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Year : 2014 | Volume : 2 | Issue : 1 | Page : 15 - 18  


Original Articles
Self reported prevalence and practices impacting the outcome of non communicable diseases among corporate professional employees in India

Dr. Rohin Rameswarapu1, Dr. RL Lakshman 2, Dr. Sameer Valsangkar3

1Assistant Professor Department of Community Medicine Malla Reddy Institute of Medical Sciences, Hyderabad. 2Associate professor, 3Senior resident, Department of Community Medicine, Gandhi Medical College, Hyderabad.

Abstract:

Background: Non communicable diseases account for 63% of the deaths worldwide and 53% of the deaths in India. Occupation in itself is a risk factor for these diseases in addition to being a modifier of the lifestyle, diet practices and physical activity practices.

Objectives: To evaluate socio-demographic factors, self reported prevalence of non communicable disease among corporate professional employees and to assess lifestyle practices and occupational risk factors risk factors modifying the risk of non communicable diseases

Materials and methods: A cross sectional study was conducted among corporate professional employees across 20 states in India. Responses were obtained after informed consent through a self administered web based questionnaire with answers entered in a backend database. A semi structured questionnaire was administered with the following parts 1) Socio-demographic information 2) Self reported prevalence of non communicable diseases 3) Lifestyle and diet practices 4) Work related factors.

Results: A total of 1582 employees consented and participated in the study. The workforce consisted of 1378 (87.1%) males and 204 (12.9%) females. The mean age was 32.88 ± 7.78 years. The commonest non communicable disease was diabetes with 350 (22.2%) reporting it followed by hypertension with 334 (21.1%) reporting it. Practices relating to exercise were moderately satisfactory, snacking was quite prevalent. Among the workers, 23.1% felt pressured, 19.8% faced difficulties in staying calm and 19% felt overburdened due to work.

Conclusions: The study evidenced that corporate employees are exposed to behavioral, life style and dietary risk factors for non communicable diseases at a young age group and that emergent measures are required for rational and cost effective prevention of non communicable diseases to reduce the burden of disease and work days lost among this productive population.

Keywords: Non communicable diseases, corporate employees, lifestyle risk factors

Corresponding Author: Dr. Rohin Rameswarapu, Department of Community Medicine, Malla Reddy Institute of Medical Sciences, Hyderabad Email: dr.rohin.r@gmail.com

Introduction:

The spectrum of disease has morphed with the tremendous changes in lifestyle, diet practices and physical activity and non communicable chronic diseases have emerged to the forefront in pockets of India. These diseases, ranging from cardiovascular, hypertensive, diabetic and cerebro-vascular disorders have numerous causal risk factors which interact among themselves leading to occurrence of disease. [1]

Non communicable diseases account for 63% of the deaths worldwide and 53% of the deaths in India. Among these, cardiovascular diseases (24%), chronic respiratory diseases (11%), cancer (6%) and diabetes (2%) are the leading cause of mortality in India. The economic burden of these diseases is also staggering and most of the expenses are met with out of the pocket expenditure. The burden of non communicable diseases and resultant mortality is expected to increase unless massive efforts are made to prevent and control these diseases and their risk factors. [2]

Paradoxically, while the burden of these non communicable diseases is higher among low socio-economic status classes in developed countries, the burden in developing countries is higher in the high socio-economic status class. This may be explained partially by the greater degree of exposure to detrimental risk factors of life style, habits, occupation and diet among low socio-economic classes in developed countries and high socio-economic classes in developing countries. [3]

A common subset of factors interacts and influences the outcome of these non communicable diseases, which makes these diseases highly amenable to prevention through primordial and primary prevention approaches. The factors that combine and interact in the occurrence of disease include sex, age, systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, smoking behavior, alcohol consumption, salt consumption and stress. [4] An assessment of these risk factors can help plan out prevention and treatment approached thereby ameliorating the burden and prevalence of non communicable diseases.

Occupation in itself is a risk factor for these non communicable diseases in addition to being a modifier of the lifestyle, diet practices and physical activity practices. [1] Occupation also adds to the causation of these diseases through the burden of stress and psycho-social distress. [5] Sedentary occupations have shown a raised association for cardiovascular morbidity and mortality and this risk remains elevated even after controlling for factors such as age, waist circumference, self-reported general health, frequency of alcohol intake, cigarette smoking, non-occupational physical activity. [6]

The current exploratory analysis was undertaken to evaluate socio-demographic factors, self reported prevalence of non communicable disease, practices modifying the risk of non communicable diseases and occupational risk factors among corporate professional employees in twenty states across India.

Methodology:

A cross sectional study was conducted among corporate professional employees across 20 states in India working in a cellular company. Employees of the company were approached with due permission and the purpose of the study was explained to them. Confidentiality was assured and it was explained that no personally identifying information regarding the employees would be released to ensure privacy. Responses were then obtained after informed consent through a self administered web based questionnaire with answers entered in a backend database.

A semi structured questionnaire was administered consisting of the following parts, namely 1) Socio-demographic information 2) Self reported prevalence of non communicable diseases 3) Lifestyle and diet practices relating to occurrence of non communicable diseases 4) Work related factors influencing the occurrence of non communicable diseases.

Variables obtained in socio-demographic information included age, sex, smoking habits, consumption of alcohol and maternal or paternal history of diseases such as cardiovascular disease, hypertension, stroke and diabetes. A regular smoker was defined as one who had smoked once a day, each day in the past week. A frequency of less than that was defined as an occasional smoker and a non smoker was defined as a person who had smoked less than 100 cigarettes in a lifetime. A consumer of alcohol was defined as one who consumed alcohol at least once a week in the past month whereas an occasional consumer was defined as a frequency less than this and people consuming alcohol only at social occasions.

Information obtained regarding clinical history of suffering from a non communicable disease such as cardiovascular disease, hypertension, stroke, diabetes and hypercholesterolemia. A verbal diagnosis from a registered medical practitioner conveyed to the participant was deemed adequate for the purposes of the study.

Information regarding practices affecting occurrence of non communicable diseases such as physical exercise, consumption of dietary fiber, high fat and sugar intake, salt consumption and snacking between meals. Adequate physical exercise was defined as moderate physical activity for at least thirty minutes most days of the week and responses were graded as yes, no or activity during some weeks. Appropriate cultural examples of foods rich in dietary factors such as fiber, fat, and sugar and salt were provided when obtaining responses regarding these. Dietary fiber was considered appropriate when consumed at least thrice a week, sugar, fat and salt consumption were considered excess when consumed more than two times in a week. In addition, responses were obtained if extra salt was added to prepared food items. Respondents were also asked if they consumed snacks between meals.

Occupational factors affecting the outcome of non communicable diseases were obtained. These included variables such as whether the respondent worked at a job which required predominantly sedentary activity, impact of work activity on life, difficulties in staying calm at work and work related pressures.

Statistical analysis was conducted using Statistical Products and Service Solutions (SPSS) version 20. Categorical data was appropriately coded and entered and numerical data was entered as such. Statistical measures obtained included descriptives including means, standard deviation, proportions and percentages.

Results:

A total of 1582 employees consented and participated in the study across 20 states.

The workforce consisted of 1378 (87.1%) males and 204 (12.9%) females. Most of the respondents belonged to a younger age group with 1037 (65.5%) of the people belonging to an age group between 26 to 35 years. Among the workers, 133 (8.4%) were aged below 25 years and the remaining 412 (26.1%) were aged above 36 years. In regards to smoking, 1226 (77.5%) were non smokers, 101 (6.4%) were occasional smokers and 255 (16.1%) were smokers. In regard to consumption of alcohol, 948 (59.9%) were non consumers, 406 (25.7%) were occasional consumers and 228 (14.4%) were consumers. Maternal and paternal history of non communicable diseases was obtained and 743 (47%) reported that at least one parent suffered from a non communicable disease. This data is reflected in table 1.

The commonest non communicable disease among the respondents was diabetes with 350 (22.2%) of the respondents suffering from it followed by hypertension with 334 (21.1%) suffering from it. Cardiovascular disease was prevalent in 62 (3.6%) of the sample, elevated levels of cholesterol in 49 (3.1%) and previous sufferers of stroke amounted to 14 (0.9%). This data is reflected in table 2.

Practices affecting outcome of non communicable diseases are presented in table 3. There were 517 (32.7%) people who exercised regularly, 504 (31.9%) who exercised occasionally and 501 (35.5%) who did not exercise. Fiber intake was inadequate in 542 (34.3%) of the respondents. High fat food intake was reported by 1056 (66.8%) of the people, consumption of sugary food by 738 (46.6%) and excessive salt consumption by 586 (37%). Among the respondents, 714 (45.1%) indulged in snacking between meals.

Occupational factors related to occurrence of non communicable diseases are presented in table 4. Most of the workers had a sedentary job with 1107 (70%) of the workers responding with a yes to the question. Among the remaining, 360 (22.8%) of the workers reported that their work was somewhat sedentary and 115 (7.3%) responded that their work was not sedentary. Three hundred (19%) of the workers reported that they felt overburdened and that their work created an imbalance in their life, 314 (19.8%) found it difficult to stay calm at their work and 365 (23.1%) felt pressured for time at work.

Discussion:

The current cross sectional study was conducted among 1582 corporate professional employees across 20 states in India through a self administered web based questionnaire regarding socio-demographic information, self reported prevalence of non communicable diseases, lifestyle, dietary and occupational factors pertaining to them.

The sample consisted of a relatively young age group, most belonging to the age group of 26 – 35 years. The Global Disease Burden study 2010 has viewed a shifting pattern of disease with increase life expectancy but associated with people suffering from disability due to non communicable diseases for a longer period starting at younger ages. [7] The study also observed the increased prevalence of non communicable diseases vis-a-vis infectious diseases. With a long latent period between exposure and the onset of observable pathological or clinical changes in non communicable, chronic diseases, it is paramount to address preventive primordial and primary preventive approaches at a younger age group before the onset of the microscopic changes in vasculature. The study sample also had a number of subjects exposed to risk factors such as alcohol among 14.4% subjects and smoking among 16.1%. In addition, some subjects were also exposed to occasional smoking and consumption of alcohol which are also risk factors for occurrence of non communicable diseases. [8, 9] Hence preventive measures need to be attuned towards these age groups. As in most occupational studies conducted in India, there was a large disparity in the sex ratio with 12.9% of the respondents being females which is reflective of the socio-cultural milieu in India. [10]

The self reported prevalence was highest for diabetes at 22.1%, followed by hypertension at 21.1%, cardiovascular disease at 3.9%, elevated cholesterol at 3.1% and the least for stroke at 0.9%. This is similar to large Indian cohort studies wherein the self reported prevalence of cardiovascular disease was 3.1%. [11] The prevalence of hypertension was much higher (21.1%) when compared to the study by Basu et al who reported a prevalence of 9.4%. However, in studies conducted in industrial settings, a similar level of prevalence was obtained (30%) as evidenced in the current study. [12] Diabetes prevalence was 15% and elevated cholesterol in 9.8% among industrial workers in a study by Prabhakaran et al. [12] These variation may be explained by regional and occupational differences.

Practices relating to exercise and physical activity were moderately satisfactory with 32.7% indulging in regular exercise and 31.9% in occasional exercise totaling to 64.6%. Fiber intake was also adequate at 65.7% but consumption of high fat, sugary food and excess of salt were unsatisfactory at 66.8%, 46.6% and 37% respectively. Snacking was also quite prevalent at 45.1%. A mixed urban-rural population study obtained the prevalence of risk factors and they observed that 77.7% indulged in some sort of physical activity which is concordant with our study. [13] However, dietary risk factors were present in only 13.3% of the respondents in their study which was much lower than the current study. Similarly, stress was a risk factor for 23.1% of their respondents [13] which is comparable to our study wherein 23.1% felt pressured, 19.8% faced difficulties in staying calm and 19% felt overburdened due to work.

Conclusions:

The study evidenced that corporate employees are exposed to behavioral, life style and dietary risk factor for non communicable diseases at a young age group and that emergent measures are required for rational and cost effective prevention of non communicable diseases to reduce the burden of disease and work days lost among this productive population.

Limitations:

The current study was a cross sectional study and inherently has the same limitations as that of its study design. Self reported prevalence was obtained based solely on verbal response for economic reasons and may hence be subject to bias.

References:

  1. Mathur P. Risk factors for non-communicable diseases: Getting beyond data. J Postgrad Med 2006;52:171-2
  2. Sharma K. Burden of non communicable diseases in India: Setting priority for action. Int J Med Sci Public Health. 2013; 2(1): 7-11.
  3. Pereira MAKriska AMCollins VRDowse GKTuomilehto JAlberti KG et al. Occupational status and cardiovascular disease risk factors in the rapidly developing, high-risk population of Mauritius. Am J Epidemiol 1998;148(2):148–59.
  4. D'Agostino RB Sr, Pencina MJ, Massaro JM, Coady S. Cardiovascular Disease Risk Assessment: Insights from Framingham. Glob Heart. 2013 Mar;8(1):11-23.
  5. Glozier N, Tofler GH, Colquhoun DM, Bunker SJ, Clarke DM, Hare DL et al. Psychosocial risk factors for coronary heart disease. Med J Aust. 2013 Aug 5;199(3):179-80.
  6. Stamatakis E1, Chau JY, Pedisic Z, Bauman A, Macniven R, Coombs N et al. Are sitting occupations associated with increased all-cause, cancer, and cardiovascular disease mortality risk? A pooled analysis of seven British population cohorts. PLoS One. 2013 Sep 26;8(9):e73753.
  7. Horton R: Global Burden of Disease study 2010: Understanding disease, injury, and risk. Lancet 2012, 380(9859):2053-2260.
  8. Schane RE, Ling PM, Glantz SA. Health effects of light and intermittent smoking: a review. Circulation. 2010;121:1518–1522.
  9. Kotz D, Fidler J, West R. Very low rate and light smokers: Smoking patterns and cessation-related behavior in England, 2006–11. Addiction. 2012 May;107(5):995-1002.
  10. Valsangkar S, Sai, KS. Impact of Musculoskeletal Disorders and Social Determinants on Health in Construction Workers. International Journal of Biological & Medical Research, 3(2), 1727-30.
  11. Vellakkal S, Subramania SV, Millett C, Basu S, Stuckler D, Ebrahim S. Socioeconomic inequalities in non-communicable diseases prevalence in India: disparities between self-reported diagnoses and standardized measures. PLoS One. 2013 Jul 15;8(7):e68219.
  12.  Prabhakaran D, Shah P, Chaturvedi V, Ramakrishnan L, Manhapra A, Reddy KS. Cardiovascular risk factor prevalence among men in a large industry of northern India. Natl Med J India. 2005;18:59–65.
  13. Sugathan TN, Soman CR, Sankaranarayanan K. Behavioural risk factors for non communicable diseases among adults in Kerala, India. Indian J Med Res 2008;127:555-63.

Table 1

Socio-demographic characteristics

Count

%

Age

<= 25 years

133

8.4%

26 – 35 years

1037

65.5%

36 – 45 years

348

22.0%

46 – 55 years

56

3.5%

> 55 years

8

0.6%

Gender

Female

204

12.9%

Male

1378

87.1%

Do you smoke?

No

1226

77.5%

Occasionally

101

6.4%

Yes

255

16.1%

Do you consume alcohol?

No

948

59.9%

Occasionally

406

25.7%

Yes

228

14.4%

Paternal/maternal history of non communicable diseases

Don't know

43

2.7%

No

796

50.3%

Yes

743

47.0%

Total

1582

100%

 

Table 2

History of non communicable diseases

Count

%

Coronary Artery Disease

No

1520

96.1%

Yes

62

3.9%

High Blood Pressure

No

1248

78.9%

Yes

334

21.1%

Brain Stroke

No

1568

99.1%

Yes

14

0.9%

Diabetes

No

1232

77.9%

Yes

350

22.1%

High Cholesterol

No

1533

96.9%

Yes

49

3.1%

Total

1582

100%

 

Table 3

Practices related to non communicable diseases

Count

%

Do you exercise for 30 minutes most days in a week?

No

561

35.5%

Irregularly

504

31.9%

Yes

517

32.7%

Do you consume fiber rich foods at least thrice a week?

No

542

34.3%

Yes

1040

65.7%

Do you consume high fat food more than twice a week?

No

526

33.2%

Yes

1056

66.8%

Do you consume foods rich in sugar more than twice a week?

No

844

53.4%

Yes

738

46.6%

Do you regularly consume salty foods or add extra salt to your food?

No

996

63.0%

Yes

586

37.0%

Do you usually snack between meals?

No

868

54.9%

Yes

714

45.1%

Total

1582

100%

 

Table 4

Occupational factors related to non communicable diseases

Count

%

Is your job sedentary and requires you to remain seated for long durations at a time?

No

115

7.3%

Some what

360

22.8%

Yes

1107

70.0%

Does your work over burden you and create a work life imbalance?

No

1282

81.0%

Yes

300

19.0%

Do you have difficulty staying calm at work?

No

1268

80.2%

Yes

314

19.8%

Are you frequently pressured for time during your work?

No

1217

76.9%

Yes

365

23.1%

Total

1582

100%

Source of Support: Nil. Conflict of Interest: None.





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