title: Quantifying urbanization as a risk factor for noncommunicable disease.
abstract: The aim of this study was to investigate the poorly understood relationship between the process of urbanization and noncommunicable diseases (NCDs) in Sri Lanka using a multicomponent, quantitative measure of urbanicity. NCD prevalence data were taken from the Sri Lankan Diabetes and Cardiovascular Study, comprising a representative sample of people from seven of the nine provinces in Sri Lanka (n = 4,485/5,000; response rate = 89.7%). We constructed a measure of the urban environment for seven areas using a 7-item scale based on data from study clusters to develop an "urbanicity" scale. The items were population size, population density, and access to markets, transportation, communications/media, economic factors, environment/sanitation, health, education, and housing quality. Linear and logistic regression models were constructed to examine the relationship between urbanicity and chronic disease risk factors. Among men, urbanicity was positively associated with physical inactivity (odds ratio [OR] = 3.22; 2.27-4.57), high body mass index (OR = 2.45; 95% CI, 1.88-3.20) and diabetes mellitus (OR = 2.44; 95% CI, 1.66-3.57). Among women, too, urbanicity was positively associated with physical inactivity (OR = 2.29; 95% CI, 1.64-3.21), high body mass index (OR = 2.92; 95% CI, 2.41-3.55), and diabetes mellitus (OR = 2.10; 95% CI, 1.58 - 2.80). There is a clear relationship between urbanicity and common modifiable risk factors for chronic disease in a representative sample of Sri Lankan adults.
authors.affiliation: British Heart Foundation Health Promotion Research Group, Department of Public Health, University of Oxford, Old Road Campus, Headington, Oxford, UK.
authors.forename: Steven
authors.initials: S
authors.lastname: Allender
authors.forename: Kremlin
authors.initials: K
authors.lastname: Wickramasinghe
authors.forename: Michael
authors.initials: M
authors.lastname: Goldacre
authors.forename: David
authors.initials: D
authors.lastname: Matthews
authors.forename: Prasad
authors.initials: P
authors.lastname: Katulanda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012307:Risk Factors; D013188:Sri Lanka / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014507:Urbanization; D055815:Young Adult