Social determinants and risk factors associated with non-communicable diseases among urban population in Nepal: A comparative study of poor, middle and rich wealth categories of urban population using STEPS survey.

backgroundNon-communicable diseases (NCDs) are significant public health concern globally, and the burden is disproportionately high among urban populations. This study aims to compare the social determinants, NCD risk, and NCD prevalence among different wealth categories and to determine the factors associated with hypertension, obesity, and diabetes among the urban population of Nepal.

methodsThis study used urban population data from cross-sectional STEP wise approach to NCD risk factor surveillance (STEPS) survey of 2019, resulting in a sample of 3460 individuals of 15-69 years for inclusion in the analysis. We used bivariate analysis to compare the social determinants, NCD risk and NCD prevalence among urban poor, urban middle and urban rich and multivariate logistic regression to determine the association between social determinants, NCD risks and obesity, hypertension and diabetes among urban population.

resultsThe study found significant differences in hypertension, obesity and diabetes by gender, ethnicity, education, employment, smoking habits, and cholesterol levels between the three wealth groups. Among the urban poor, low education, unemployment and smoking habits were more prevalent, while high cholesterol was more prevalent among the urban rich. The significant factors associated with overweight and obesity after Bonferroni correction included Hilly region with higher odds of overweight (AOR=2.33, 95% CI=1.45-3.75,). In contrast, being from Karnali (AOR= 0.36, 95% CI=0.22-0.58) and Sudurpaschim (AOR=0.42, 95% CI=0.26-0.66) provinces were associated with lower odds of overweight and cholesterol, while cholesterol was associated with higher odds of obesity (AOR=1.01, 95% CI=1.01-1.02). Disadvantaged janajatis had the lower odds of overweight (AOR = 0.52, 95% CI = 0.36-0.78). Factors that remained significantly associated with hypertension and pre-hypertension after Bonferroni correction included: age, with higher odds of hypertension (AOR=1.03, 95% CI=1.02-1.04); men, who had higher odds of both pre-hypertension (AOR=1.68, 95% CI=1.19-2.36) and hypertension (AOR=2.23, 95% CI=1.56-3.47). Being obese (AOR = 5.12, 95% CI = 2.95-8.87, p = 0.001) and overweight (AOR = 1.69, 95% CI = 1.19-2.39, p = 0.003) were significantly associated with hypertension. Similarly, urban population residing in the hilly region had higher odds of diabetes (AOR=6.44, 95% CI=3.31-11.10) compared to the mountain region; those living in the Tarai region had higher odds of pre-diabetes (AOR=5.07, 95% CI=2.44-10.5) and diabetes (AOR=5.96, 95% CI=3.12-19.86). Respondents with high cholesterol higher odds of both pre-hypertension (AOR=1.00, 95% CI=1.00-1.02) and hypertension (AOR=1.03, 95% CI=1.02-1.04), pre-diabetics (AOR=1.00, 95% CI=1.00-1.02) and diabetics (AOR=1.03, 95% CI=1.02-1.04).

conclusionThe findings indicate significant disparities in education, employment, and lifestyle habits across wealth groups; urban poor lacked education and employment. Factors such as ecological region, province, gender and age were associated with an increased risk of various health conditions such as being overweight, pre-hypertension, pre-diabetes, and diabetes. Improved health outcomes among urban populations interventions targeting increased access to education, additional investment in specific areas where outcomes are worst, and interventions to improve equitable access to healthcare are needed.