title: Urbanization and non-communicable disease in Southeast Asia: a review of current evidence.
abstract: OBJECTIVE
  Non-communicable diseases (NCDs) have been highlighted as a major public health issue in the Southeast (SE) Asian region. One of the major socio-environmental factors that are considered to be associated with such a rise in NCDs is urbanization. Urbanization is associated with behavioural changes such as eating an unhealthy diet, and a decrease in physical activities, which may result in associated obesity. The SE Asian region also has a substantive burden of infectious disease such as HIV and malaria, which may modify associations between urbanization and development of NCDs.
  
  
  METHODS
  A systematic review was conducted until April 2013.
  
  
  METHODS
  Using four databases: EMBASE, PubMed, GlobalHealth and DigitalJournal, the systematic review pools existing evidence on urban-rural gradients in NCD prevalence/incidence.
  
  
  RESULTS
  The study found that in SE Asia, urban exposure was positively associated with coronary heart disease, diabetes and respiratory diseases in children. Urban exposure was negatively associated with rheumatic heart diseases. The stages of economic development may also modify the association between urbanization and NCDs such as diabetes.
  
  
  CONCLUSIONS
  There was pronounced heterogeneity between associations. It is recommended that future studies examine the major constituents of NCDs separately and also focus on the interplay between lifestyle and infectious risk factors for NCDs. Prospective studies are needed to understand the diverse causal pathways between urbanization and NCDs in SE Asia.
authors.affiliation: Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom; Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Thailand. Electronic address: chaisiri.angkurawaranon@lshtm.ac.uk.
authors.forename: C
authors.initials: C
authors.lastname: Angkurawaranon
authors.affiliation: Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Thailand.
authors.forename: W
authors.initials: W
authors.lastname: Jiraporncharoen
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Thailand.
authors.forename: B
authors.initials: B
authors.lastname: Chenthanakij
authors.affiliation: Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom.
authors.forename: P
authors.initials: P
authors.lastname: Doyle
authors.affiliation: Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom.
authors.forename: D
authors.initials: D
authors.lastname: Nitsch
mesh_terms: D001210:Asia, Southeastern / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002908:Chronic Disease; D003920:Diabetes Mellitus / Q000453:epidemiology*; D006801:Humans; D009369:Neoplasms / Q000453:epidemiology*; D012140:Respiratory Tract Diseases / Q000453:epidemiology*; D014507:Urbanization
keywords: Cancer; Cardiovascular disease; Chronic respiratory disease; Diabetes; Non-communicable disease; Southeast Asia; Urbanization