Trends and Determinants of Common Non-Communicable Diseases

Non-communicable diseases (NCDs) are responsible for approximately 74% of all global deaths, contributing close to 41 million deaths annually (Goel et al., 2025). Disability-adjusted life-years (DALYs) attributed to NCDs worldwide have surged from 1.47 billion in 2010 to 1.73 billion by 2021 (Goel et al., 2025). These figures underscore the accelerating global burden of NCDs including cardiovascular diseases, diabetes, cancers, and chronic respiratory illnesses and mark a critical turning point in global public health, demanding robust research and translational action. Over recent decades, the global health has shifted substantially from infectious to chronic diseases. Between 1975 and 2016, the prevalence of obesity rose markedly from under 1% to 10.8% in men and 14.9% in women (Di Cesare, 2019). Simultaneously, diabetes prevalence nearly doubled from 4.3% to 9.0% among men, and from 5.0% to 7.9% among women (Di Cesare, 2019). Raised blood pressure afflicts over 1.13 billion adults globally, disproportionately impacting populations in low- and middle-income countries (LMICs) (Di Cesare, 2019). This epidemiologic transition is largely attributed to demographic changes such as population ageing and growth, alongside evolving lifestyle behaviors namely unhealthy diets, physical inactivity, tobacco use, and harmful alcohol consumption (Goel et al., 2025; Di Cesare, 2019). The burgeoning burden of NCDs has also emerged as a significant threat to economic productivity, especially within LMICs where chronic diseases contribute to diminished labour force participation and long-term health expenditures (Doh et al., 2024). A systematic review of socioeconomic status (SES) gradients in low-income settings revealed that lower SES groups tend to suffer higher burdens of cardiovascular disease and cancer, whereas the prevalence of diabetes is often higher in more affluent populations (Williams et al., 2018). These global patterns provide critical context for interpreting the determinants of NCDs and indicate that socioeconomic disparities remain central to disease distribution and mortality. Sub-Saharan Africa (SSA) is experiencing a rapid epidemiologic shift. Though infectious diseases once predominated, chronic diseases now account for an increasing share of morbidity and mortality. Many regions in SSA report rising rates of hypertension, diabetes, and obesity, frequently coexisting with persistent infectious disease burdens. Healthcare systems, historically designed to combat communicable diseases, are often ill-equipped to manage the chronic care demands posed by NCDs. Existing studies in SSA underscore significant service delivery gaps limited diagnostic capacity, scarce workforce, inadequate awareness, and insufficient financing all of which undermine prevention and management efforts. The economic toll of NCDs in these settings are substantial: chronic illness leads to lower workforce productivity, increased out-of-pocket spending, and potential socio-political instability (Doh et al., 2024). Moreover, health systems struggle to integrate NCD care into primary healthcare platforms, limiting access even in urban centres. In Nigeria, NCDs now contribute nearly 30% of total deaths, and the national burden of NCD-related DALYs has increased by approximately 21% between 2010 and 2019, while infectious disease DALYs decreased (Odunyemi et al., 2023). This illustrates Nigeria’s epidemiological transition and highlights the growing significance of chronic diseases within a predominantly youthful yet rapidly urbanizing population. The prevalence of modifiable risk factors such as obesity, hypertension, unhealthy diet, and sedentary lifestyle has risen across urban and rural populations, with higher rates among urban women and educated groups (Odunyemi et al., 2023). As the economic transition advances, risk factor clustering in middle-socioeconomic groups is emerging, challenging previous understandings of disease distribution along socioeconomic lines. Research based on the 2018-19 Nigeria Living Standards Survey demonstrates that households caring for persons with NCDs incur expenditures equivalent to approximately ₦122,314.60 (~US$398) per annum constituting nearly 24% of food spending. Approximately 30% of such households faced catastrophic health expenditures, and 20% became further impoverished (Odunyemi et al., 2023). These findings suggest that the financial burden of NCDs is both high and inequitable, disproportionately affecting low-income households and rural regions. Nigeria’s decentralized health system framework presents distinct challenges in policy coherence and implementation. National NCD policies, while comprehensive on paper, rely heavily on top-down implementation strategies that have shown limited penetration at subnational and primary care levels (Ajisegiri et al., 2021). Policy fragmentation, weak coordination across federal, state, and local governments, and fragmented health financing have hampered consistent NCD prevention and management efforts (Ajisegiri et al., 2021). These systemic barriers are compounded by inadequate integration of NCD screening and treatment into primary healthcare, insufficient workforce capacity, and lack of sustained funding. Consequently, tertiary centers such as the Federal Medical Center (FMC) Bida often become de facto referral points for advanced NCD cases, but are burdened by disconnected data systems, inadequate risk profiling, and limited ability to support upstream prevention. Despite the growing body of literature on non-communicable diseases in Nigeria and globally, significant gaps remain particularly in relation to facility-based evidence and trend analyses within tertiary care settings such as the Federal Medical Center Bida. First, while national health surveys such as the Demographic and Health Survey (DHS), the World Health Organization STEPwise approach to Surveillance (STEPS), and the Nigeria Living Standards Survey (NLSS) provide cross-sectional and population-based data on NCD prevalence, they do not capture longitudinal patterns or facility-specific caseloads over time. As a result, the temporal evolution of NCD presentations at healthcare facilities is poorly understood, limiting the ability to evaluate local trends or service responses to rising burdens. Additionally, while there is substantial documentation of community-level determinants such as poverty, low education, and urbanization far fewer studies assess how these risk factors manifest among patients seeking care in tertiary facilities. Hospital-based evidence, particularly from secondary or tertiary settings in rural or semi-urban areas such as Bida, remains underrepresented in the literature. Without this data, it is challenging to establish how demographic, behavioral, and clinical determinants influence patient presentations and outcomes at the facility level. Moreover, most studies examining NCD determinants in Nigeria tend to focus on broad national or state-level analyses, often failing to disaggregate results by healthcare tier or geographic region. For instance, the comparative study by Noel et al. (2025) on predictors of behavioral risk factors among people living with HIV and HIV-negative patients at Jos University Teaching Hospital offers critical insights into risk behavior predictors, such as urban residence, income, and self-rated health. However, such findings may not fully reflect the patient population or contextual realities of FMC Bida, thus highlighting the need for localized investigations. A further gap exists in the application of theoretical frameworks within Nigerian NCD literature. While international studies frequently employ models such as the Social Determinants of Health (SDH) or the Health Belief Model (HBM) to interpret behavioral and structural drivers of disease, Nigerian facility-based studies rarely integrate such frameworks. This limits the analytical depth of findings and restricts the ability to contextualize determinants within a broader health systems or psychosocial perspective. Incorporating these frameworks can enhance understanding of how social and environmental contexts influence individual risk and service utilization. Another notable limitation is the paucity of comparative rural-urban analyses within facility contexts. Studies from other sub-Saharan African countries, such as Pilusa et al. (2025) in rural South Africa, have highlighted the high prevalence of hypertension, diabetes, and behavioral risk factors among rural populations, driven by socio-economic deprivation and limited healthcare access. However, similar evidence from rural Nigerian settings is scarce, and no longitudinal data exist from FMC Bida to establish whether such rural patterns are reflected in its patient caseloads. Finally, the health system’s readiness to systematically document and respond to changing NCD burdens at the facility level remains questionable. While national policy documents emphasize the integration of NCD services into primary healthcare, actual implementation at the tertiary level is inconsistently reported. Ajisegiri et al. (2021) have underscored the limitations in subnational policy execution due to weak coordination, fragmented financing, and the absence of effective monitoring mechanisms. Yet, how these systemic challenges translate into clinical practice at institutions like FMC Bida is largely undocumented. In the absence of regular data audits or structured NCD reporting systems, the ability of facilities to detect, manage, and prevent the worsening of chronic disease outcomes is severely constrained. These critical literature and data gaps justify the need for empirical, facility-based research focused on identifying patterns, determinants, and contextual drivers of common non-communicable diseases in North-Central Nigeria. The current study seeks to fill this void by examining both trend data and determinant profiles using hospital records from FMC Bida, thereby contributing to the development of evidence-based and contextually grounded NCD interventions. Given the accelerating global and African rise in NCD burden, and the growing recognition of socioeconomic, behavioral, and health system determinants, localized facility-level analyses can add significant value to the evidence base. In Nigeria, while national and community surveys offer general prevalence estimates, there remains a paucity of time-trend analyses and risk determinant studies based on actual clinical caseloads at tertiary centres. Without such data, resource allocation, risk stratification, and targeted prevention strategies lack the empirical grounding necessary for effective implementation. This study addresses that critical gap by extracting and analyzing hospital records at FMC Bida over a multi-year period to determine trends in common NCD diagnoses (e.g., hypertension, diabetes, CVD, respiratory illnesses); assessing socio-demographic and behavioral risk determinants among facility attendees, in line with theoretical frameworks such as Social Determinants of Health and the Health Belief Model, thereby integrating global theoretical insights with local empirical data; providing evidence on facility-level burden and risk profiles, which has policy relevance for state-level health planning, resource allocation, and integration of NCD prevention into primary healthcare, particularly in Niger State’s context; and contributing to improved public health strategy, by informing interventions tailored to high-risk populations identified through facility trends, addressing a gap highlighted in both national critiques of NCD policy implementation (Ajisegiri et al., 2021) and the observed household economic burden (Odunyemi et al., 2023). In summary, this research will offer novel empirical evidence on how NCD burdens and determinants unfold within a tertiary facility in North-Central Nigeria. It bridges global epidemiologic trends such as those documented by Di Cesare (2019), Goel et al. (2025), and Williams et al. (2018) with Nigeria-specific policy and economic realities (Odunyemi et al., 2023; Ajisegiri et al., 2021). The study’s findings are expected to support evidence-based policy formulation, health service planning, and targeted prevention programming within Niger State and comparable settings.

The aim of this study is to assess the trends and identify the key determinants of common non-communicable diseases (NCDs) over a ten-year period.

1. 1What have been the trends in the prevalence of common non-communicable diseases at FMC Bida over the past ten years (2015-2024)?
2. 2What are the socio-demographic characteristics of patients diagnosed with common NCDs at FMC Bida?
3. 3What is the association between smoking history and the type of common NCD diagnosed among patients at FMC Bida?
4. 4What is the relationship between age and clinical outcomes among NCD patients at FMC Bida?