title: Rural, urban and migrant differences in non-communicable disease risk-factors in middle income countries: a cross-sectional study of WHO-SAGE data.
abstract: BACKGROUND
  Understanding how urbanisation and rural-urban migration influence risk-factors for non-communicable disease (NCD) is crucial for developing effective preventative strategies globally. This study compares NCD risk-factor prevalence in urban, rural and migrant populations in China, Ghana, India, Mexico, Russia and South Africa.
  
  
  METHODS
  Study participants were 39,436 adults within the WHO Study on global AGEing and adult health (SAGE), surveyed 2007-2010. Risk ratios (RR) for each risk-factor were calculated using logistic regression in country-specific and all country pooled analyses, adjusted for age, sex and survey design. Fully adjusted models included income quintile, marital status and education.
  
  
  RESULTS
  Regular alcohol consumption was lower in migrant and urban groups than in rural groups (pooled RR and 95%CI: 0.47 (0.31-0.68); 0.58, (0.46-0.72), respectively). Occupational physical activity was lower (0.86 (0.72-0.98); 0.76 (0.65-0.85)) while active travel and recreational physical activity were higher (pooled RRs for urban groups; 1.05 (1.00-1.09), 2.36 (1.95-2.83), respectively; for migrant groups: 1.07 (1.0 -1.12), 1.71 (1.11-2.53), respectively). Overweight, raised waist circumference and diagnosed diabetes were higher in urban groups (1.19 (1.04-1.35), 1.24 (1.07-1.42), 1.69 (1.15-2.47), respectively). Exceptions to these trends exist: obesity indicators were higher in rural Russia; active travel was lower in urban groups in Ghana and India; and in South Africa, urban groups had the highest alcohol consumption.
  
  
  CONCLUSIONS
  Migrants and urban dwellers had similar NCD risk-factor profiles. These were not consistently worse than those seen in rural dwellers. The variable impact of urbanisation on NCD risk must be considered in the design and evaluation of strategies to reduce the growing burden of NCDs globally.
authors: Department of Primary Care and Public Health, Imperial College, Reynolds Building, St Dunstand's Road, London, United Kingdom.
authors: Oyinlola
authors: O
authors: Oyebode
authors: Department of Primary Care and Public Health, Imperial College, Reynolds Building, St Dunstand's Road, London, United Kingdom.
authors: Utz J
authors: UJ
authors: Pape
authors: Department of Primary Care and Public Health, Imperial College, Reynolds Building, St Dunstand's Road, London, United Kingdom.
authors: Anthony A
authors: AA
authors: Laverty
authors: Department of Primary Care and Public Health, Imperial College, Reynolds Building, St Dunstand's Road, London, United Kingdom.
authors: John T
authors: JT
authors: Lee
authors: Public Health Foundation of India, New Delhi, India.
authors: Nandita
authors: N
authors: Bhan
authors: Department of Primary Care and Public Health, Imperial College, Reynolds Building, St Dunstand's Road, London, United Kingdom; Public Health Foundation of India, New Delhi, India.
authors: Christopher
authors: C
authors: Millett
mesh_terms: D000293:Adolescent; D000328:Adult; D000375:Aging; D003430:Cross-Sectional Studies; D019049:Developed Countries; D005247:Feeding Behavior; D005260:Female; D063426:Human Migration; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D012307:Risk Factors; D012424:Rural Population; D012907:Smoking / Q000453:epidemiology*; D014171:Transients and Migrants; D014505:Urban Population; D014944:World Health Organization; D055815:Young Adult