Academic journal article Bulletin of the World Health Organization

Level of Urbanization and Noncommunicable Disease Risk Factors in Tamil Nadu, India/Niveau D'urbanisation et Facteurs De Risque De Maladies Non Transmissibles a Tamil Nadu (Inde)/Nivel De Urbanizacion Y Factores De Riesgo De Enfermedades No Transmisibles En Tamil Nadu, India

Academic journal article Bulletin of the World Health Organization

Level of Urbanization and Noncommunicable Disease Risk Factors in Tamil Nadu, India/Niveau D'urbanisation et Facteurs De Risque De Maladies Non Transmissibles a Tamil Nadu (Inde)/Nivel De Urbanizacion Y Factores De Riesgo De Enfermedades No Transmisibles En Tamil Nadu, India

Article excerpt

Introduction

Over the last few decades, traditional societies in many developing countries have experienced rapid and unplanned urbanization, which has led to lifestyles characterized by unhealthy nutrition, reduced physical activity and tobacco consumption. (1) These unhealthy lifestyles are associated with common modifiable risk factors for chronic diseases such as hypertension, diabetes mellitus, dyslipidaemia and obesity. (2)

It is expected that by 2020 in developing countries, non-communicable diseases (NCDs) will account for 69% of all deaths, with cardiovascular diseases in the lead. (3) The prevalence of diabetes mellitus will almost double in the next 25 years and at least 75% of those affected will be in developing countries. The burden of disease will be worse in these countries, as the majority of sufferers are expected to be relatively young, of lower socioeconomic status and to suffer from severe disease of premature onset. (4)

Using the dichotomous United Nations definition of urbanization (based on country specific definitions using one or more of population density, population size or administrative division) for more than 100 countries, Ezatti et al. (5) found that both body mass index (BMI) and blood cholesterol levels rose rapidly in tandem with increases in national income and level of urbanization. Work undertaken in Sri Lanka shows a greater increase in BMI and other risk factors for cardiovascular disease among urban dwellers than among their rural counterparts. (6)

Timely interventions in those stages of development in which environmental conditions shift and common modifiable risk factors emerge may help prevent and control chronic disease. It is important to identify these crucial stages and to determine what elements of urbanization are linked to the emergence of risk factors. A greater understanding of these relationships may help us identify interventions that are most likely to be effective in preventing NCDs in countries undergoing rapid urbanization and improve our capacity to stem the rapid increase in NCDs.

The objectives of this study were to: establish the feasibility of collecting a multi-component scale of urbanicity in Tamil Nadu, India; and, examine the relationships between urbanicity and chronic disease risk in Tamil Nadu, India.

Methods

The study was based on the working hypothesis that urbanicity, defined as the level of urbanization in a given locality, (7) is associated with risk factors for chronic disease. It was conducted in three steps: (i) constructing a measure of urbanicity using a validated scale (8) based on data from the Census of India 2001; (ii) calculating the prevalence of NCD risk factors in seven study areas in the state of Tamil Nadu, India, by using data from an NCD risk factor surveillance survey conducted locally in 2003-2004 as part of a larger study (9); and (iii) testing for an association between urbanicity and the prevalence of NCD risk factors in the study areas.

Setting

The urban arm of this study was set in Chennai (formerly Madras) and the rural arm was set in six settlements (Agaram, Chunampet, Illeedu, Pudupattu, Puthiram Kottai and Vanniyanallur) in the Kancheepuram district, around 120 km south of Chennai.

Measuring urbanicity

An existing composite continuous measure of urbanicity previously used and validated for the Philippines by Dahly and Adair (8,10) was identified through an earlier systematic review. (11) It comprised seven elements: population size, population density, access to markets, communications, transport, education and health services. We replicated it in its entirety for three items--population size, population density and education--and modified the remaining four elements to better suit the Indian context. We assigned a maximum of 10 points to each item of the adapted scale, with a resulting range from 0 (no urbanicity) to 70 (high urbanicity) points. …

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