Exploring Risk Constellations for Noncommunicable Diseases: A Community-Based Study From Northern India

Noncommunicable diseases (NCDs) have emerged as a leading public health challenge in rural India, largely driven by the clustering of non-modifiable, behavioral, and intermediate risk factors.

To determine the distribution and clustering of NCD risk factors, a community-based cross-sectional study was conducted among rural adults from three villages, namely, Umraha, Narayanpur, and Chittauna, in the Chiraigaon block of Varanasi district, North India. Using a multistage, stratified random sampling technique, 425 individuals aged 25-64 years were selected. Data collection was carried out over one year, from February 2019 to January 2020, using a culturally adapted WHO STEPwise questionnaire.

Behavioral risks were highly prevalent, including inadequate fruit and vegetable intake (n = 424, 99.8%), physical inactivity (n = 387, 91.1%), excess dietary salt consumption (n = 354, ~83%], tobacco use (n = 156, 36.7%), and alcohol intake (n = 93, 21.9%). The intermediate risks included hypertension (n = 134, 31.5%), central obesity (n = 123, 28.9%), and overweight/obesity (n = 108, 25.4%). A family history of NCDs was reported by 225 (52.9%) participants. Risk factor clustering revealed that no individual was risk-free; 228 (53%) individuals were classified as high-risk (≥5 risk factors), and the median number of risk factors was 5. Multivariate logistic regression identified age as the strongest predictor of high-risk status, with adults aged 45-64 years having nearly fourfold higher odds than those aged 25-44 years (adjusted odds ratio (AOR) 3.95; 95% confidence interval (CI): 2.36-6.61). Lower educational attainment also significantly increased the odds of being at high risk (P < 0.05), while gender and occupation lost significance in the adjusted models.

Substantial clustering of modifiable NCD risk factors in this rural setting emphasizes the urgent shift from a conventional high-risk approach to community-led macro-level blanket intervention.