Elsevier

Public Health

Volume 128, Issue 10, October 2014, Pages 886-895
Public Health

Review Paper
Urbanization and non-communicable disease in Southeast Asia: a review of current evidence

https://doi.org/10.1016/j.puhe.2014.08.003Get rights and content

Abstract

Objective

Non-communicable diseases (NCDs) have been highlighted as a major public health issue in the Southeast (SE) Asian region. One of the major socio-environmental factors that are considered to be associated with such a rise in NCDs is urbanization. Urbanization is associated with behavioural changes such as eating an unhealthy diet, and a decrease in physical activities, which may result in associated obesity. The SE Asian region also has a substantive burden of infectious disease such as HIV and malaria, which may modify associations between urbanization and development of NCDs.

Study design

A systematic review was conducted until April 2013.

Methods

Using four databases: EMBASE, PubMed, GlobalHealth and DigitalJournal, the systematic review pools existing evidence on urban-rural gradients in NCD prevalence/incidence.

Results

The study found that in SE Asia, urban exposure was positively associated with coronary heart disease, diabetes and respiratory diseases in children. Urban exposure was negatively associated with rheumatic heart diseases. The stages of economic development may also modify the association between urbanization and NCDs such as diabetes.

Conclusion

There was pronounced heterogeneity between associations. It is recommended that future studies examine the major constituents of NCDs separately and also focus on the interplay between lifestyle and infectious risk factors for NCDs. Prospective studies are needed to understand the diverse causal pathways between urbanization and NCDs in SE Asia.

Introduction

In 2011, The Lancet launched a series of articles on ‘Health in Southeast Asia’, one of which highlighted non-communicable diseases (NCDs) as a major public health issue in the region.1 Under the World Health Organization's framework, one of the major upstream socio-environmental factors considered to be associated with such a rise in NCDs is urbanization.2 Urbanization is associated with increased downstream behavioural risk factors such as unhealthy diets and decreases in physical activity which is thought to result in obesity. All of these risk factors are seen as shared causes for NCDs which are classified into four main groups: cardiovascular disease (mainly ischaemic heart disease and cerebrovascular disease), cancer, chronic respiratory disease and diabetes.

The associations between urbanization, risk factors for NCDs and development of NCDs are established in western countries, but evidence from low- and middle-income countries are often based on extrapolation from large population surveys.3, 4 Furthermore, many low- and middle-income countries face the double burden of infectious and non-infectious diseases.5 A subset of infectious agents are thought to be associated with the development of some NCDs such as cancer6 and rheumatic heart disease.7 The interplay between socio-environmental and behavioural risk factors, along with the potential modifying role of infectious risk factors, may result in variations in the association between urbanization and different NCDs which may differ from what is seen in more developed countries.8

The aim of this study is to provide a systematic review of studies exploring the relationship between urban exposure and the four major groups of NCDs in Southeast (SE) Asia. In particular, the review will investigate whether the associations are consistent across i) different countries, ii) different subtypes of diseases classified within the same group of NCDs and iii) across different groups of NCDs. Due to different underlying causes/mechanisms for developing NCDs along with possible interplay between infectious and non-infectious causes of NCDs, the authors hypothesized that the association between urban exposure and NCDs is likely to vary by country and across NCD subtypes.

Section snippets

Search strategies and procedures

Four databases were used for searches: EMBASE, PubMed, GlobalHealth and DigitalJournal until April 2013. DigitalJournal is a database which contains electronic health science journals from SE Asia.9 Separate searches for each of the four main groups of NCDs had been conducted. The search strategies using EMBASE can be found in Appendix 1. For DigitalJournal, only simple keyword searches were possible. The search terms for urban exposure only were used. An additional cited-reference search from

Results

Three hundred and six abstracts were screened and 14 articles were assessed for cardiovascular disease. Four hundred and fifty nine abstracts were screened and 24 articles were assessed for cancer. One hundred abstracts were screened and 15 articles were assessed for chronic respiratory disease. Three hundred and sixteen abstracts were screened and fifty articles were assessed for diabetes. The flow charts for the number of articles included in the review can be found in Appendix 2. After

Discussion

The review found evidence for associations between urbanization and NCDs in SE Asia. However, these associations were variable between countries and also between diseases classified within the same group of NCDs and across different groups of NCDs. Different pathways between urban exposure and types of NCDs should be considered to explain these variations.

Ethical approval

Ethical approval was not sought, as it was not required for conducting a systematic review.

Funding

CA is funded by the Faculty of Medicine Development Scholarship. (Faculty of Medicine, Chiang Mai University, Thailand).

Competing interests

None declared.

References (67)

  • J.C. Baltazar et al.

    Prevalence and correlates of diabetes mellitus and impaired glucose tolerance among adults in Luzon, Philippines

    Diabetes Res Clin Pract

    (2004)
  • H. King et al.

    Diabetes and associated disorders in Cambodia: two epidemiological surveys

    Lancet

    (2005)
  • S. Yusuf et al.

    Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study

    Lancet

    (2004 Sep 11–17)
  • D.J.P. Barker

    Developmental origins of chronic disease

    Public Health

    (2012)
  • D. Ogoina et al.

    The role of infections in the emergence of non-communicable diseases (NCDs): compelling needs for novel strategies in the developing world

    J Infect Public Health

    (2009)
  • R.J. Coker et al.

    Emerging infectious diseases in southeast Asia: regional challenges to control

    Lancet

    (2011)
  • de Martel et al.

    Global burden of cancers attributable to infections in 2008: a review and synthetic analysis

    Lancet Oncol

    (2012)
  • World Health Organization

    Global status report on noncommunicable disease

    (2010)
  • R.J. Biggar et al.

    AIDS-related cancer and severity of immunosuppression in persons with AIDS

    J Natl Cancer Inst

    (June 20, 2007)
  • M.J. Eisenberg

    Rheumatic heart disease in the developing world: prevalence, prevention, and control

    Eur Heart J

    (January 1, 1993)
  • D.A. Leon

    Cities, urbanization and health

    Int J Epidemiol

    (February 1, 2008)
  • Digital journals ASEAN digital health science journals. Available from: http://www.digitaljournals.org/content/about-us...
  • United Nations. United nations statistics division. Available from: http://unstats.un.org/unsd/snaama/dnllist.asp...
  • J.P.T. Higgins et al.

    Assessing risk of bias in included studies

  • A. Liberati et al.

    The PRISMA Statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration

    PLoS Med

    (2009)
  • M. Ishine et al.

    Comprehensive geriatric assessment for community-dwelling elderly in Asia compared with those in Japan: III. Phuto in Vietnam

    Geriatrics Gerontol Int

    (2005)
  • H. Myo Thet et al.

    Prevalence of cardiovascular diseases in rural area of Hmawbi and urban Yangon city

    Asia Pac J Public Health

    (1992)
  • T. Wada et al.

    Comprehensive geriatric assessment for community-dwelling elderly in Asia compared with those in Japan: VI. Maubin in Myanmar

    Geriatrics Gerontol Int

    (2005)
  • T.O. Lim et al.

    Descriptive analysis of total medical admissions and common medical disorders in 1987 Kuantan General Hospital, using computerized in-patients' discharge record

    Med J Malays

    (1991 Sep)
  • M. Ishine et al.

    Comprehensive geriatric assessment for community-dwelling elderly in Asia compared with those in Japan: VII. Khon Khen in Thailand

    Geriatrics Gerontol Int

    (2006)
  • T. Wada et al.

    Comprehensive geriatric assessment for community-dwelling elderly in Asia compared with those in Japan: V. West Java in Indonesia

    Geriatrics Gerontol Int

    (2005)
  • E.G. Bovill et al.

    An epidemiologic study of osteogenic sarcoma in Malaysia. Incidence in urban as compared with rural environments and in each of three separate racial groups, 1969–1972

    Clin Orthop Relat Res

    (1975)
  • S. Simarak et al.

    Cancer of the oral cavity, pharynx/larynx and lung in North Thailand: case-control study and analysis of cigar smoke

    Br J Cancer

    (1977)
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