Urban-Rural Health Transitions in India: A Comprehensive Review of Non-communicable Disease Trends and Risk Landscapes

India is experiencing a dual burden of non-communicable disease (NCD) risk factors, with distinct patterns emerging across rural and urban geographies. While behavioral risks such as tobacco and alcohol use remain entrenched in rural settings, urban populations are disproportionately affected by metabolic risks such as hypertension, diabetes, and obesity. This review aims to synthesize national data to understand the geographic divergence of NCD risk factors and their implications for public health policy. A comprehensive literature review was conducted using data from the National Family Health Surveys (NFHS-4 and NFHS-5), the National Noncommunicable Disease Monitoring Survey (NNMS), and the Indian Council of Medical Research - India Diabetes (ICMR-INDIAB) study. Risk factors were categorized into behavioral (e.g., tobacco use and alcohol consumption), metabolic (e.g., hypertension, overweight, and raised blood sugar), and biochemical (e.g., dyslipidemia) domains. Comparative analyses were performed across urban and rural populations to assess temporal trends and disparities. The review showed that rural populations demonstrated a higher prevalence of tobacco use (42.7% in rural men vs. 28.8% in urban men) and alcohol consumption, while urban populations had higher rates of physical inactivity, overweight, hypertension, and raised blood sugar. Obesity among rural women is also rising, indicating a shifting nutrition transition. Biochemical risk factors such as hypercholesterolemia were more prevalent in urban areas but remain underdiagnosed across both geographies. India's NCD burden is characterized by a clear urban-rural divide in risk factor prevalence, necessitating geographically differentiated policy responses. Public health strategies must integrate behavior change in rural areas and metabolic risk management in urban settings, while addressing gender and equity gaps. Strengthening primary healthcare and aligning intersectoral efforts are crucial to achieving long-term NCD control and health equity.