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

Aarav Sharma1, Priya Nair2, Rohan Mehta3, Ananya Iyer4*ORCID 

¹ Department of Community Medicine, Institute of Medical Sciences, New Delhi, India.
² Centre for Epidemiology and Population Health, National Health University, Mumbai, Maharashtra, India.
3 Department of Public Health Research, School of Public Health, Bengaluru, Karnataka, India.
4 Department of Preventive and Social Medicine, College of Medicine, Chennai, Tamil Nadu, India.
DOI: 10.18081/ajbm.2026.3.269

Publication History: Received 5 May 2026 • Revised 15 June 2026 • Accepted 15 July 2026 • Available online 18 August 2026
Copyright: © 2026 Iyer et al. This is an open-access article under a Creative Commons license (CC BY 4.0).
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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.

Method

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

Recommended Citation

Sharma A, Nair P, Mehta R, A Iyer. Epidemiological Trends, Risk Factors, and Population Burden of Non-Communicable Diseases in India: A Nationwide Population-Based Analysis. Advanced Journal of Biomedicine & Medicine. 2026;14(3):269-293. doi:10.18081/ajbm.2026.3.269

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Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

References

  1. International Institute for Population Sciences, ICF. National Family Health Survey (NFHS-4), 2015-16: India. International Institute for Population Sciences; 2017.
  2. International Institute for Population Sciences, ICF. National Family Health Survey (NFHS-5), 2019-21: India. International Institute for Population Sciences; 2021.
  3. India State-Level Disease Burden Initiative Collaborators. Nations within a nation: variations in epidemiological transition across the states of India, 1990-2016 in the Global Burden of Disease Study. Lancet. 2017;390(10111):2437-2460. doi:10.1016/S0140-6736(17)32804-0
  4. India State-Level Disease Burden Initiative CVD Collaborators. The changing patterns of cardiovascular diseases and their risk factors in the states of India: the Global Burden of Disease Study 1990-2016. Lancet Glob Health. 2018;6(12). doi:10.1016/S2214-109X(18)30407-8
  5. India State-Level Disease Burden Initiative CRD Collaborators. The burden of chronic respiratory diseases and their heterogeneity across the states of India: the Global Burden of Disease Study 1990-2016. Lancet Glob Health. 2018;6(12). doi:10.1016/S2214-109X(18)30409-1
  6. India State-Level Disease Burden Initiative Diabetes Collaborators. The increasing burden of diabetes and variations among the states of India: the Global Burden of Disease Study 1990-2016. Lancet Glob Health. 2018;6(12). doi:10.1016/S2214-109X(18)30387-5
  7. India State-Level Disease Burden Initiative Cancer Collaborators. The burden of cancers and their variations across the states of India: the Global Burden of Disease Study 1990-2016. Lancet Oncol. 2018;19(10):1289-1306. doi:10.1016/S1470-2045(18)30447-9
  8. India State-Level Disease Burden Initiative Air Pollution Collaborators. The impact of air pollution on deaths, disease burden, and life expectancy across the states of India: the Global Burden of Disease Study 2017. Lancet Planet Health. 2019;3(1). doi:10.1016/S2542-5196(18)30261-4
  9. India State-Level Disease Burden Initiative Malnutrition Collaborators. The burden of child and maternal malnutrition and trends in its indicators in the states of India: the Global Burden of Disease Study 1990-2017. Lancet Child Adolesc Health. 2019;3(12):855-870. doi:10.1016/S2352-4642(19)30273-1
  10. Dare AJ, Fu SH, Patra J, et al. Renal failure deaths and their risk factors in India 2001-13: nationally representative estimates from the Million Death Study. Lancet Glob Health. 2017;5(1). doi:10.1016/S2214-109X(16)30275-4
  11. GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204-1222. doi:10.1016/S0140-6736(20)30925-9
  12. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1223-1249. doi:10.1016/S0140-6736(20)30752-2
  13. GBD 2019 Demographics Collaborators. Global age-sex-specific fertility, mortality, healthy life expectancy, and population estimates in 204 countries and territories, 1950-2019. Lancet. 2020;396(10258):1160-1203. doi:10.1016/S0140-6736(20)30977-6
  14. GBD 2019 Tobacco Collaborators. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019. Lancet. 2021;397(10292):2337-2360. doi:10.1016/S0140-6736(21)01169-7
  15. GBD 2016 Alcohol Collaborators. Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2018;392(10152):1015-1035. doi:10.1016/S0140-6736(18)31310-2
  16. Di Cesare M, Khang YH, Asaria P, et al. Inequalities in non-communicable diseases and effective responses. Lancet. 2013;381(9866):585-597. doi:10.1016/S0140-6736(12)61851-0
  17. Bennett JE, Kontis V, Mathers CD, et al. NCD Countdown 2030: pathways to achieving Sustainable Development Goal target 3.4. Lancet. 2020;396(10255):918-934. doi:10.1016/S0140-6736(20)31761-X
  18. Beaglehole R, Bonita R, Horton R, et al. Priority actions for the non-communicable disease crisis. Lancet. 2011;377(9775):1438-1447. doi:10.1016/S0140-6736(11)60393-0
  19. Nugent R, Bertram MY, Jan S, et al. Investing in non-communicable disease prevention and management to advance the Sustainable Development Goals. Lancet. 2018;391(10134):2029-2035. doi:10.1016/S0140-6736(18)30667-6
  20. Nethan S, Sinha D, Mehrotra R. Non communicable disease risk factors and their trends in India. Asian Pac J Cancer Prev. 2017;18(7):2005-2010. doi:10.22034/APJCP.2017.18.7.2005
  21. Arokiasamy P. India’s escalating burden of non-communicable diseases. Lancet Glob Health. 2018;6(12). doi:10.1016/S2214-109X(18)30448-0
  22. Geldsetzer P, Manne-Goehler J, Theilmann M, et al. Diabetes and hypertension in India: a nationally representative study of 1.3 million adults. JAMA Intern Med. 2018;178(3):363-372. doi:10.1001/jamainternmed.2017.8094
  23. Prenissl J, Manne-Goehler J, Jaacks LM, et al. Hypertension screening, awareness, treatment, and control in India: a nationally representative cross-sectional study among individuals aged 15 to 49 years. PLoS Med. 2019;16(5). doi:10.1371/journal.pmed.1002801
  24. Anchala R, Kannuri NK, Pant H, et al. Hypertension in India: a systematic review and meta-analysis of prevalence, awareness, and control of hypertension. J Hypertens. 2014;32(6):1170-1177. doi:10.1097/HJH.0000000000000146
  25. Ramakrishnan S, Zachariah G, Gupta K, et al. Prevalence of hypertension among Indian adults: results from the Great India Blood Pressure Survey. Indian Heart J. 2019;71(4):309-313. doi:10.1016/j.ihj.2019.09.012
  26. Thrift AG, Ragavan RS, Riddell MA, et al. Hypertension in rural India: the contribution of socioeconomic position. J Am Heart Assoc. 2020;9(7). doi:10.1161/JAHA.119.014486
  27. Sharma S, Bansal P, Mittal C, et al. Hypertension and its association with body mass index among the Indian population: findings from a nationwide survey, NFHS-4, 2015-16. J Family Med Prim Care. 2022;11(9):5826-5833. doi:10.4103/jfmpc.jfmpc_168_22
  28. Ross S, Ponsford MJ, Gill D, et al. The burden of risk factors for non-communicable disease in India: results from the National Family Health Survey-5. BMC Public Health. 2022;22:1541.
  29. Guthi VR, Darivemula S, Mullen S, et al. Hypertension treatment cascade among men and women of reproductive age in India: analysis of National Family Health Survey-5, 2019-2021. BMC Public Health. 2024;24:620.
  30. Seenappa K, Manjunath R, Manjunath M, et al. District-wise heterogeneity in blood pressure, hypertension, and their determinants among Indians: National Family Health Survey-5. Int J Public Health. 2024;69:1606766. doi:10.3389/ijph.2024.1606766
  31. Manne-Goehler J, Geldsetzer P, Agoudavi K, et al. Health system performance for people with diabetes in 28 low- and middle-income countries: a cross-sectional study of nationally representative surveys. PLoS Med. 2019;16(3). doi:10.1371/journal.pmed.1002751
  32. Anjana RM, Unnikrishnan R, Deepa M, et al. Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study. Lancet Diabetes Endocrinol. 2023;11(7):474-489. doi:10.1016/S2213-8587(23)00119-5
  33. Anjana RM, Pradeepa R, Deepa M, et al. Prevalence of diabetes and prediabetes in urban and rural India: phase I results of the ICMR-INDIAB study. Diabetologia. 2011;54(12):3022-3027. doi:10.1007/s00125-011-2291-5
  34. Deepa M, Grace M, Binukumar B, et al. High burden of prediabetes and diabetes in three large cities in South Asia: the CARRS Study. Diabetes Res Clin Pract. 2015;110(2):172-182. doi:10.1016/j.diabres.2015.09.005
  35. Anjana RM, Pradeepa R, Das AK, et al. Physical activity and inactivity patterns in India: results from the ICMR-INDIAB study. Int J Behav Nutr Phys Act. 2014;11:26. doi:10.1186/1479-5868-11-26
  36. Luhar S, Timæus IM, Jones R, et al. Forecasting the prevalence of overweight and obesity in India to 2040. PLoS One. 2020;15(2). doi:10.1371/journal.pone.0229438
  37. Ahirwar R, Mondal PR. Prevalence of obesity in India: a systematic review. Diabetes Metab Syndr. 2019;13(1):318-321. doi:10.1016/j.dsx.2018.08.032
  38. Kalra S, Kapoor N, Verma M, et al. Defining and diagnosing obesity in India: a call for advocacy and action. J Obes Metab Syndr. 2023;32(4):337-344. doi:10.7570/jomes23056
  39. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157-163. doi:10.1016/S0140-6736(03)15268-3
  40. Misra A, Chowbey P, Makkar BM, et al. Consensus statement for diagnosis of obesity, abdominal obesity and metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India. 2009;57:163-170.
  41. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries: the INTERHEART study. Lancet. 2004;364(9438):937-952. doi:10.1016/S0140-6736(04)17018-9
  42. Joshi P, Islam S, Pais P, et al. Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. JAMA. 2007;297(3):286-294. doi:10.1001/jama.297.3.286
  43. O’Donnell MJ, Chin SL, Rangarajan S, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries: INTERSTROKE. Lancet. 2016;388(10046):761-775. doi:10.1016/S0140-6736(16)30506-2
  44. Khatib R, McKee M, Shannon H, et al. Availability and affordability of cardiovascular disease medicines and their effect on use in high-income, middle-income, and low-income countries. Lancet. 2016;387(10013):61-69. doi:10.1016/S0140-6736(15)00469-9
  45. Gupta R, Mohan I, Narula J. Trends in coronary heart disease epidemiology in India. Ann Glob Health. 2016;82(2):307-315. doi:10.1016/j.aogh.2016.04.002
  46. Jha P, Jacob B, Gajalakshmi V, et al. A nationally representative case-control study of smoking and death in India. N Engl J Med. 2008;358(11):1137-1147. doi:10.1056/NEJMsa0707719
  47. Sinha DN, Suliankatchi RA, Gupta PC, et al. Global burden of all-cause and cause-specific mortality due to smokeless tobacco use: systematic review and meta-analysis. Tob Control. 2018;27(1):35-42. doi:10.1136/tobaccocontrol-2016-053302
  48. Giovino GA, Mirza SA, Samet JM, et al. Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys. Lancet. 2012;380(9842):668-679. doi:10.1016/S0140-6736(12)61085-X
  49. Tata Institute of Social Sciences, Ministry of Health and Family Welfare, Government of India. Global Adult Tobacco Survey GATS 2 India 2016-17. Tata Institute of Social Sciences; 2018.
  50. World Health Organization. WHO Report on the Global Tobacco Epidemic, 2023: Protect People From Tobacco Smoke. World Health Organization; 2023.
  51. World Health Organization. Noncommunicable Diseases Progress Monitor 2022. World Health Organization; 2022.
  52. World Health Organization. Global Report on Hypertension: The Race Against a Silent Killer. World Health Organization; 2023.
  53. Ministry of Health and Family Welfare, Government of India. Operational Guidelines: National Programme for Prevention and Control of Non-Communicable Diseases, 2023-2030. Ministry of Health and Family Welfare; 2023.
  54. Netterström-Wedin F, Dalal K. Treatment-seeking behaviour among 15-49-year-olds with self-reported heart disease, cancer, chronic respiratory disease, and diabetes: a national cross-sectional study in India. BMC Public Health. 2023;23(1):2197. doi:10.1186/s12889-023-17123-3
  55. Sasikumar M, Marconi SD, Dharmaraj A, Mehta K, Das M, Goel S. Prevalence of risk factors and estimation of 10-year risk for cardiovascular diseases among the male adult population of Tamil Nadu, India: an insight from NFHS-5. Indian Heart J. 2023;75(4):251-257. doi:10.1016/j.ihj.2023.06.003
  56. Singh S, Zaki RA, Chandra N, et al. Urban-rural differences in the prevalence of diabetes and associated risk factors in India: evidence from the National Family Health Survey-5. BMC Public Health. 2024;24:1373.
  57. Chakrabarty M, Dasgupta P, Ghosh S, et al. Spatial clustering of overweight and obesity among women in India: evidence from the National Family Health Survey-5, 2019-2021. BMC Public Health. 2024;24:2034.
  58. Virk A, Kumari A, Kaur M, et al. Tobacco use in currently married pregnant and lactating women in India: key findings from the National Family Health Survey-5. Lancet Reg Health Southeast Asia. 2024;21:100290. doi:10.1016/j.lansea.2023.100290
  59. Bhandari Y, Das A, Aditi A, Kishore J, Goel S. Tobacco and alcohol use among lactating women and its association with child nutrition in India: findings from National Family Health Survey 2019-2021. Public Health. 2024;236:153-160. doi:10.1016/j.puhe.2024.07.026

 

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Sharma A, Nair P, Mehta R, A Iyer (2026). Epidemiological Trends, Risk Factors, and Population Burden of Non-Communicable Diseases in India: A Nationwide Population-Based Analysis . Advanced Journal of Biomedicine & Medicine, 14(3), 269-293. https://doi.org/10.18081/ajbm.2026.3.269
Sharma A, Nair P, Mehta R, A Iyer. " Epidemiological Trends, Risk Factors, and Population Burden of Non-Communicable Diseases in India: A Nationwide Population-Based Analysis ." Advanced Journal of Biomedicine & Medicine, vol. 14, no. 3, 2026, pp. 269-293. DOI: 10.18081/ajbm.2026.3.269.
Sharma A, Nair P, Mehta R, A Iyer. Epidemiological Trends, Risk Factors, and Population Burden of Non-Communicable Diseases in India: A Nationwide Population-Based Analysis . AJBM. 2026;14(3):269-293. DOI: 10.18081/ajbm.2026.3.269. PMID: .
Sharma A, Nair P, Mehta R, A Iyer 2026, " Epidemiological Trends, Risk Factors, and Population Burden of Non-Communicable Diseases in India: A Nationwide Population-Based Analysis ", Advanced Journal of Biomedicine & Medicine, vol. 14, no. 3, pp. 269-293.
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Sharma A, Nair P, Mehta R, A Iyer (2026). Epidemiological Trends, Risk Factors, and Population Burden of Non-Communicable Diseases in India: A Nationwide Population-Based Analysis . Advanced Journal of Biomedicine & Medicine, 14(3), 269-293. https://doi.org/10.18081/ajbm.2026.3.269

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