Comparative Burden of Non-Communicable Diseases Across Urban and Rural Divisions of Pakistan

Abstract

Background:
Pakistan is experiencing a rapid epidemiological transition, with non-communicable diseases (NCDs) surpassing infectious diseases as the leading cause of mortality. Urbanization, sedentary lifestyles, and socioeconomic disparities contribute to an increasing NCD burden. However, limited data exist comparing disease patterns between urban and rural regions of the country.

Objective:
To compare the prevalence and determinants of major NCDs across urban and rural divisions of five representative Pakistani regions—Lahore, Multan, Quetta, Swat, and Gilgit—through a multicenter, population-based assessment.

Methods:
A cross-sectional, multicenter comparative study was conducted from January to December 2025. A total of 2,850 adults (aged ≥18 years) were enrolled using multistage stratified random sampling. Data were collected through standardized WHO STEPS questionnaires and clinical measurements of blood pressure, glucose levels, and body mass index. Statistical analyses included descriptive statistics, chi-square tests, t-tests, and multivariate logistic regression using SPSS version 27, with significance set at p<0.05.

Results:
The overall NCD prevalence was 38.6%, with hypertension (21.9%) and diabetes mellitus (14.2%) as the most frequent conditions. Urban participants exhibited significantly higher NCD prevalence (43.1%) than rural participants (31.8%) (p<0.001). Obesity (22.1% vs. 11.3%) and physical inactivity (49.7% vs. 31.4%) were markedly more prevalent in urban populations. Age ≥45 years (AOR 2.9; 95% CI: 2.2–3.8) and obesity (AOR 3.1; 95% CI: 2.4–4.0) were the strongest predictors of NCDs.

Conclusion:
Urban regions of Pakistan bear a higher NCD burden, reflecting the influence of lifestyle and environmental factors. Region-specific health interventions focusing on prevention, early detection, and equitable resource distribution are essential to address this growing national health challenge.

Keywords:
Chronic Disease; Cross-Sectional Studies; Epidemiology; Hypertension; Noncommunicable Diseases; Pakistan; Prevalence; Risk Factors