Review PaperUrbanization and non-communicable disease in Southeast Asia: a review of current evidence
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.
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