Non-communicable diseases risk factors and their determinants: A cross-sectional state-wide STEPS survey, Haryana, North India

Autoři: JS Thakur aff001;  Gursimer Jeet aff001;  Ria Nangia aff001;  Divya Singh aff001;  Sandeep Grover aff002;  Tanica Lyngdoh aff003;  Arnab Pal aff004;  Ramesh Verma aff005;  Ramnika Aggarwal aff006;  Mohd. Haroon Khan aff007;  Rajiv Saran aff008;  Sanjay Jain aff009;  K. L. Gupta aff010;  Vivek Kumar aff010
Působiště autorů: Department of Community Medicine and School of Public Heath, Post Graduate Institute of Medical Education and Research, Chandigarh, India aff001;  Department of Psychiatry, Post Graduate of Medical Education and Research, Chandigarh, India aff002;  Indian Institute of Public Health Association, Public Health Foundation of India, Gurugram, India aff003;  Department of Biochemistry, Post Graduate Institute of Medical Education and Research, Chandigarh, India aff004;  Department of Social and Preventive Medicine, Post Graduate Institute of Medical Sciences, Rohtak, India aff005;  Department of Community Medicine, Kalpana Chawla Medical College, Karnal, India aff006;  Department of Community Medicine, Shaheed Hasan Khan Mewati Government Medical College, Mewat, India aff007;  Department of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America aff008;  Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India aff009;  Department of Nephrology, Post Graduate of Medical Education and Research, Chandigarh, India aff010
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0208872



Recent studies have documented high variation in epidemiologic transition levels among Indian states with noncommunicable disease epidemic rising swiftly. However, the estimates suffer from non-availability of reliable data for NCDs from sub populations. In order to fill the knowledge gap, the distribution and determinants of NCD risk factors were studied along with awareness, treatment and control of NCDs among the adult population in Haryana, India.


NCD risk factors survey was conducted among 5078 residents, aged 18–69 years during 2016–17. Behavioural risk factors were assessed using STEPS instrument, administered through an android software (mSTEPS). This was followed by physical measurements using standard protocols. Finally, biological risk factors were determined through the analysis of serum and urine samples.


Males were found to be consuming tobacco and alcohol at higher rates of 38.9% (95% CI: 35.3–42.4) and 18.8% (95% CI: 15.8–21.8). One- tenth (11%) (95% CI: 8.6–13.4) of the respondents did not meet the specified WHO recommendations for physical activity for health. Around 35.2% (95%CI: 32.6–37.7) were overweight or obese. Hypertension and diabetes were prevalent at 26.2% (95% CI: 24.6–27.8) and 15.5% (95% CI: 11.0–20.0). 91.3% (95% CI: 89.3–93.3) of the population had higher salt intake than recommended 5gms per day.


The documentation of strikingly high and uniform distribution of different NCDs and their risk factors in state warrants urgent need for evidence based interventions and advocacy of policy measures.

Klíčová slova:

Age groups – Alcohol consumption – Medical risk factors – Obesity – Physical activity – Surveys – Urban areas


1. WHO, Government of India. Ministry of Health and Family Welfare. National Action Plan and Monitoring Framework for Prevention and Control of Noncommunicable Diseases NCDs. New Delhi: Government of India; 2013. p. 9.

2. Government of India. National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS) approved. New Delhi: Press information Bureau; 2010 [cited 2013 16 March].

3. Registrar General of India, Ministry of Home Affairs, Government of India. Census- Primary Census Abstracts. New Delhi, India: 2011.

4. Government of India. Review of performance. Chapter 4. New Delhi: Government of India, 2015.

5. Ministry of Health and Family Welfare, World Bank, Niti Aayog. Healthy states, progrssive India- Report on the ranks of the states and union territories. New Delhi, India: 2018.

6. Indian Council of Medical Research, Public Health Foundation of India and Institute of Health metrics and Evaluation. India: Health of the Nation’s States—The India State- Level Disease Burden Initiative. New Delhi: ICMR, PHFI, and IHME, 2017.

7. Jeet G, Sharma A, Mohanta TG, Trakroo A. Health seeking behavior of the mother for the special care new-born units discharged child: A comparative study. Indian journal of public health. 2013;57(2):113. doi: 10.4103/0019-557X.115007 23873201

8. Washington DCWB. World Bank. World Development Indicators. Washington, D.C: 2013.

9. World Health Organisation.(2005).WHO STEPS Surveillance manual: The WHO STEPwise approach to chronic disease risk factor surveillance. Geneva: World Health Organisation; 2005.

10. Kish L. A Procedure for Objective Respondent Selection within the Household. Journal of the American Statistical Association. 1949;44(247):380–7. doi: 10.2307/2280236

11. Thakur J, Jeet G, Tripathy J. m-STEPS: Developing and implementing a smart innovative android tool for noncommunicable disease risk factor (STEPS) survey in India. International Journal of Noncommunicable Diseases. 2016;1(2):91–3. doi: 10.4103/2468-8827.192018

12. Thakur JS, Jeet G, Pal A, Singh S, Singh A, Deepti SS, et al. Profile of Risk Factors for Non-Communicable Diseases in Punjab, Northern India: Results of a State-Wide STEPS Survey. PLoS ONE. 2016;11(7):e0157705. doi: 10.1371/journal.pone.0157705 27389020

13. Global Adult Tobacco Survey (GATS): Core Questionnaire with Optional Questions v2.0 [Internet]. Atlanta, Georgia: Centers for Disease Control and Prevention; 2010 [cited 2018].

14. Kann L, McManus T, Harris WA, Shanklin SL, Flint KH, Queen B, et al. Youth Risk Behavior Surveillance—United States, 2017. Morbidity and mortality weekly report Surveillance summaries (Washington, DC: 2002). 2018;67(8):1–114. Epub 2018/06/15.

15. Kurt Kroenke RLS, Williams Janet BW. The PHQ-9 Validity of a Brief Depression Severity Measure. Journal of General Internal Medicine. 2001;16.

16. World Health Organization. Global school-based student health survey (GSHS) [Internet]. Geneva: World Health Organization; 2018 [cited 2018].

17. OMRON Healthcare Asia. Automatic Blood Pressure Monitor HEM-7120 [Internet]. OMRON Healthcare Co. Ltd. Japan; [cited 2018 4/10/2018].

18. SECA. SECA 203 Ergonomic circumference measuring tape with extra Waist-To-Hip-Ratio calculator (WHR): SECA, Hamburg, germany; [cited 2018].

19. Waist Cicumference and Waist-Hip ratio: Report of a WHO Expert Consultation. Geneva, Switzerland: World Health Organization, 2008.

20. Abbott Freestyle Optium H Blood Glucose Monitoring System [Internet]. Illinois, USA: Abbott Laboratories; [cited 2018].

21. Epi Info 3.5.2 ed. Atlanta, Georgia: Center for Disease and Prevention; 2004.

22. Encyclopedia of Survey Research Methods. In: Lavrakas PJ, editor. Thousand Oaks, California2008.

23. IBM SPSS Statistics for Windows. 21.0 ed. Armonk, New York: IBM Corporation; 2012.

24. Riley L, Guthold R, Cowan M, Savin S, Bhatti L, Armstrong T, et al. The World Health Organization STEPwise Approach to Noncommunicable Disease Risk-Factor Surveillance: Methods, Challenges, and Opportunities. American Journal of Public Health. 2016;106(1):74–8. doi: 10.2105/AJPH.2015.302962 26696288

25. Non Communicable Diseases Risk Factors: STEPS Survey Nepal 2013. Government of Nepal, Ministry of Health and Population; Nepal Health Research Council, WHO Country Office for Nepal, 2013.

26. Zaman MM, Bhuiyan MR, Karim MN, MoniruzZaman, Rahman MM, Akanda AW, et al. Clustering of non-communicable diseases risk factors in Bangladeshi adults: An analysis of STEPS survey 2013. BMC public health. 2015;15:659. Epub 2015/07/15. doi: 10.1186/s12889-015-1938-4 26169788.

27. Esteghamati A, Abbasi M, Alikhani S, Gouya MM, Delavari A, Shishehbor MH, et al. Prevalence, awareness, treatment, and risk factors associated with hypertension in the Iranian population: the national survey of risk factors for noncommunicable diseases of Iran. American journal of hypertension. 2008;21(6):620–6. Epub 2008/05/03. doi: 10.1038/ajh.2008.154 18451810.

28. Pelzom D, Isaakidis P, Oo MM, Gurung MS, Yangchen P. Alarming prevalence and clustering of modifiable noncommunicable disease risk factors among adults in Bhutan: a nationwide cross-sectional community survey. BMC public health. 2017;17(1):975. doi: 10.1186/s12889-017-4989-x 29268747

29. Sugathan TN, Soman CR, Sankaranarayanan K. Behavioural risk factors for non communicable diseases among adults in Kerala, India. The Indian journal of medical research. 2008;127(6):555–63. Epub 2008/09/04. 18765874.

30. National Institute of Medical Statistics, Indian Council of Medical Research (ICMR). IDSP Non-Communicable Disease Risk Factors Survey, Phase-I States of India, 2007–08. New Delhi, India: 2009.

31. Sinha DN, Gupta PC, Pednekar MS. Tobacco use among students in the eight North-eastern states of India. Indian journal of cancer. 2003;40(2):43–59. Epub 2004/01/13. 14716119.

32. Hakim S, Chowdhury MAB, Uddin MJ. Correlates of unsuccessful smoking cessation among adults in Bangladesh. Prev Med Rep. 2017;8:122–8. Epub 2017/10/13. doi: 10.1016/j.pmedr.2017.08.007 29021949.

33. Jayakrishnan R, Uutela A, Mathew A, Auvinen A, Mathew PS, Sebastian P. Smoking cessation intervention in rural kerala, India: findings of a randomised controlled trial. Asian Pacific journal of cancer prevention: APJCP. 2013;14(11):6797–802. Epub 2014/01/01. doi: 10.7314/apjcp.2013.14.11.6797 24377608.

34. Health Department of Haryana [Internet]. Haryana: Government of Haryana; 2018 [cited 2018 22.10.2018].

35. Islami F, Torre LA, Jemal A. Global trends of lung cancer mortality and smoking prevalence. Translational lung cancer research. 2015;4(4):327–38. Epub 2015/09/18. doi: 10.3978/j.issn.2218-6751.2015.08.04 26380174.

36. Srinath Reddy K, Shah B, Varghese C, Ramadoss A. Responding to the threat of chronic diseases in India. Lancet. 2005;366(9498):1744–9. Epub 2005/11/18. doi: 10.1016/S0140-6736(05)67343-6 16291069.

37. Patel V, Chatterji S, Chisholm D, Ebrahim S, Gopalakrishna G, Mathers C, et al. Chronic diseases and injuries in India. Lancet. 2011;377(9763):413–28. Epub 2011/01/14. doi: 10.1016/S0140-6736(10)61188-9 21227486.

38. International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-4), 2015–16. Mumbai, India: IIPS, 2017.

39. Srivastava RK, Bachani D. Burden of NCDs, Policies and Programme for Prevention and Control of NCDs in India. Indian journal of community medicine: official publication of Indian Association of Preventive & Social Medicine. 2011;36(Suppl 1):S7–S12. Epub 2012/05/26. doi: 10.4103/0970-0218.94703 22628916

40. Ritchie H, Roser M. Alcohol consumption. Our World In Data. 2018.

41. Indian Alcohol Policy Alliances. Alcohol Atlas of India. Institute of Alcohol Studies, 2008.

42. National Institute for Medical Research, World Health Organization. Tanzania STEPS Survey Report. Tanzania: National Institute for Medical Research, World Health Organization, 2013.

43. Bui TV, Blizzard CL, Luong KN, Truong Nle V, Tran BQ, Otahal P, et al. National survey of risk factors for non-communicable disease in Vietnam: prevalence estimates and an assessment of their validity. BMC public health. 2016;16:498. doi: 10.1186/s12889-016-3160-4 27286818

44. Maimela E, Alberts M, Modjadji SE, Choma SS, Dikotope SA, Ntuli TS, et al. The Prevalence and Determinants of Chronic Non-Communicable Disease Risk Factors amongst Adults in the Dikgale Health Demographic and Surveillance System (HDSS) Site, Limpopo Province of South Africa. PLoS One. 2016;11(2):e0147926. Epub 2016/02/18. doi: 10.1371/journal.pone.0147926 26882033

45. Ministry of Statistics and Programme Implementation, National Statistics Organization, National Sample Survey Office. Nutritional Intake in India, 2011–2012. 2014 560(68/1.0/3).

46. Government of India. Working Group Report on Productivity Enhancement of Crops in Haryana. Hisar, India: Haryana Kisan Ayog, Government of India, 2013.

47. WHO. Global Status Report on noncommunicable diseases 2014. Geneva: World Health Organisation, 2014.

48. WHO Expert Consultation. Appropriate body-mass index for Asian populations and itscimplications for policy and intervention strategies. The Lancet. 2004;363. Epub January 10, 2004.

49. Huse O, Hettiarachchi J, Gearon E, Nichols M, Allender S, Peeters A. Obesity in Australia. Obesity Research & Clinical Practice. 2018;12(1):29–39. doi: 10.1016/j.orcp.2017.10.002 29097148

50. Vogel L. Overweight or overfat? Many Canadians are both. Canadian Medical Association Journal. 2017;189(37):E1202–E3. doi: 10.1503/cmaj.109-5472 28923805

51. Friedrich MJ. Global obesity epidemic worsening. JAMA. 2017;318(7):603-. doi: 10.1001/jama.2017.10693 28810033

52. Oliver Huse JH, Emma Gearona, Melanie Nichols, Steven Allender, Anna Peeters. Obesity in Australia. Obesity Research & Clinical Practice. 2018:29–39.

53. Das C. NPCDCS: Progress & Challenges and National Multi-Sectoral Action Plan. First World NCD Congress 2017. Chandigarh, India: World NCD Congress; 2017.

54. Gebremariam LW, Chiang C, Yatsuya H, Hilawe EH, Kahsay AB, Godefay H, et al. Non-communicable disease risk factor profile among public employees in a regional city in northern Ethiopia. Scientific reports. 2018;8(1):9298. Epub 2018/06/20. doi: 10.1038/s41598-018-27519-6 29915239.

55. Jeet G, Thakur JS, Prinja S, Singh M. Cost-effectiveness of “National Program on Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS)” in Punjab and Haryana state and efficiency analysis of various scale up scenarios. [PhD Thesis]. In press 2018.

56. Soliman EZ, Mendis S, Dissanayake WP, Somasundaram NP, Gunaratne PS, Jayasingne IK, et al. A Polypill for primary prevention of cardiovascular disease: a feasibility study of the World Health Organization. Trials. 2011;12:3. Epub 2011/01/06. doi: 10.1186/1745-6215-12-3 21205325

57. Lin JS, O’Connor EA, Evans CV, Senger CA, Rowland MG, Groom HC. U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews. Behavioral Counseling to Promote a Healthy Lifestyle for Cardiovascular Disease Prevention in Persons With Cardiovascular Risk Factors: An Updated Systematic Evidence Review for the US Preventive Services Task Force. Rockville: Agency for Healthcare Research and Quality (US); 2014.

58. Liu M, Pan C, Jin M. A Chinese diabetes risk score for screening of undiagnosed diabetes and abnormal glucose tolerance. Diabetes technology & therapeutics. 2011;13(5):501–7. Epub 2011/03/17. doi: 10.1089/dia.2010.0106 21406016.

59. National Institute of Mental Health and Neuro Sciences Bengaluru. National Mental Health Survey of India, 2015–16: Prevalence, Pattern and Outcomes. Bengaluru, India: National Institute of Mental Health and Neuro Sciences, NIMHANS, 2016.

60. Murthy R. National mental health survey of India 2015–2016. Indian Journal of Psychiatry. 2017;59(1):21–6. doi: 10.4103/psychiatry.IndianJPsychiatry_102_17 28529357

61. Ministry of Health Republic of Marshall Islands, WHO Western Pacific Region. NCD Risk Factors STEPS Report 2002. Suva, Fiji: Ministry of Health Republic of Marshall Islands, WHO Western Pacific Region, 2007.

62. Bhutta ZA, Lassi ZS, Pariyo G, Huicho L. WHO Global Health Workforce Alliance. Global Experience of Community Health Workers for Delivery of Health Related Millennium Development Goals: A Systematic Review, Country Case Studies, and Recommendations for Integration into National Health Systems. Geneva: 2010.

Článek vyšel v časopise


2019 Číslo 11