title: Urban-rural differences in the prevalence of non-communicable diseases risk factors among 25-74 years old citizens in Yangon Region, Myanmar: a cross sectional study.
abstract: Recent societal and political reforms in Myanmar may upturn the socio-economy and, thus, contribute to the country's health transition. Baseline data on urban-rural disparities in non-communicable disease (NCD) risk factors are not thoroughly described in this country which has been relatively closed for more than five decades. We aim to investigate urban-rural differences in mean values and the prevalence of selected behavioral and metabolic risk factors for non-communicable diseases and 10-years risk in development of coronary heart diseases (CHD).
  
  
  
  Two cross-sectional studies were conducted in urban and rural areas of Yangon Region in 2013 and 2014 respectively, using the WHO STEPwise approach to surveillance of risk factors of NCDs. Through a multi-stage cluster sampling method, 1486 participants were recruited.
  
  
  
  Age-standardized prevalence of the behavioral risk factors tended to be higher in the rural than urban areas for all included factors and significantly higher for alcohol drinking (19.9% vs. 13.9%; p = 0.040) and low fruit & vegetable consumption (96.7% vs. 85.1%; p = 0.001). For the metabolic risk factors, the tendency was opposite, with higher age-standardized prevalence estimates in urban than rural areas, significantly for overweight and obesity combined (40.9% vs. 31.2%; p = 0.023), obesity (12.3% vs.7.7%; p = 0.019) and diabetes (17.2% vs. 9.2%; p = 0.024). In sub-group analysis by gender, the prevalence of hypercholesterolemia and hypertriglyceridemia were significantly higher in urban than rural areas among males, 61.8% vs. 40.4%; p = 0.002 and 31.4% vs. 20.7%; p = 0.009, respectively. Mean values of age-standardized metabolic parameters showed higher values in urban than rural areas for both male and female. Based on WHO age-standardized Framingham risk scores, 33.0% (95% CI = 31.7-34.4) of urban dwellers and 27.0% (95% CI = 23.5-30.8) of rural dwellers had a moderate to high risk of developing CHD in the next 10 years.
  
  
  
  The metabolic risk factors, as well as a moderate or high ten-year risk of CHD were more common among urban residents whereas behavioral risk factors levels were higher in among the rural people of Yangon Region. The high prevalences of NCD risk factors in both urban and rural areas call for preventive measures to reduce the future risk of NCDs in Myanmar.
authors.affiliation: Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway. aungsh@gmail.com.|International Relations Division, Ministry of Health, Nay Pyi Taw, Myanmar. aungsh@gmail.com.
authors.forename: Aung Soe
authors.initials: AS
authors.lastname: Htet
authors.affiliation: Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Marius B
authors.initials: MB
authors.lastname: Bjertness
authors.affiliation: Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Lhamo Y
authors.initials: LY
authors.lastname: Sherpa
authors.affiliation: Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Marte Karoline
authors.initials: MK
authors.lastname: Kjøllesdal
authors.affiliation: Faculty of Medicine, SEGi University, Petaling Jaya, Malaysia.
authors.forename: Win Myint
authors.initials: WM
authors.lastname: Oo
authors.affiliation: Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Haakon E
authors.initials: HE
authors.lastname: Meyer
authors.affiliation: Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Hein
authors.initials: H
authors.lastname: Stigum
authors.affiliation: Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Espen
authors.initials: E
authors.lastname: Bjertness
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D004032:Diet / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D015438:Health Behavior; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology*; D008875:Middle Aged; D002052:Myanmar / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data*
keywords: Myanmar; Non-communicable diseases; Risk factors; Urban-rural differences; Yangon