title: Common risk factors for chronic non-communicable diseases among older adults in China, Ghana, Mexico, India, Russia and South Africa: the study on global AGEing and adult health (SAGE) wave 1.
abstract: BACKGROUND
  Behavioral risk factors such as tobacco use, unhealthy diet, insufficient physical activity and the harmful use of alcohol are known and modifiable contributors to a number of NCDs and health mediators. The purpose of this paper is to describe the distribution of main risk factors for NCDs by socioeconomic status (SES) among adults aged 50 years and older within a country and compare these risk factors across six lower- and upper-middle income countries.
  
  
  METHODS
  The study population in this paper draw from SAGE Wave 1 and consisted of adults aged 50-plus from China (N=13,157), Ghana (N=4,305), India (N=6,560), Mexico (N=2,318), the Russian Federation (N=3,938) and South Africa (N=3,836). Seven main common risk factors for NCDs were identified: daily tobacco use, frequent heavy drinking, low level physical activity, insufficient vegetable and fruit intake, high risk waist-hip ratio, obesity and hypertension. Multiple risk factors were also calculated by summing all these risk factors.
  
  
  RESULTS
  The prevalence of daily tobacco use ranged from 7.7% (Ghana) to 46.9% (India), frequent heavy drinker was the highest in China (6.3%) and lowest in India (0.2%), and the highest prevalence of low physical activity was in South Africa (59.7%). The highest prevalence of respondents with high waist-to-hip ratio risk was 84.5% in Mexico, and the prevalence of self-reported hypertension ranging from 33% (India) to 78% (South Africa). Obesity was more common in South Africa, the Russia Federation and Mexico (45.2%, 36% and 28.6%, respectively) compared with China, India and Ghana (15.3%, 9.7% and 6.4%, respectively). China, Ghana and India had a higher prevalence of respondents with multiple risk factors than Mexico, the Russia Federation and South Africa. The occurrence of three and four risk factors was more prevalent in Mexico, the Russia Federation and South Africa.
  
  
  CONCLUSIONS
  There were substantial variations across countries and settings, even between upper-middle income countries and lower-middle income countries. The baseline information on the magnitude of the problem of risk factors provided by this study can help countries and health policymakers to set up interventions addressing the global non-communicable disease epidemic.
authors.affiliation: Shanghai Municipal Centre for Disease Control (Shanghai CDC), 1380 Zhongshan Rd (W), Shanghai, 200336, P.R. China. wufan@scdc.sh.cn.
authors.forename: Fan
authors.initials: F
authors.lastname: Wu
authors.affiliation: Shanghai Municipal Centre for Disease Control (Shanghai CDC), 1380 Zhongshan Rd (W), Shanghai, 200336, P.R. China. guoyanfei@scdc.sh.cn.
authors.forename: Yanfei
authors.initials: Y
authors.lastname: Guo
authors.affiliation: World Health Organization, HIS/HSI/MCS, Geneva, Switzerland. chatterjis@who.int.
authors.forename: Somnath
authors.initials: S
authors.lastname: Chatterji
authors.affiliation: Shanghai Municipal Centre for Disease Control (Shanghai CDC), 1380 Zhongshan Rd (W), Shanghai, 200336, P.R. China. zhengyang@scdc.sh.cn.
authors.forename: Yang
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: World Health Organization, HIS/HSI/MCS, Geneva, Switzerland. naidoon@who.int.
authors.forename: Nirmala
authors.initials: N
authors.lastname: Naidoo
authors.affiliation: National Center for Chronic and Noncommunicable Disease Control and Prevention (NCNCD), Chinese Center for Disease Control and Prevention (China CDC), Beijing, P.R. China. jy78@vip.sina.com.
authors.forename: Yong
authors.initials: Y
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authors.affiliation: Department of Community Health, University of Ghana Medical School, Accra, Ghana. biritwum@africaonline.com.gh.
authors.forename: Richard
authors.initials: R
authors.lastname: Biritwum
authors.affiliation: Department of Community Health, University of Ghana Medical School, Accra, Ghana. aeyawson@yahoo.com.
authors.forename: Alfred
authors.initials: A
authors.lastname: Yawson
authors.affiliation: Department of Community Health, University of Ghana Medical School, Accra, Ghana. nadia.minicuci@unipd.it.|National Research Council, Institute of Neuroscience, Padova, Italy. nadia.minicuci@unipd.it.
authors.forename: Nadia
authors.initials: N
authors.lastname: Minicuci
authors.affiliation: National Institute of Public Health, Mexico City, Mexico. asalinas@insp.mx.
authors.forename: Aaron
authors.initials: A
authors.lastname: Salinas-Rodriguez
authors.affiliation: National Institute of Public Health, Mexico City, Mexico. bmanrique@insp.mx.
authors.forename: Betty
authors.initials: B
authors.lastname: Manrique-Espinoza
authors.affiliation: Russian Academy of Medical Sciences, Moscow, Russian Federation. tmaximova@mail.ru.
authors.forename: Tamara
authors.initials: T
authors.lastname: Maximova
authors.affiliation: University of Limpopo, Turfloop, South Africa. karl.pel@mahidol.ac.th.|Mahidol University, Salaya, Thailand. karl.pel@mahidol.ac.th.|Human Sciences Research Council, Port Elizabeth/Pretoria, South Africa. karl.pel@mahidol.ac.th.
authors.forename: Karl
authors.initials: K
authors.lastname: Peltzer
authors.affiliation: Human Sciences Research Council, Port Elizabeth/Pretoria, South Africa. NPhaswanamafuya@hsrc.ac.za.|Office of the Deputy Vice Chancellor: Research and Engagement, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa. NPhaswanamafuya@hsrc.ac.za.
authors.forename: Nancy
authors.initials: N
authors.lastname: Phaswanamafuya
authors.affiliation: Department of Anthropology, University of Oregon, Eugene, Oregon, USA. jjosh@uoregon.edu.
authors.forename: James J
authors.initials: JJ
authors.lastname: Snodgrass
authors.affiliation: , Atlanta, GA, USA. lizthiele747@gmail.com.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Thiele
authors.affiliation: Epidemiology and Global Health, Umeå University, Umeå, Sweden. Nawi.Ng@epiph.umu.se.
authors.forename: Nawi
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authors.lastname: Ng
authors.affiliation: World Health Organization, HIS/HSI/MCS, Geneva, Switzerland. paul.r.kowal@gmail.com.|University of Newcastle Research Centre for Gender, Health and Ageing, Newcastle, Australia. paul.r.kowal@gmail.com.
authors.forename: Paul
authors.initials: P
authors.lastname: Kowal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000437:Alcoholism / Q000453:epidemiology; D001837:Body Weights and Measures; D002681:China / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology*; D004032:Diet; D015444:Exercise; D005869:Ghana / Q000453:epidemiology; D015438:Health Behavior; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D015995:Prevalence; D012306:Risk; D012307:Risk Factors; D012426:Russia / Q000453:epidemiology; D057566:Self Report; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D049629:Waist-Hip Ratio