and chronic respiratory diseases together account for more than two- thirds of all deaths worldwide, with a rapidly increasing burden observed in South Asian countries including India. Urbanization, population ageing, sedentary lifestyles, unhealthy dietary practices, tobacco use, harmful alcohol consumption, and rising levels of obesity have accelerated this epidemiological transition, placing considerable strain

on health systems traditionally oriented toward communicable diseases [1,2].

In India, non-communicable diseases contribute to over 60% of total deaths, with a significant share occurring in individuals aged 30–70 years, leading to substantial economic loss and reduced productivity. Recognizing the need for early detection and prevention, the Government of India has implemented the National Programme for Prevention and Control of Non-Communicable Diseases (NPNCD), which emphasizes population-based and opportunistic screening for individuals aged 30 years and

above through primary healthcare platforms. A central component of this strategy is the use of the Community- Based Assessment Checklist, a simple, questionnaire- based risk assessment tool administered by frontline health workers to identify individuals at increased risk for common non-communicable diseases [3,4].

The Community-Based Assessment Checklist (CBAC) incorporates demographic, behavioural, and anthropometric parameters, including age, tobacco and alcohol use, physical activity, waist circumference, and family history of non-communicable diseases, enabling early risk stratification and timely referral for confirmatory screening and management. Several studies conducted across diverse settings in India have demonstrated that a substantial proportion of apparently healthy adults score above the recommended risk threshold, highlighting the hidden burden of non- communicable disease risk in both urban and rural populations. Evidence further suggests that higher checklist scores are significantly associated with advancing age, tobacco use, obesity, physical inactivity, and positive family history, underscoring the tool’s relevance for preventive health planning [5,6,7].

Urban populations, particularly those utilizing public primary care facilities, represent a critical target group for non-communicable disease prevention strategies due to their exposure to lifestyle-related risk factors and easier access to screening services. However, there remains limited published evidence from urban Gujarat evaluating the distribution of non-communicable disease risk using standardized community-based tools within routine health service settings. This study was therefore undertaken to assess non-communicable disease risk using the CBAC among adults aged 30 years and above attending an urban primary health centre in Gujarat, and to examine its association with selected demographic, behavioural, and clinical factors.

A cross-sectional observational study was conducted at the Ektanagar Urban Primary Health Center under Vadodara Municipal Corporation, Gujarat, which functions as a training centre affiliated with Government Medical College Baroda. The study was carried out over a three- month period from January to March 2023. Adults aged 30 years and above attending the outpatient department during the study period constituted the study population. A total of 306 participants were enrolled using purposive sampling. All eligible individuals were included after obtaining written informed consent, while those unwilling to participate were excluded. measurements including waist circumference. Blood pressure was measured using a calibrated sphygmomanometer following standard protocols. Classification was done according to Joint National Committee guidelines, with high blood pressure defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg. Community-Based Assessment Checklist scores were calculated as per standard criteria, and a score of four or more was considered indicative of increased non-communicable disease risk. Ethical principles were strictly followed throughout the study. Participation was voluntary, confidentiality was maintained, and the study was conducted in accordance with the Declaration of Helsinki after obtaining written informed consent from all participants. Data were entered into Microsoft Excel 2019 and analysed using Jamovi software version 2.4.14.0. Quantitative variables were summarized using mean and standard deviation, while qualitative variables were expressed as frequencies and percentages. Associations were assessed using the chi-square test, with a p value of less than 0.05 considered statistically significant.

A total of 306 participants aged 30 years and above were included in the study. Females constituted a slightly higher proportion of the study population (168; 54.9%) compared to males (138; 45.1%). The mean (standard deviation) age of participants was 52 ± 13.8 years. Nearly one-fourth of participants (24.5%) belonged to the 30–39 years age group, followed by 23.5% in the 60–69 years age group and 22.5% in the 50–59 years age group.

With respect to behavioural risk factors, the majority of participants were non-smokers (82.3%) and non-alcohol users (98%). Regular physical activity of at least 150 minutes per week was reported by 71.5% of participants. Obesity was prevalent in both genders, with a higher proportion observed among females (45.2%) compared to males (39.8%). A positive family history of non- communicable diseases was reported by 16.6% of participants. The detailed socio-demographic, behavioural, and anthropometric characteristics of the study population are presented in Table 1.

Data

were

collected

using

the

Community-Based

Assessment Checklist (CBAC) recommended under the National Programme for Prevention and Control of Non- Communicable Diseases (NPNCD). The checklist was

administered

in    the

local

language

and

captured

information

on      socio-demographic

characteristics,

behavioural risk factors, physical activity, family history

of  non-communicable

diseases,

and

anthropometric

Table 1: Characteristics of study participants

Source: Compiled by authors

Distribution       of

Community-Based

Assessment

1. A substantial proportion of individuals were identified

Checklist scores                                                                                           with      scores     indicating      increased     risk      for     non-

The

distribution

of     Community-Based

Assessment

communicable diseases.

Checklist scores among participants is depicted in Figure

Figure 1: CBAC score distribution among participants

Source: Compiled by authors

Association of CBAC score with demographic and clinical variables

When the age group of 30–39 years was considered as the reference category, a statistically significant association was observed between increasing age and higher Community-Based Assessment Checklist scores, particularly among participants aged 40–49 years, 50–59 years, 60–69 years, and 70–79 years (p < 0.05). The association was not statistically significant for participants

aged more than 80 years.

Smoking status showed a significant association with checklist scores, with higher risk observed among current smokers and those with a history of smoking (p = 0.002). Physical inactivity was also significantly associated with higher checklist scores, with participants reporting less than 150 minutes of weekly physical activity demonstrating greater risk (p = 0.001). Additionally, a positive family history of non-communicable diseases was

significantly associated with higher checklist scores (p = 0.01).

Gender and alcohol consumption were not found to be

significantly associated with Community-Based Assessment Checklist scores. The detailed associations are presented in Table 2.

Table 2: Association of CBAC score with demographic and clinical variables

Source: Compiled by authors

Blood pressure status of participants

Overall, 240 participants had normal blood pressure, while 66 were classified as having high blood pressure. Among females, 45.1% had normal blood pressure, whereas 11.8% of males were identified with high blood pressure. The association between gender and blood pressure status was not statistically significant (p = 0.10).

The mean (standard deviation) systolic blood pressure was 122 ± 17.21 mmHg, and the mean diastolic blood pressure was 84.5 ± 7.92 mmHg. Blood pressure distribution according to gender is presented in Table 3.

Table 3: Blood Pressure Status according Gender

Note: Chi square test (p value<0.05 considered statistically significant) Source: Compiled by authors

Association of blood pressure with selected variables

A statistically significant association was observed between blood pressure status and increasing age. Compared to the reference age group of 30–39 years, participants aged 60–69 years, 70–79 years, and above 80 years demonstrated a significantly higher prevalence of elevated blood pressure (p = 0.001).

Gender was significantly associated with blood pressure status, with males showing a higher prevalence of elevated blood pressure compared to females (p = 0.021). Physical activity was also significantly associated with blood pressure, with individuals reporting less than 150 minutes of physical activity per week demonstrating a higher prevalence of elevated blood pressure (p = 0.008).

Smoking status showed a significant association with

blood pressure, particularly among individuals with a history of smoking and daily smokers. Body mass index demonstrated a significant association with blood pressure, with obesity showing a higher prevalence of elevated blood pressure when compared to individuals with normal body mass index (p = 0.001).

Waist circumference showed variable associations with blood pressure across gender-specific categories. Family history of non-communicable diseases demonstrated a borderline significant association with blood pressure status (p = 0.05). Alcohol consumption did not show a statistically significant association with blood pressure.

The detailed associations between blood pressure and selected demographic, behavioural, and anthropometric variables are presented in Table 4.

Table 4: Association of blood pressure with selected variables

Note: Chi square test for association (p value of <0.05 considered statistically significant) 

Source: Compiled by authors

The present study assessed the distribution of non- communicable disease (NCD) risk and its association with selected demographic, behavioural, and clinical factors among adults aged 30 years and above attending an urban primary health centre in Gujarat, using the Community- Based Assessment Checklist (CBAC). The findings demonstrate a substantial proportion of adults with elevated CBAC scores, reinforcing the presence of a considerable hidden burden of NCD risk even among individuals seeking routine primary care services.

Distribution of CBAC risk and comparison with other studies

In this study, a significant proportion of participants were identified with CBAC scores indicating increased risk for NCDs. This finding is consistent with multiple Indian studies reporting that one-third to over half of adults aged 30 years and above fall into the high-risk category when screened using CBAC [1,2,4,13].

Studies from urban Karnataka, Haryana, and Odisha have similarly reported high-risk prevalence ranging from 34% to 57%, highlighting the widespread nature of NCD risk across diverse geographic and socio-cultural contexts [2,5,13].

The prevalence observed in the present study aligns closely with findings from urban and peri-urban settings, where lifestyle transitions, physical inactivity, and rising obesity contribute significantly to NCD risk [9,15].

Compared to some rural studies reporting lower prevalence of high-risk scores, the higher burden in urban Gujarat may reflect increased exposure to sedentary occupations, dietary changes, and central obesity [3,22].

Age as a determinant of NCD risk

Age emerged as one of the strongest determinants of elevated CBAC scores, with a statistically significant increase in risk observed from the fifth decade of life onwards. This gradient mirrors findings from multiple studies across India, where CBAC scores consistently rise with advancing age. The accumulation of behavioural and biological risk factors over time, along with age-related metabolic changes, likely explains this association [4,5,7,14].

Importantly, the lack of significant association in participants aged above 80 years may be attributed to the small number of individuals in this age group, a limitation also reported in other community-based studies. Nonetheless, the findings support the NP-NCD strategy of prioritizing screening from 30 years of age, with intensified focus on middle-aged and older adults [6].

Behavioural risk factors and lifestyle associations Smoking showed a significant association with higher CBAC scores in the present study, consistent with extensive evidence identifying tobacco use as a major contributor to NCD risk [3,4,9,16].

Similar associations have been reported among both urban and rural populations, as well as among marginalized and occupational  groups.  Tobacco  use  remains  a  key

modifiable risk factor, and its strong association with CBAC underscores the checklist’s sensitivity to behavioural determinants [17,21].

Physical inactivity was another significant contributor to elevated CBAC scores. Participants reporting less than 150 minutes of weekly physical activity were more likely to be classified as high risk, a finding consistent with previous studies from Haryana, Delhi, and West Bengal. Although a majority of participants in this study reported adequate physical activity, the association highlights the importance of sustained activity levels in mitigating NCD risk [5,9,14].

Alcohol consumption, while prevalent in only a small proportion of participants, did not show a statistically significant association with CBAC scores. Similar findings have been reported in some validation studies, suggesting that alcohol-related risk may be underreported or inadequately captured through self-reporting tools [11,22].

Anthropometric factors and family history

Obesity and increased waist circumference were common in the study population, particularly among females. These findings align with national data showing rising central obesity in urban India, especially among women [9,15].

Although waist circumference showed variable associations with blood pressure, its inclusion in CBAC remains critical, given its established role in predicting metabolic and cardiovascular risk [10,12].

Family history of NCDs was significantly associated with higher CBAC scores, consistent with findings across multiple studies. This reinforces the importance of genetic predisposition and shared environmental factors in NCD risk and supports the inclusion of family history in community-level screening tools [3,4,7,18].

Blood pressure patterns and associated factors

The prevalence of elevated blood pressure observed in this study is comparable to findings from other community- based screenings in India [10,22]. Increasing age, male gender, physical inactivity, smoking, and obesity were significantly associated with elevated blood pressure, reflecting well-established epidemiological patterns [7,10].

The absence of a significant association between gender and blood pressure in crude analysis, despite males showing higher prevalence of elevated blood pressure, may reflect confounding by behavioural and anthropometric factors. Similar observations have been reported in urban studies where lifestyle factors mediate gender differences in hypertension risk [9,15].

Programmatic implications

The findings of this study strongly support the operational relevance of CBAC as promoted under the NP-NCD framework. Evidence from implementation studies shows that CBAC enables high coverage, early identification, and effective referral when integrated into routine primary care and community outreach [6,19].

However, several studies have also highlighted challenges related to follow-up, health literacy, and system-level barriers that limit translation of screening into sustained

care [8,16,18].

In the context of urban Gujarat, where primary health centres serve as key access points for preventive services, routine CBAC-based screening can facilitate early lifestyle counselling, targeted referrals, and linkage to longitudinal care through the NCD portal. Strengthening counselling services and ensuring continuity of care remain essential to maximize the benefits of screening.

The present study demonstrates that a substantial proportion of adults attending an urban primary health centre in Gujarat are at elevated risk for non- communicable diseases. Increasing age, tobacco use, physical inactivity, obesity, and family history were significant determinants of higher risk scores, while elevated blood pressure was strongly associated with age, gender, physical activity, smoking, and body mass index. The Community-Based Assessment Checklist proved to be a feasible and effective screening tool for early identification of individuals at increased risk for non- communicable diseases in routine urban primary care settings. Integration of systematic CBAC-based screening with lifestyle counselling and referral services at the primary healthcare level has the potential to reduce future NCD burden and premature mortality. Acknowledgement: We thank Dean, Medical College Baroda, Medical Officer (Urban Primary Health Center, Ektanagar, Vadodara) for granting permission to conduct the study. Funding: No funding sources Conflict of interest: None

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