Associated Factors for Non-Communicable Diseases: A Comprehensive Analysis of Mental, Behavioral, Biological, and Sociodemographic Determinants
DOI:
https://doi.org/10.56338/mppki.v9i9.11006Keywords:
Non-communicable Diseases, Risk Factors, Metabolic Syndrome, Mental HealthAbstract
Introduction: Non-communicable diseases (NCDs) are the leading cause of death and disability in Indonesia, placing a growing burden on the healthcare system and economy. This study examined the sociodemographic and health-related factors associated with NCDs among adults aged 35 years and older, using cross-sectional data from the national health survey.
Methods: This study was a secondary analysis of the 2018 Indonesian Basic Health Research, a national survey that employed systematic two-stage random sampling. The analysis included 177,919 adults aged 35 years and older. Complex-sample multivariable binary logistic regression was used to identify factors associated with NCDs. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were estimated after adjustment for potential confounders.
Results: Individuals aged ≥55 years had twice the odds of reporting NCDs compared with younger adults (aOR: 2.025; 95% CI: 1.888–2.172). Participants presenting four metabolic syndrome (MetS) components had more than fivefold higher odds of NCDs (95% CI: 4.822–7.153). Individuals with mental health conditions (MHCs) had 2.6-fold higher odds of NCDs than those without MHCs. Former smokers had more than twice the odds of NCDs compared with current smokers. Being male, employed, and in the highest spending group were independently associated with 1.3- to 1.5-fold higher odds of NCDs. In contrast, engaging in physical activity at or below the World Health Organization (WHO)-recommended level was associated with lower odds of NCDs.
Conclusion: Older age, MetS, MHCs, former smoking, male sex, employment, and higher socioeconomic status were independently associated with increased odds of NCDs, whereas physical activity was associated with lower odds. The strong association between MetS and NCDs highlights the importance of early metabolic risk screening and integrated interventions addressing metabolic health, mental health, smoking cessation, and physical activity to reduce the burden of NCDs.
Downloads
References
Arifin H, Chou KR, Ibrahim K, Fitri SUR, Pradipta RO, Rias YA, et al. Analysis of Modifiable, Non-Modifiable, and Physiological Risk Factors of Non-Communicable Diseases in Indonesia: Evidence from the 2018 Indonesian Basic Health Research. J Multidiscip Healthc. 2022; 15:2203–21. https://doi.org/10.2147/JMDH.S382191
Kurniawan F, Sigit FS, Trompet S, Yunir E, Tarigan TJE, Harbuwono DS, et al. Lifestyle and clinical risk factors in relation with the prevalence of diabetes in the Indonesian urban and rural populations: The 2018 Indonesian Basic Health Survey. Prev Med Rep. 2024 Feb 1; 38:102629. https://doi.org/10.1016/J.PMEDR.2024.102629
Sasongko MB, Wardhana FS, Febryanto GA, Agni AN, Supanji S, Indrayanti SR, et al. The estimated healthcare cost of diabetic retinopathy in Indonesia and its projection for 2025. British Journal of Ophthalmology. 2020 Apr 1;104(4):487–92. https://doi.org/10.1136/BJOPHTHALMOL-2019-313997
García-Morales C, Heredia-Pi I, Guerrero-López CM, Orozco E, Ojeda-Arroyo E, Nigenda G, et al. Social and economic impacts of non-communicable diseases by gender and its correlates: a literature review. Int J Equity Health. 2024 Dec 31;23(1):274. https://doi.org/10.1186/s12939-024-02348-4
Mboi N, Murty Surbakti I, Trihandini I, Elyazar I, Houston Smith K, Bahjuri Ali P, et al. On the road to universal health care in Indonesia, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 2018; 392:581–91. https://doi.org/10.1016/S0140-6736(18)30595-6
Oktaria V, Mahendradhata Y. The health status of Indonesia’s provinces: the double burden of diseases and inequality gap. Lancet Glob Health. 2022 Nov 1;10(11): e1547–8. https://doi.org/10.1016/S2214-109X(22)00405-3
Rosmiati R, Reswari Haryana N, Firmansyah H, Edwin Fransiari M. Non-Communicable Disease is Associated with Productivity Loss of Indonesian Urban Workers. In: Proceedings of the 6th International Conference on Innovation in Education, Science, and Culture, ICIESC 2024, 17 September 2024, Medan, Indonesia [Internet]. Medan: European Alliance for Innovation; 2024 [cited 2025 Sep 6]. Available from: https://eudl.eu/doi/10.4108/eai.17-9-2024.2353068 https://doi.org/10.4108/EAI.17-9-2024.2353068
Rusyda AL. Exploring the Non-Communicable Disease Burden in Indonesia – Findings from the 2023 Health Survey. Indonesian Journal of Public Health Nutrition (IJPHN). 2025 Apr 30;5(2):146–59. https://doi.org/10.7454/ijphn.v5i2.1064
Marmot M, Bell R. Social determinants and non-communicable diseases: time for integrated action. The BMJ. 2019 Jan 28;364: l251. https://doi.org/10.1136/BMJ.L251
dos Santos Pereira DB, Conde WL. Overweight and obesity in adulthood, sociodemographic factors, lifestyle, and the early burden of noncommunicable diseases among Americans: NHANES 2007–2018. American Journal of Human Biology. 2023 Aug 1;35(8): e23905. https://doi.org/10.1002/ajhb.23905
National Institute of Health Research and Development. The 2018 Basic Health Research Report. Lembaga Penerbit Balitbangkes [Internet]. Lembaga Penerbit Badan Penelitian dan Pengembangan Kesehatan; 2018 [cited 2025 Jul 29]. 1–156 p. Available from: https://repository.badankebijakan.kemkes.go.id/id/eprint/3514/
Zhu L, Spence C, Yang WJ, Ma GX. The IDF Definition Is Better Suited for Screening Metabolic Syndrome and Estimating Risks of Diabetes in Asian American Adults: Evidence from NHANES 2011–2016. J Clin Med. 2020 Dec 1;9(12):3871. https://doi.org/10.3390/JCM9123871
Haam JH, Kim BT, Kim EM, Kwon H, Kang JH, Park JH, et al. Diagnosis of Obesity: 2022 Update of Clinical Practice Guidelines for Obesity by the Korean Society for the Study of Obesity. J Obes Metab Syndr. 2023 Jun 30;32(2):121–9. https://doi.org/10.7570/JOMES23031
Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension. 2020 Jun 1;75(6):1334–57. https://doi.org/10.1161/HYPERTENSIONAHA.120.15026
Prasetio CE, Triwahyuni A, Prathama AG. Psychometric Properties of Self-Report Questionnaire-20 (SRQ-20) Indonesian Version. Jurnal Psikologi. 2022 Apr 25;49(1):69–86. https://doi.org/10.22146/JPSI.69782
Idaiani S. Validity and Reliability of Depression, Anxiety, and Psychosis Questionnaire of Mini International Neuropsychiatric Interview (MINI) in Indonesia. ASEAN Journal of Psychiatry [Internet]. 2020 Dec 28 [cited 2026 Aug 27];21(1):1–1. Available from: https://www.aseanjournalofpsychiatry.org/abstract/validity-and-reliability-of-depression-anxiety-and-psychosis-questionnaire-of-mini-international-neuropsychiatric-interv-53675.html
World Health Organization. WHO guidelines on physical activity and sedentary behaviour [Internet]. Geneva; 2020 [cited 2025 Jul 29]. 1–120 p. Available from: https://www.who.int/publications/i/item/9789240015128
Kusumah CK. 12-Years Compulsory Education Policy and Education Participation Completeness: Evidence from Indonesia. The Journal of Indonesia Sustainable Development Planning. 2021 Aug 13;2(2):187–201. doi:10.46456/JISDEP.V2I2.138
Sulistyaningrum E, Tjahjadi AM. Income Inequality in Indonesia: Which Aspects Cause the Most? Journal of Indonesian Economy and Business. 2022 Sep 27;37(3):229–53. https://doi.org/10.22146/JIEB.V37I3.2015
Ragino YI, Stakhneva EM, Polonskaya Y V., Kashtanova E V. The Role of Secretory Activity Molecules of Visceral Adipocytes in Abdominal Obesity in the Development of Cardiovascular Disease: A Review. Biomolecules. 2020 Mar 1;10(3):374. doi:10.3390/BIOM10030374
Masoudkabir F, Mohammadifard N, Mani A, Ignaszewski A, Davis MK, Vaseghi G, et al. Shared Lifestyle-Related Risk Factors of Cardiovascular Disease and Cancer: Evidence for Joint Prevention. The Scientific World Journal. 2023; 2023:2404806. https://doi.org/10.1155/2023/2404806
Agorastos A, Chrousos GP. The neuroendocrinology of stress: the stress-related continuum of chronic disease development. Mol Psychiatry. 2022 Jan;27(1):502–13. https://doi.org/10.1038/s41380-021-01224-9
Chan KL, Cathomas F, Russo SJ. Central and Peripheral Inflammation Link Metabolic Syndrome and Major Depressive Disorder. Physiology (Bethesda). 2019 Mar 1;34(2):123–33. https://doi.org/10.1152/PHYSIOL.00047.2018
Thuy Duyen N, Van Minh H, Van Huy N, Bao Giang K, Thu Ngan T, Xuan Long N, et al. Patterns of behavioral risk factors for non-communicable diseases in Vietnam: A narrative scoping review. Health Psychol Open. 2020;7(2):2055102920967248. https://doi.org/10.1177/2055102920967248
Jang H, Kim R, Lee JT, Lee DH, Giovannucci EL, Oh H. Overall and abdominal obesity and risks of all-cause and cause-specific mortality in Korean adults: a pooled analysis of three population-based prospective cohorts. Int J Epidemiol. 2023 Aug 2;52(4):1060–73. https://doi.org/10.1093/IJE/DYAC242
Li M, Zhu P, Wang SX. Risk for Cardiovascular Death Associated with Waist Circumference and Diabetes: A 9-Year Prospective Study in the Wan Shou Lu Cohort. Front Cardiovasc Med. 2022 Apr 26; 9:856517. https://doi.org/10.3389/FCVM.2022.856517
Vasan RS, Pan S, Larson MG, Mitchell GF, Xanthakis V. Arteriosclerosis, Atherosclerosis, and Cardiovascular Health: Joint Relations to the Incidence of Cardiovascular Disease. Hypertension. 2021 Nov 1;78(5):1232–40. https://doi.org/10.1161/HYPERTENSIONAHA.121.18075
Powell-Wiley TM, Poirier P, Burke LE, Després JP, Gordon-Larsen P, Lavie CJ, et al. Obesity and Cardiovascular Disease a Scientific Statement from the American Heart Association. Circulation. 2021 May 25;143(21): E984–1010. https://doi.org/10.1161/CIR.0000000000000973
Massy ZA, Drueke TB. Combination of Cardiovascular, Kidney, and Metabolic Diseases in a Syndrome Named Cardiovascular-Kidney-Metabolic, With New Risk Prediction Equations. Kidney Int Rep. 2024 Sep 1;9(9):2608–18. https://doi.org/10.1016/j.ekir.2024.05.033
Moghadam-Ahmadi A, Soltani N, Ayoobi F, Jamali Z, Sadeghi T, Jalali N, et al. Association between metabolic syndrome and stroke: a population based cohort study. BMC Endocr Disord. 2023 Jun 6;23(1):131. https://doi.org/10.1186/S12902-023-01383-6
Liu Q, Wu S, Shao J, Liu Y, Lu Y, Wu H, et al. Metabolic syndrome parameters’ variability and stroke incidence in hypertensive patients: evidence from a functional community cohort. Cardiovasc Diabetol. 2024 Jun 15;23(1):203. https://doi.org/10.1186/s12933-024-02282-3
Karra P, Winn M, Pauleck S, Bulsiewicz-Jacobsen A, Peterson L, Coletta A, et al. Metabolic dysfunction and obesity-related cancer: beyond obesity and metabolic syndrome. Obesity (Silver Spring). 2022 Jul;30(7):1323–34. https://doi.org/10.1002/OBY.23444
Fentie D, Derese T, Yazie B, Getachew Y. Metabolic syndrome and associated factors among severely ill psychiatric and non-psychiatric patients: a comparative cross-sectional study in Eastern Ethiopia. Diabetol Metab Syndr. 2021 Nov 10;13(1):130. https://doi.org/10.1186/s13098-021-00750-4
Gao X, Qin Y, Jiao S, Hao J, Zhao J, Wang J, et al. Genetic evidence for the causal relations between metabolic syndrome and psychiatric disorders: a Mendelian randomization study. Transl Psychiatry. 2024 Jan 20;14(1):46. https://doi.org/10.1038/s41398-024-02759-5
Sharma SK, Vishwakarma D, Puri P. Gender disparities in the burden of non-communicable diseases in India: Evidence from the cross-sectional study. Clin Epidemiol Glob Health. 2020 Jun 1;8(2):544–9. https://doi.org/10.1016/J.CEGH.2019.11.011
Ding J, Fu R, Yuan T, Brenner H, Hoffmeister M. Lifestyle scores and their potential to estimate the risk of multiple non-communicable disease-related endpoints: a systematic review. BMC Public Health. 2025 Jan 23;25(1):293. https://doi.org/10.1186/s12889-025-21537-6
Eze II, Mbachu CO, Azuogu BN, Ossai E, Unah AI, Akamike IC, et al. Effect of on-site behavioural modification intervention on lifestyle risk factors of hypertension among adult market traders in Abakaliki, Nigeria. Int J Health Promot Educ. 2021 Jan 2;59(1):35–49. https://doi.org/10.1080/14635240.2020.1713188
Khetan A, Zullo M, Rani A, Gupta R, Purushothaman R, Bajaj NS, et al. Effect of a Community Health Worker-Based Approach to Integrated Cardiovascular Risk Factor Control in India: A Cluster Randomized Controlled Trial. Glob Heart. 2019 Dec 1;14(4):355–65. https://doi.org/10.1016/j.gheart.2019.08.003
Darukaradhya TB, Krishnamurthy J. Modifying Non-communicable Disease Behaviours through Effective Health Communication and Behaviour Change: A Systematic Review. Preventive Medicine: Research & Reviews. 2025 Jan;2(1):24–39. https://doi.org/10.4103/PMRR.PMRR_45_24