European Journal of Cardiovascular Medicine

The International Diabetes Federation (IDF) estimated that the number of individuals living with Diabetes would increase from approximately 65 million in 2013 to 100 million by 2035. Despite the increasing burden of Non-Communicable Diseases, both research and the allocation of resources to combat Non-Communicable Diseases remain limited.¹

The NCDs like Diabetes, Hypertension, Obesity, CVS etc. are estimated to account for around 60% of all deaths. NCDs cause considerable loss in potentially productive years of life. Losses due to premature deaths related to heart diseases, stroke and Diabetes are also projected to increase over the years.

Individuals with Non-Communicable Diseases also have a higher risk of increased health expenditure, and a substantial proportion of households face catastrophic health expenditure and subsequent impoverishment due to NCD related expenses.²

India has been witnessing an increase in urbanization in the last decade. Coupled with this are changes in lifestyle, unhealthy eating habits, tobacco consumption, and smoking, and rise in alcohol intake has resulted in the growing number of NCDs in India. In 2017, NCD deaths in India comprised 49% of all-cause mortality, of which cardiovascular diseases (23%), chronic respiratory diseases (9%), cancer (6%), and diabetes (2.4%) were the major causes.³ The global burden of NCDs is increasing rapidly as a result of a number of factors, such as economic development and related erosion of traditional food practices (increase in the intake of processed foods high in fat, salt, and sugar) and change in cultural norms (increase in the use of tobacco and alcohol), decline in the physical activity, and increase in the sedentary lifestyles.⁴

Objectives of the study

1. To assess the prevalence of Non-Communicable Diseases (Hypertension, Pre-Diabetes Mellitus and Obesity) among the adult population of Kokrajhar District.
2. To assess the prevalence of risk factors of common non-communicable diseases in adult population of Kokrajhar District.

Study Type: Community-based, Descriptive Cross-sectional study.

Study Population: Adult Population of 18 –59 years of age.

Study Area:  Villages under Titaguri area which is  one of  the  field  practice  areas and Family adoption areas  of  the  Department  of Community    Medicine,   Kokrajhar Medical  College.

Study Duration: July 2024 to September 2024.

Sample Size calculation: The sample size was calculated by the formula N = 4pq/l², Where p represents prevalence of diabetes which was 15.5% (Thakur J, Jeet G, et al. (2019) Non-communicable diseases risk factors and their determinants: A cross-sectional state-wide STEPS survey, Haryana, North India. PLoS ONE 14(11): e0208872. https://doi.org/10.1371/journal.pone.0208872).⁵ ‘l’ is allowable error, taken as 5%. Therefore, a sample size of 210 was taken.

An area map was made, and the first household was selected randomly near to landmark of the village Schools and then every household was visited until the required sample size was obtained. If an eligible subject was not found in the household, then an adjacent one was visited. If more than one eligible adult were found in the same household, then only one was included in the study by random selection.

Ethical Clearance: Ethical clearance had been obtained  from the Institutional Ethical Committee of Kokrajhar Medical College an Hospital, Kokrajhar,Assam.

Inclusion Criteria: Permanent residents of Kokrajhar District (residing for more than 6 months)

Exclusion Criteria:

• Pregnant lady
• Those with known psychiatric illness
• Individuals having serious morbidity

Consent: Informed consent were  taken from all the participants before data collection and confidentiality was  maintained.

Data collection: Information regarding risk factors of NCDs were collected by using Pre tested, per-designed questionnaire. Non-stretchable measuring  tape, digital  weighing  scale,  portable  stadiometer,  digital BP  apparatus  were   used  to  measure  waist  and  hip circumference,  weight,  height,  and  blood  pressure, respectively. Blood samples were collected and tested in Kokrajhar Medical College & Hospital and expenses were borned by the investigators and confirmation of Diabetes Mellitus was  done based on ADA criteria.

Data analysis: Data has  been entered in MS excel sheet. Qualitative data were expressed in proportions and chi-square test has been applied.  Mean and standard deviation were used for quantitative data.  Suitable tests    of    significance    has been      applied    wherever necessary.

The socio demographic characteristics of the study population are shown in Table 1. It was observed that 56.1% of the cases are male and 43.9% female with a male, female ratio of 1.3:1. Amongst the study population, Hindus were 48%, Christians (44.8%) and 7.1% were Muslims. In the martital status, 56.7% of the study participants are married followed by unmarried (33.9 %), widow (5.2%), widower (3.85) and divorcee (0.4%).

* WHO Obesity: Preventing and managing global epidemic WHO/NUT/98. WHO1998
** Mean ± SD

Table 2 shows that 37.2 % of the participants are heavy workers particularly working in agriculture sectors, 40.9 % are moderate workers and 21.9 % are sedentary workers. BMI grading among the study participants shows that 7.6% are obese, 13.3 % are pre-obese, 31.9 are overweight and 47.2 are normal. Regarding Tobacco use, 66.2 % of the study participants are consuming tobacco with a mean duration of intake of 11.46 ± 8.21 years. Additionally, 72.3 % are consuming alcohol with mean years of intake of 9.98 ± 7.49 years. During the study, it was found that 56.7% had a family history of hypertension, followed by 26.6% had Diabetes Mellitus,   21.9 % obesity, 5.3 % Cardiovascular Diseases, 5.2 % Dyslipidemia, and 2.3 % stroke.

*Figures within Parenthesis shows column wise percentage

Table 3 shows the laboratory test of the study participants where 12.7 % of the males and 9.7% of the females were Diabetic. Amongst the study Participants, 17% of the males and 12 % of the females were hypertensive while  28 % of the males and 30.4 % of the females were pre-hypertensive. The waist circumference shows that 19% of the males and 18.8 % of the females have abnormal waist circumference. The measurement of the Waist-to-hip ratio shows that 13.5% of the males and 11.9 % of the females have abnormal waist-to-hip ratio.

This study was conducted to assess the risk factors and prevalence of Non-Communicable diseases among the adult population of Kokrajhar District. A higher prevalence of risk factors for non-communicable diseases was found in the present study, which calls for interventions. A high prevalence of behavioral, biological, and biochemical risk factors for non-communicable diseases has been observed.

In the present study, the overall prevalence of Diabetes was found to be 11.4% where males (60%) were affected more than the females. The findings are in conformation with the study “Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17) 2023” conducted by Anjana RM et al⁶ which implies that prevalence of NCDs among the population in Kokrajhar is equally prevalent and deserves equal attention.

Assessment of physical activity shows that 37.2 % of the participants are heavy workers particularly working in the agriculture sectors, 40.9 % are moderate workers and 21.9 % are sedentary workers. BMI grading amongst the study participants shows that 7.6% are obese, 13.3 % are pre-obese, 31.9% are overweight and 47.2% are normal. Mathur P et al (2021)  found that the Prevalence of physical inactivity and overweight were  41.3% and 26.1% respectively.⁷

In our study,17% of the males and 12 % of the females are hypertensive while  28 % of the males and 30.4 % of the females are pre hypertensive. Considerable variation in prevalence of HTN (20–59%) was seen among the studies from rural east India with higher prevalence seen from Assam (owing to the indigenous prevalence of excess salt, alcohol, and Khaini consumption among tea plantation workers of Assam. Lifestyle changes (harmful dietary practices, consumption of tobacco, and sedentary habits) occurring because of rapid urbanization and economic progress in urban areas have also contributed to the growing epidemic of HTN in urban areas of India.(Hazarika et al,2002).⁸

In our study, the BMI grading amongst the study participants shows that 7.6% are obese, 13.3 % are pre obese, 31.9 are overweight and 47.2 are normal. Pandya H et el (2011) has also clearly shown in his study that obesity calculated by raised BMI (>23) and Waist CCircumference (M: >90 cm, F: >80 cm) is associated with diabetes mellitus. Almost 70% of diabetic patients were obese and we can use the word “Diabesity” as synonym for diabetes in Gujarati population .⁹

In terms of tobacco consumption, 66.2 % of the study participants are consuming tobacco with a mean years of intake of 11.46± 8.21 years. Among the study subjects, 72.3 % are consuming alcohol with mean years of intake of 9.98± 7.49 years. Mahesh B Tondare (2017) in his study found that  29.93% were currently using tobacco either in the form of chewing or smoking, among these 98.42% were males. 27.29% were currently consuming alcohol, of these males comprised 97.77%. Among the studied population 13.3% were hypertensive and 3.42% were diabetics.¹⁰

A high prevalence of risk factors for non-communicable diseases was found in the present study which emphasizes the need of interventions to reduce these risk factors. There is huge scope to curb the modifiable risk factors among the Adult Population by encouraging them to modify their behavior related life styles such as smoking habits, alcohol use etc. Comprehensive health education programmes are required  to increase knowledge of NCD risk factors, particularly in individual with high prevalence rates, abnormal Waist Circumference, Abnormal Waist Hip Ratio, increased BMI, Pre Hypertension and Pre Diabetes.. Furthermore, efforts to improve healthcare access and screening services are critical for early detection and management of NCDs, addressing a significant proportion of undiagnosed cases, and ensuring effective health outcomes, particularly among high-risk individuals.

Limitations of the study

In the present study, all patients were interviewed so there may be subjective variation or conscious falsification regarding sensitive questions like addiction which cannot be verified. Recall bias might be present.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee of Kokrajhar Medical College and Hospital

Acknowledgement

We express sincere gratitude to Principal, Kokrajhar Medical College Medical College & Hospital, for permitting to carry out the work in this Institution. We also offer our sincere gratitude & regards to the MBBS students (2023 Batch) for conducting the study at the household level during their Family Adoption Programme as Per NMC norms.

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