Epidemiological Trends, Risk Factors, and Population Burden of Non-Communicable Diseases in India: A Nationwide Population-Based Analysis

Abstract

Background India is experiencing a rapid epidemiological transition characterized by persistent undernutrition alongside increasing obesity and cardiometabolic disease. This study examined recent changes and population inequalities in major behavioral and metabolic risk factors for non-communicable diseases (NCDs) across India. Methods A nationwide repeated cross-sectional analysis was conducted using data from the fourth and fifth Indian National Family Health Surveys: NFHS-4 (2015–2016) and NFHS-5 (2019–2021). Harmonized comparisons were restricted to consistent age groups and indicator definitions. Outcomes included overweight or obesity, tobacco use, alcohol consumption, hypertension, and raised random blood glucose. Patterns were examined by sex, age, residence, household wealth, body mass index, and geographic location. Results Among adults aged 15–49 years, overweight or obesity increased from 21% to 24% among women and from 19% to 23% among men. Conversely, thinness declined from 23% to 19% among women and from 20% to 16% among men. Tobacco use decreased from 7% to 4% among women and from 45% to 39% among men, while alcohol consumption declined from 29% to 22% among men and remained approximately 1% among women. Hypertension increased from approximately 11% to 11.7% among women and from 15% to 16.1% among men aged 15–49 years. Raised random blood glucose also increased, from approximately 6% to 7.5% among women and from 8% to 9.1% among men. In NFHS-5, hypertension affected 21.3% of women and 24.0% of men aged 15 years or older, while raised glucose or glucose-lowering medication use affected 13.5% and 15.6%, respectively. Cardiometabolic risk increased sharply with age and BMI and was generally higher in urban and wealthier populations. Tobacco exposure remained concentrated among rural, socioeconomically disadvantaged, and scheduled-tribe populations. Marked state-level variation was observed across all major indicators. Conclusion India has achieved measurable reductions in tobacco use and male alcohol consumption, but these improvements are being challenged by increasing obesity, hypertension, and abnormal glucose. The coexistence of undernutrition and metabolic disease, together with pronounced socioeconomic and geographic inequalities, requires an integrated, life-course and equity-oriented NCD strategy. Strengthening early detection, treatment continuity, healthy food environments, physical activity, and targeted behavioral-risk reduction will be essential to limit premature NCD morbidity and mortality. Keywords: Non-communicable diseases; Epidemiological transition; Hypertension; Obesity; diabetes; NFHS