MAMC Journal of Medical Sciences

Original Article
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Prevalence of Risk Factors for Noncommunicable Diseases in

Working Population
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 10/14/2023

Sumita Sandhu, Raman Chauhan1, S. R. Mazta1

Department of Community Medicine, Maulana Azad Medical College, New Delhi, 1Department of Community Medicine, Indira Gandhi Medical College, Shimla,
Himachal Pradesh, India

Abstract
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 21st 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.

Key words: Non communicable diseases, World Health Organization STEPS, Risk factors

Introduction Noncommunicable diseases (NCDs) are the leading cause

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.
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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.[1] 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%.[2] 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%).[3]
Address for correspondence: Dr. Sumita Sandhu,
Room No. 26, Lok Nayak Resident Doctors Hostel, Maulana Azad Medical
College, New Delhi, India.
E‑mail: kikaasmrngsumi@gmail.com

MAMC Journal of Medical Sciences ¦ May-Aug 2015 ¦ Volume 1 ¦ Issue 2 101

 Sandhu, et al.: Risk Factors Profile for Noncommunicable Diseases

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.[4]
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kg/height in m2. 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

The rise of NCDs among younger populations may jeopardize sociodemographic factors. A P value < 0.05 was considered
many countries’ “demographic dividend,” including the as statistically significant.
economic benefits expected to be generated during the period
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when a relatively larger part of the population is of working Results

age. Instead, these countries will have to contend with the costs
Total 350 participants were included in the study. The mean
associated with populations that are living with longer episodes
age of participants was 45.3 ± 10 years and the mean age
of ill health. A growing number of young adults are being
of female participants 46.2 ± 9.8 years. Distribution of
affected, prompting the conclusion that the country could lose study participants according to age group and educational
the next generation to chronic disease.[5] Attempts to “treat the status is shown in Tables 1 and 2, respectively. Thirty
way out” of NCDs will not be affordable for most middle‑ and four percent of the study population was educated up to
low‑income countries. Action should be oriented toward curbing graduation. The maximum numbers of participants were
the NCD risk factors and promoting healthier lifestyles to reduce from the clerical group (46.3%) followed by professional/
NCD incidence rates and push back the age of NCD onset.[6] executive/manager (23.43%) and unskilled group (16.6%).
The purpose of this study is to identify the major risk factors The prevalence of tobacco use was 23.4% and mainly
for NCDs. As the disease burden has also shifted from the used as smoking. The prevalence of cigarette smoking was
older age group to the more productive middle age group. higher (63.1%) than bidi smoking (50.1%) among daily
Workplaces having productive populations need special smokers. The mean age of initiation of smoking in males
attention owing to their higher vulnerability for NCDs. was 27.6 ± 9.78 years. The mean number of bidi (10 ± 4.5)
Number of studies has been conducted to see the prevalence smoked per day was higher than the mean number of
of individual NCD, but very few studies have been done to see cigarette (6.97 ± 4.6). Only 3.1% of participants were
the prevalence of risk factors for NCDs in totality. smokeless tobacco users. Tobacco use was highest (23%) in
35–44 years and was significantly higher among males.
Materials and Methods The overall prevalence of alcohol consumption in the study
The study was conducted in 10 public sector institutions population was 36% and consumption within past 12 months
of Boileauganj, urban field practice area of Department
of Community Medicine, Indira Gandhi Medical College, Table 1: Distribution of the study population
Shimla. The adult population (18 years and above) working
Age groups (years) Male n (%) Female n (%) Total n (%)
in public sector institutions were included in the study. Due to
15-24 2 (100) 0 (0) 2 (0.1)
unavailability of data on risk factors for NCDs, the sample size
25-34 43 (76.8) 13 (23.2) 56 (16)
of convenience was taken. Subjects were randomly selected
35-44 81 (81) 19 (19) 100 (28.6)
for the study by using random number generator. To conduct
45-54 79 (69.3) 35 (30.7) 114 (32.6)
this study prior permission was taken from the head of each 55 and above 59 (75.6) 19 (24.4) 78 (22.3)
institution. A written consent of selected employees was also Total 264 (75.4) 86 (24.6) 350 (100)
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 Table 2: Distribution of study population according to the
were interviewed to determine the socioeconomic and educational status
behavioral risk profile by using WHO STEPS questionnaire. It Grades Male n (%) Female n (%) Total n (%)
consists of core items including age, sex, literacy, education in Illiterate 3 (1.1) 9 (10.5) 12 (3.43)
years, tobacco use, alcohol consumption, fruits, and vegetables < primary school 1 (0.4) 6 (7) 7 (2)
intake and physical activity. In Step 2, Anthropometric Primary school 13 (4.9) 8 (9.3) 21 (6)
measurements including weight, height, waist circumference, Secondary school 72 (27.3) 15 (17.4) 87 (24.9)
and hip circumference and blood pressure were taken at their High school 46 (17.4) 12 (13.9) 58 (16.6)
workplaces. Height and weight measurements were taken to Graduate 92 (34.8) 28 (32.6) 120 (34.3)
calculate the body mass index (BMI) that is used to determine Postgraduate 37 (14) 8 (9.3) 45 (12.9)
the overweight and obesity. BMI was calculated as weight in Total 264 (75.4) 86 (24.6) 350 (100)

102 MAMC Journal of Medical Sciences ¦ May-Aug 2015 ¦ Volume 1 ¦ Issue 2

 Sandhu, et al.: Risk Factors Profile for Noncommunicable Diseases

was 93.6% and among those 8.5% were daily drinkers. The than females (4.2%). Highest (9.5%) prevalence was seen in
daily fruits and vegetable consumption was 1.4% and 16.6%, >55 years of age group.
respectively. None of the participants had reported having
According to the national cholesterol education program Adult
more than five serving of fruits and vegetables per day as five
Treatment Panel III Guidelines,[9] high serum cholesterol levels
servings are recommended by WHO. Half of the participants
were seen in 12.4% of the participants. High serum cholesterol
were indulging in travel related physical activity. 15.7%
levels were seen among females.
participants were doing regular yoga and vigorous activity was
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reported by only 1.43%. The mean time spent in travel‑related

activities (walking/cycling) was 29.04 ± 12.5 min. Fifty one Discussion
percent of the participants were having a low level of physical The present study shows the prevalence of tobacco use was
activity followed by 47% in moderate physical activity 23.4% and tobacco smoking was 21.4%. In a study in Jordan,[10]
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 10/14/2023

according to WHO Global Physical Activity Questionnaire.[7] tobacco smoking was found to be 29%. Smokeless tobacco
About 33.1% of the participants were overweight and 6% was consumed by only 3.1% participants, which was low as
were obese according to the WHO classification. Only 4.3% compared to the other studies. The prevalence of smokeless
were underweight. The mean BMI of the participants was tobacco was higher (20%) in a study[11] and 7.1% in study[12]
24.09 ± 3.6 kg/m2 and in males, it was 24 ± 3.3 kg/m2 and conducted in Haryana. This difference could be due to ban on
24.3 ± 4.3 kg/m2 in females. Central obesity (>90 cm in men gutkha, khaini, and other chewing tobacco product in Shimla.
and >80 cm in women)[8] was found in 40.5% male and 66.3% The overall alcohol consumption was 36% and was 93.6% among
of female participants. The high waist‑hip ratio (>1 for men those who had consumed alcohol within past 12 months in the
and >0.85 for women)[8] was found in 15.5% males and 71% present study. Daily drinking and heavy drinking was reported
females. by 8.5% and 21.4% of study participants. A study[13] conducted
History of raised blood pressure and diabetes mellitus and in Vietnam found that the ever alcohol consumption was 87.2%
lifestyle modification is shown in Table 3. Joint National and within past 12 months, it was 80.9%.
Committee guidelines for the management and treatment of Though fruits and vegetable consumption reduces the risk
Hypertension. Forty six percent were prehypertensive and among of NCDs, the present study showed larger proportion of
them 48.1% were males and 38.4% were females. Twenty nine population consumed significantly less (P = 0.003) amount of
percent of the participants were in Stage‑1 hypertension, and only fruits and vegetables (i.e., <5 servings of fruits and vegetables
3.7% were in Stage‑2 hypertension raised blood pressure was per day). Daily fruits and vegetables were consumed by 1.4%
significantly high among males (37.1%) than females (18.6%). and 16.6%, respectively. Similar finding was seen in a study[14]
The prevalence was highest (46.2%) in > 55 years of age group. in which daily fruit consumption was 1% and vegetable
There was a steep rise in the prevalence after 34–44 years of consumption was 16.8%.
age. It was significantly (P = 0.001) high among males (37.8%)
than females (18.6%). Physical inactivity is a major risk factor in promoting obesity,
which itself is a risk factor for the other chronic diseases. The
According to the WHO/International Diabetes Federation present study shows that the majority (51%) of participants
recommendations on the diagnosis of diabetes mellitus and had a low level of physical activity and remaining 47% and 2%
impaired fasting blood sugar, raised blood sugar level was were seen with moderate and high levels of physical activity.
found in 5.8%. The mean blood sugar was 93.63 ± 17.37 mg/dl A study conducted in 9 Asian sites including India, found
and it was slightly higher among males than females. Impaired 51.7% males and 54.2% females with low level of physical
fasting blood sugar was seen in 3.6% of the participants. activity.[10]
The prevalence of diabetes was more among males (6.7%)
Hypertension is an important determinant of the risk of
cardiovascular diseases. The prevalence of hypertension was
Table 3: History of raised BP/diabetes, treatment, and 32.6% in the present study. It was significantly (P = 0.001)
lifestyle modification more among males (37.8%) than females (18.6%), which could
Risk factor Hypertensive Diabetes be due to less number of female participants in the study as
n (%) n (%) well as less behavioral risk factors among females. A study[15] in
Whoever had their BP measured by a 240 (68.6) 150 (43) Kerala showed that 34.9% were hypertensive and among them
doctor or health worker 36.2% were males and 33.6% were females. High prevalence
Diagnosed hypertension 87 (36.2) 18 (12) of hypertension was seen in 55–64 years of age group in a
Diagnosed and currently taking drugs 50 (57.5) 10 (55.6) study performed in Haryana.[12]
Advised dietary modifications 79 (90.8) 11 (61.1)
Advised to lose weight 47 (54) 8 (44.4) Over the past few decades, the country has experienced major
Advised to stop smoking 14 (16.1) 3 (16.7) transitions that had an impact on health. Profound changes have
Advised to start or do more exercise 39 (44.8) 11 (61.1) occurred in economic development, nutritional status, fertility,
BP: Blood pressure and mortality rates and consequently, the disease profile has

MAMC Journal of Medical Sciences ¦ May-Aug 2015 ¦ Volume 1 ¦ Issue 2 103

 Sandhu, et al.: Risk Factors Profile for Noncommunicable Diseases
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.
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Conclusions
The present study shows the high burden of major risk factors.
Lifestyle modification is the chief nonpharmacological method
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 10/14/2023
for prevention and control of NCDs and their risk factors.
Recommendation
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.
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How to cite this article: Sandhu S, Chauhan R, Mazta SR. Prevalence
of Risk Factors for Noncommunicable Diseases in Working Population.
MAMC J Med Sci 2015;1:101-4.
Source of Support: Nil. Conflict of Interest: None declared.