Age-stratified prevalence and associated risk factors of hypertension, diabetes and hypercholesterolemia in Nepal: Insights from the STEPS survey 2019

BACKGROUND: Non-communicable diseases (NCDs) are a major global public health challenge, particularly in low- and middle-income countries such as Nepal. Despite the growing burden of hypertension, diabetes, and hypercholesterolemia, limited evidence exists on age-stratified patterns of NCDs and associated risk factors, especially among younger populations. This study investigated age-stratified prevalence of hypertension, diabetes and hypercholesterolemia and risk factors in Nepal to inform age-specific preventions and policy interventions. METHODS: We analyzed nationally representative data from the 2019 STEPS Survey, including 3,219 participants aged 15-69 years. Descriptive statistics and chi-square tests describe participant characteristics. Multivariable logistic regression assessed associations between risk factors and NCDs, while univariate logistic regression, Wilcoxon scores, and pairwise multiple comparisons examined age-group differences in prevalence of NCDs and risk factors. RESULTS: The mean participant age was 35.3 ± 12.8 years, with 56% female. Among adults aged ≥60 years, 50% used tobacco and 31.5% consumed alcohol. Alcohol consumption was also notably prevalent among individuals aged 15-29 years, affecting 30.7% of this age group. Physical inactivity was identified in 18.9% of the overall study population. The highest rates of overweight (30.2%) and stress (80.1%) were among adults aged 30-44, with obesity (9.0%) peaking at 45-59 years. Men (OR 2.04, 95% CI 1.62-2.55) and those aged 60 years or older (OR 4.92, 95% CI 3.35-7.22) had higher odds of hypertension. Diabetes (OR 6.34, 95% CI 3.58-11.23) and hypercholesterolemia (OR 2.66, 95% CI 1.77-3.98) were most prevalent in the 45-59 age group. CONCLUSIONS: The prevalence of NCDs and risk factors increases with age, yet substantial burdens exist among younger adults. Age-specific targeted policies should promote healthy behaviors and routine screening in youth, emphasize metabolic risk management and early detection in middle age, and ensure sustained treatment access and continuity of care for older adults.