Multilevel analysis of noncommunicable diseases and associated factors among Ethiopian adults: evidence from the 2024 STEPS survey.

BACKGROUND: Noncommunicable diseases (NCDs) such as cardiovascular disease, hypertension, and diabetes are a major and growing global health burden, particularly in low- and middle-income countries including Ethiopia. However, evidence on their distribution and associated individual- and community-level factors remains limited. Therefore, this study aimed to address this gap and generate evidence to inform prevention strategies and public health policy.

METHODS: Nationally representative cross-sectional study was conducted. Data were collected using the standardized WHO STEPwise approach. A multistage, stratified cluster sampling method was employed. In the first stage, 728 enumeration areas (EAs) were selected as primary sampling units. In the second stage, a new listing of households was collected from each EA. From these updated lists, 15 households were randomly selected, and one individual aged 18-69 years was subsequently selected at random from each household. Among the 34,594,270 weighted households included in the study, 29,546,369 completed interviews and were included in the analysis. Multilevel logistic regression analysis was employed to identify factors associated with noncommunicable diseases. A series of four models were fitted, and the model with the lowest Bayesian Information Criterion (BIC), and Akaike's Information Criterion (AIC) values was selected as the best-fitting model for interpretation.

RESULTS: In this study, the prevalence of self-reported history of cardiovascular disease, hypertension, and diabetes was 5.4%, 17.3%, and 4.2%, respectively. Age ≥44 (adjusted OR (AOR) 1.6; 95% CI 1.13-2.22)), Female (AOR 1.7; 95% CI 1.17-2.38)), obese (AOR 2.6; 95% CI 1.34-4.98)), normal weight (AOR 0.6; 95% CI 0.42-0.91), and high altitude (AOR 2.3; 95% CI 1.02-5.16), were significantly associated with self-reported history of cardiovascular disease. Besides, aged 30-44 (AOR 1.9; 95% CI 1.57-2.31), age 45-59 (AOR 3.9; 95% CI 3.09-4.84), age ≥60 (AOR 7.2; 95% CI: 5.54-9.41), divorced/widowed (AOR 1.6; 95% CI: 1.21-2.20), informal employment (AOR 0.8; 95% CI 0.62-0.96), normal BMI (AOR 1.7; 95% CI 1.37-2.07), overweight (AOR 3.1; 95% CI 2.39-4.04), obesity (AOR 5.2; 95% CI 3.61-7.39), urban residence (AOR 1.5; 95% CI 1.17-1.82), moderate altitude (AOR 1.4; 95% CI 1.08-1.70), and high altitudes (AOR 1.4; 95% CI 1.01-2.01) were significantly associated with hypertension. Aged 30-44 (AOR 2.1; 95% CI 1.40-3.11), age 45-59(AOR 3.6; 95% CI 2.35-5.63), age ≥ 60(AOR 5.1; 95% CI 3.11-8.40), overweight (AOR 1.7; 95% CI 1.08-2.60), obese (AOR 3.1; 95% CI 1.78-5.45), urban residence (AOR 1.5; 95% CI 1.02-2.10), and those live in high altitude (AOR 0.5; 95% CI 0.28-0.96) were significantly associated with diabetes.

CONCLUSION: The findings indicate a substantial burden of noncommunicable diseases in Ethiopia, particularly hypertension, followed by self-reported history of cardiovascular disease and diabetes. The study identified many core individual- and community-level factors influence noncommunicable diseases. Therefore, targeted interventions focusing on factors such as age, sex, obesity, and place of residence may contribute to reducing the burden of noncommunicable diseases. Strengthening national noncommunicable diseases prevention and control programs, including routine screening for cardiovascular disease, hypertension, and diabetes across all levels of the health system, may improve early detection and management.