Selected non-communicable diseases prevalence and factors in Omanis Aged 35–39 years: South Sharqiyah screening program 2023–2024

Abstract

Objectives

The aims of this study were to determine the prevalence of hypercholesterolemia, obesity, elevated blood pressure, hyperglycemia, and reduced kidney function, and identify their associated factors, among Omanis aged 35–39 years in South Sharqiyah during 2023–2024.

Methods

An analytical cross-sectional study was conducted in all primary health centers in South Sharqiyah Governorate during 2023–2024. Data were obtained from the Shifa 3+ electronic health system and screening registration forms. Eligible participants were Omani residents aged 35–39 years who attended the national non-communicable disease (NCD) screening program. Individuals were excluded with diabetes, hypertension, chronic kidney disease, or pregnancy up to 6 months postpartum. The primary outcomes were hyperglycemia, elevated blood pressure, hypercholesterolemia, obesity, and reduced kidney function. Multimorbidity was defined as the presence of two or more chronic conditions. Prevalence was reported with 95% confidence intervals, and associations were assessed using chi-square tests and logistic regression. Statistical significance was set at p < 0.05. Analyses were performed using IBM SPSS Statistics version 31.0.10.

Results

The median age of the study population was 37.0 years (interquartile range, 36.0–38.0), and 58.3% were female. Hypercholesterolemia was the most prevalent condition (47.0%), followed by obesity (40.6%), elevated blood pressure (14.1%), hyperglycemia (5.0%), and reduced kidney function (0.1%). Significant associations were found between high waist circumference and obesity (adjusted odds ratio (aOR) = 6.6), family history of diabetes and hyperglycemia (aOR = 2.772), hyperglycemia and elevated blood pressure (aOR = 2.734), and male sex and hypercholesterolemia (aOR = 1.803). Multimorbidity was present in 23.8% of participants and was associated with male sex and family history of dyslipidemia. The most common multimorbidity pattern was the co-occurrence of hypercholesterolemia and obesity.

Conclusion

NCDs and multimorbidity were common in the study population. These findings highlight the importance of continued attention to early detection and the prevention of NCDs among this group.

Introduction

Non-communicable diseases (NCDs) are a major global public health challenge and leading cause of morbidity and mortality worldwide.¹ In 2021, NCDs accounted for 18 million deaths among individuals aged younger than 70 years.¹ According to World Health Organization data from 2019, Gulf Cooperation Council countries spent approximately 3.3% of their gross domestic product on NCDs.² In Oman, NCDs accounted for 6% of deaths and contributed to an economic loss of 4% compared with 45% in the Kingdom of Saudi Arabia, 37% in Yemen, and 7% in the United Arab Emirates (UAE).² Diabetes mellitus was ranked as the third leading cause of death among NCDs, accounting for 6% of deaths, after ischemic heart disease (54%) and stroke (23%).² The four principal types of NCDs responsible for most NCD-related deaths are chronic respiratory diseases, cardiovascular diseases, diabetes, and cancers.¹ Both modifiable and non-modifiable factors contribute to the development of NCDs. Modifiable factors include behavioral factors, such as an unhealthy diet, alcohol consumption, physical inactivity, and tobacco use, as well as metabolic factors, including elevated body mass index, blood glucose, blood pressure, and cholesterol. Non-modifiable factors include age, genetics, sex, and race.^1,3

The NCD screening program is essential for estimating disease prevalence and identifying associated factors to inform planning and public health responses.¹ In UAE, a retrospective analysis of annual health screening data from 2021 demonstrated a substantial burden of NCDs, with more than 90% of participants presenting with at least one modifiable risk factor.⁴ In Qatar, a study conducted between 2017 and 2019 to assess the prevalence of NCDs and associated factors reported reductions in the prevalence of elevated blood pressure, obesity, and high HbA1c, suggesting the benefits of continuous program monitoring and improved treatment strategies.⁵ In response to the increased global burden of NCDs, the United Nations incorporated NCD prevention and control into the Sustainable Development Goals, with a target of reducing premature mortality from NCDs by one-third by 2030.¹ This agenda includes several strategies that aim to reduce exposure to risk factors for NCD.¹

Oman Vision 2040 emphasizes the importance of advancing healthcare services to strengthen public health measures. Oman launched the national NCD screening program in 2007 to promote early detection, prevention, and intervention for NCDs.⁶ These diseases are commonly clustered and share modifiable risk factors, thereby increasing the overall cardiometabolic risk.¹ Oman implemented this program comprehensively across all primary healthcare institutions.⁶ Initially, the program targeted individuals aged over 40 years.⁶ In 2025, the Oman Ministry of Health conducted a study following the WHO STEPwise approach to NCD risk factor surveillance (STEPS).⁷

The present study addressed an important gap in the existing evidence by focusing on Omani adults aged 35–39 years in South Sharqiyah Governorate, which is an age group that was recently included in the national NCD screening program following its expansion in 2023. Previous studies of NCDs in Oman largely focused on broader age groups or older populations, and provided limited information on the burden of selected NCDs among adults aged 35–39 years within the context of the expanded screening program. In addition, evidence specific to South Sharqiyah Governorate remains limited. By examining this population using data from the national screening program, the present study obtained regional evidence on the prevalence of selected NCDs and their associated factors among younger adults, which may contribute to understanding the burden of NCDs and inform future research and prevention strategies.

The objectives of this study were to determine the prevalence of the selected NCDs detected by Oman's national NCD screening program during 2023–2024, specifically hypercholesterolemia, obesity, elevated blood pressure, hyperglycemia, and reduced kidney function, and to identify their associated factors among Omanis aged 35–39 years in South Sharqiyah Governorate.

Materials and Methods

Study design and setting

An analytical cross-sectional study was conducted across all primary healthcare institutions in South Sharqiyah Governorate, Oman.

Oman is one of the Gulf countries, with a population of 5.41 million.⁸ The country comprises 11 governorates, which are further divided into 60 wilayats.⁹ South Sharqiyah Governorate is in southeastern Oman and consists of five wilayats: Sur, Jaalan Bani Bu Ali, Jaalan Bani Bu Hassan, Al-Kamil and Al-Wafi, and Masirah.⁹ The study was conducted in five participating wilayats in South Sharqiyah Governorate at 20 primary healthcare institutions distributed across urban and rural areas (Ashkharah, Ruways, As Siwayh, Asilah, Khuwaymah, Ayjah, Ras Al Hadd, Tiwi, Wadi Al Minqul, Wadi Bani Jabir, Kamil, Wafi, Tahwah, Sayq & Sabt, Ghaina, Falaj Al Mashayikh, and Jaalan Bani Bu Hasan Health Centers; Jaalan and Sur Extended Health Centers; and Masirah Hospital).

Data collection

Data were obtained from Oman's Shifa 3+ electronic health system and cross-validated against the corresponding manual registration forms collected during the 2025–2026 study period for participants screened in 2023–2024. Shifa 3+ is the electronic health information system used across all institutions of the Oman Ministry of Health, and it includes an individualized data entry sheet for the national NCD screening program.^6,10

Study size and participants

In total, 4223 participants were included representing all eligible Omanis aged 35–39 years enrolled in the screening program during the study period. Eligible participants were Omani nationals aged 35–39 years registered in the national NCD screening program during 2023–2024 and residing in South Sharqiyah Governorate. Exclusion criteria were a prior history of chronic diseases, specifically diabetes mellitus, hypertension, or chronic kidney disease, and pregnancy up to 6 months postpartum.

Therefore, the prevalence estimates reported in this study represent newly detected conditions identified through the screening program among participants without a prior diagnosis, rather than the overall prevalence of these diseases in the study population.

This study used the complete eligible program population (census approach) rather than a sample selected through a sampling procedure, so a priori sample size calculation was not performed.

Outcomes

The primary outcomes were the selected NCDs identified through the national NCD screening program: hypercholesterolemia, obesity, elevated blood pressure, hyperglycemia, and reduced kidney function. Definitions were adopted from the Operational and Management Guidelines for the National NCDs Screening Program Manual. Hyperglycemia was defined as random blood sugar ≥11.1 mmol/L and/or fasting blood sugar ≥7.0 mmol/L. Elevated blood pressure was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg. Hypercholesterolemia was defined as a serum cholesterol level ≥5.2 mmol/L. Obesity was defined as a body mass index ≥30 kg/m². Reduced kidney function was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m².⁶

Variables

Independent variables included demographic characteristics such as age, sex, wilayat, and year of participation. Age was analyzed both as a continuous variable and categorical yearly age groups (35, 36, 37, 38, and 39 years). For wilayat-level analysis, Masirah was merged with Jaalan Bani Bu Ali due to its small population and low prevalence of the conditions under study. Additional variables included personal and family history characteristics. Personal history characteristics comprised physical inactivity defined as < 150 min per week of moderate-intensity physical activity, smoking defined as the use of any form or amount of tobacco, ethanol use defined as consumption of any amount of alcohol, and nephrotoxic drug use defined as long-term or frequent use of non-steroidal anti-inflammatory drugs, other analgesics, diuretics, or herbal medicines, whether prescribed or obtained over the counter.⁶ Family history characteristics included the presence or absence of diabetes, hypertension, dyslipidemia, obesity, ischemic heart disease, premature cardiovascular death (males aged <55 years and females aged <65 years), and chronic kidney disease among first-degree relatives.⁶ Additional variables measured in this study included waist circumference defined as high at ≥ 94 cm in males and ≥80 cm in females, proteinuria defined as urine dipstick protein of 1+ or more, and hematuria defined as the presence of blood in urine dipstick.⁶ Percentages were also calculated for “any NCD” defined as the presence of at least one of the five studied NCDs, and “multimorbidity” defined as the presence of two or more NCDs.

Measurements

Anthropometric and clinical measurements were performed by trained nurses using standardized procedures. Height and weight were measured using a stadiometer and calibrated scale, respectively, with participants barefoot. Body mass index was calculated as weight in kilograms divided by height in meters squared. Waist circumference was measured using a non-stretchable tape at the midpoint between the lower rib margin and the iliac crest. Blood pressure was measured after the participant had rested in a seated position, and the higher reading from both arms was recorded. Venous blood samples were collected to measure fasting or random blood glucose, serum creatinine, and total cholesterol. Urinalysis was performed using a urine dipstick to test for proteinuria and hematuria.

Bias

Potential sources of bias were considered during study design and analysis. Selection bias was partially minimized by including all available participant records that met the eligibility criteria during the study period. However, the study only included individuals who attended screening services, so the findings may not be generalizable to the entire target population. Single measurements may have overestimated the true prevalence of some conditions. Information bias may also have occurred because some variables were self-reported, such as smoking and alcohol use. In addition, the use of both electronic records and manual registration forms may have introduced data inconsistencies. To minimize this potential issue, data validation and consistency checks were performed during data cleaning. Potential confounding was addressed using multivariable regression, and effect modification was explored through stratified analysis.

Statistical methods

Data were analyzed using IBM SPSS Statistics version 31.0.10. Categorical variables were summarized as frequencies and percentages for descriptive analysis, whereas continuous variables were summarized as means with standard deviations and medians with interquartile ranges (IQRs), as appropriate. The prevalences of NCDs were expressed as percentages with 95% confidence intervals (95% CIs). The chi-square test was used to assess associations between variables and the outcomes of interest. Binary logistic regression analysis was performed to identify independent factors associated with each outcome. Variables were examined using both bivariate and multivariable analyses. The proportion of missing data varied across variables. Less than 20% of the data were missing for most clinical variables, but 52% were missing for waist circumference. Personal and family history variables had a higher proportion of missing data (61%). Missing data were assessed using Little's missing completely at random (MCAR) test. The test result was not statistically significant (χ² = 322.884, df = 312, p = 0.324), indicating that the missing data were consistent with the MCAR assumption. Therefore, complete-case analysis was conducted for all comparisons. Due to the very low prevalence of reduced kidney function, further analyses of its associations with risk factors were not performed. This study was performed in accordance with the STROBE guidelines for observational studies.

Results

Participants' characteristics

In total, 4223 participants were included in the study, with a median age of 37.0 years (IQR, 36.0–38.0 years). Females accounted for 58.3% of the study population. Participants from Jaalan Bani Bu Ali and Masirah wilayats constituted the largest proportion of the sample (42.5%), where 20.3% were recruited from Jaalan Extended Health Center (Table 1).

Table 1.

Distribution of demographic characteristics among participants in the NCD screening program in South Sharqiyah, Oman, 2023–2024 (n = 4223).

Characteristics	n (%)
Age (years)
35	931 (22.0)
36	847 (20.1)
37	809 (19.2)
38	831 (19.7)
39	805 (19.1)
Age -median (IQR)	37.0 (36.0–38.0)
Gender
Male	1759 (41.7)
Female	2464 (58.3)
Wilayat (per health center)
Jaalan Bani Bu Ali + Masirah	1795 (42.5)
Ashkharah health center	215 (5.1)
Ruways health center	168 (4.0)
As Siwayh health center	59 (1.4)
Asilah health center	126 (3.0)
Jaalan extended health center	858 (20.3)
Khuwaymah health center	90 (2.1)
Masirah Hospital	279 (6.6)
Sur	1044 (24.7)
Ayjah health center	149 (3.5)
Ras Al Hadd health center	191 (4.5)
Sur Extended health center	320 (7.6)
Tiwi health center	245 (5.8)
Wadi Al Minqul health center	126 (3.0)
Wadi Bani Jabir health center	13 (0.3)
Al-Kamil and Al-Wafi	707 (16.7)
Kamil health center	279 (6.6)
Wafi health center	261 (6.2)
Tahwah health center	109 (2.6)
Sayq & Sabt health center	58 (1.4)
Jaalan Bani Bu Hassan	677 (16)
Ghaina health center	66 (1.6)
Falaj Al Mashayikh health center	117 (2.8)
Jaalan Bani Bu Hasan health center	494 (11.7)

Prevalence of selected NCDs

Hypercholesterolemia was the most prevalent NCD (47.0%, 95% CI: 45.50–48.60), followed by obesity (40.6%, 95% CI: 38.90–42.30), elevated blood pressure (14.1%, 95% CI: 13.10–15.20), hyperglycemia (5.0%, 95% CI: 4.30–5.80), and reduced kidney function (0.1%, 95% CI: 0.00–0.30) (Figure 1).

Figure 1.

Prevalence of NCDs and multimorbidity among participants in the NCD screening program in South Sharqiyah, Oman, 2023–2024.

Prevalence of selected NCDs by gender

Among the identified cases, obesity was more prevalent among females, who accounted for 70.9% (95% CI: 68.48–73.28) of cases, compared with 29.1% among males (95% CI: 26.72–31.52). Similarly, females comprised a higher proportion of elevated blood pressure cases (55.6%, 95% CI: 51.55–59.64) than males (44.4%, 95% CI: 40.36–48.45). Hypercholesterolemia was also more common among females, comprising 52.6% of cases (95% CI: 50.31–54.80), compared with 47.4% among males (95% CI: 45.20–49.69). Hyperglycemia had a nearly equal distribution in females and males, at 50.6% (95% CI: 43.14–58.01) and 49.4% (95% CI: 41.99–56.86), respectively. By contrast, reduced kidney function was more frequently observed among males, who comprised 80.0% of the five identified cases (95% CI: 37.55–96.38) compared with 20.0% among females (95% CI: 3.62–62.45) (Table 2).

Table 2.

Distribution of NCDs by sociodemographic characteristics among participants in the NCD screening program in South Sharqiyah, Oman, 2023–2024.

Participant characteristics	Hypercholesterolemia n (%) (n = 1893)	Obesity n (%) (n = 1373)	Elevated blood pressure n (%) (n = 577)	Hyperglycemia n (%) (n = 170)	Reduced kidney function (n = 5)
Age (years)
35	379 (20.0)	297 (21.6)	110 (19.1)	26 (15.3)	0 (00.0)
36	361 (19.1)	247 (18.0)	107 (18.5)	37 (21.8)	1 (20.0)
37	363 (19.2)	254 (18.5)	106 (18.4)	34 (20.0)	1 (20.0)
38	384 (20.3)	289 (21.0)	127 (22.0)	40 (23.5)	1 (20.0)
39	406 (21.4)	286 (20.8)	127 (22.0)	33 (19.4)	2 (40.0)
Gender
Male	898 (47.4)	399 (29.1)	256 (44.4)	84 (49.4)	4 (80.0)
Female	995 (52.6)	974 (70.9)	321 (55.6)	86 (50.6)	1 (20.0)
Wilayat
Jaalan Bani Bu Ali + Masirah	745 (39.4)	679 (49.5)	248 (43.0)	72 (42.4)	2 (40.4)
Sur	493 (26.0)	225 (16.4)	148 (25.6)	37 (21.8)	1 (20.0)
Al-Kamil and Al-Wafi	304 (16.1)	218 (15.9)	78 (13.5)	18 (10.6)	1 (20.0)
Jaalan Bani Bu Hassan	351 (18.5)	251 (18.3)	103 (17.9)	43 (25.3)	1 (20.0)
Year of participation
2023	1100 (58.1)	813 (59.2)	327 (56.7)	89 (52.4)	5 (100.0)
2024	793 (41.9)	560 (40.8)	250 (43.3)	81 (47.6)	0 (00.0)

Prevalence of selected NCDs by age

Obesity was highest at 35 years (21.6%, 95% CI: 19.50–23.90) and lowest at 36 years (18.0%, 95% CI: 16.10–20.10). The distribution of elevated blood pressure cases varied across age groups, ranging from 18.4% (95% CI: 15.40–21.70) at 37 years to 22.0% (95% CI: 18.80–25.60) at 38 and 39 years. Hyperglycemia was lowest at 35 years (15.3%, 95% CI: 10.70–21.50) and highest at 38 years (23.5%, 95% CI: 17.80–30.50). Hypercholesterolemia varied slightly across age groups, ranging from 19.1% (95% CI: 17.40–20.90) at 36 years to 21.4% (95% CI: 19.70–23.40) at 39 years. Reduced kidney function was rare across all age groups, with no cases observed at 35 years, while 20.0% (95% CI: 3.60–62.50) of cases were each observed at 36, 37, and 38 years, increasing to 40.0% (95% CI: 11.80–76.90) at 39 years (Table 2).

Prevalence of selected NCDs by wilayat

Disease prevalence varied across wilayats, where Jaalan Bani Bu Ali and Masirah consistently had the highest prevalences of obesity (49.5%, 95% CI: 46.81–52.10), elevated blood pressure (43.0%, 95% CI: 38.94–47.02), hyperglycemia (42.4%, 95% CI: 34.93–49.78), and hypercholesterolemia (39.4%, 95% CI: 37.15–41.56), whereas Al-Kamil and Al-Wafi consistently had the lowest prevalences of these conditions at 15.9% (95% CI: 13.94–17.81), 13.5% (95% CI: 10.73–16.31), 10.6% (95% CI: 5.96–15.21), and 16.1% (95% CI: 14.41–17.71), respectively. Reduced kidney function was uncommon across all wilayats, with the highest proportion observed in Jaalan Bani Bu Ali and Masirah (40.0%, 95% CI: 0.00–82.94) and 20.0% (95% CI: 0.00–55.06) in each of the remaining wilayats (Table 2).

Prevalence of selected NCDs by participating year

When the findings were compared between 2023 and 2024, obesity was slightly higher in 2023 than 2024 (59.21%, 95% CI: 56.61–61.81 vs 40.79%, 95% CI: 38.19–43.39). Elevated blood pressure was also higher in 2023 than 2024 (56.67%, 95% CI: 52.63–60.72 vs 43.33%, 95% CI: 39.28–47.37), as were hyperglycemia (52.35%, 95% CI: 44.84–59.86 vs 47.65%, 95% CI: 40.14–55.16) and hypercholesterolemia (58.11%, 95% CI: 55.89–60.33 vs 41.89%, 95% CI: 39.67–44.11). Reduced kidney function was reported for all five cases in 2023 (100.00%, 95% CI: 56.55–100.00), with no cases in 2024 (Table 2).

Prevalence of additional screening measurements

Additional screening measurements included waist circumference, proteinuria, and hematuria. Overall, high waist circumference was observed in 74.6% of participants (95% CI: 72.60–76.50). By sex, high waist circumference was more common among females (87.2%, 95% CI: 85.20–89.00) than males (53.8%, 95% CI: 50.20–57.40; p < 0.001). Proteinuria was observed in 1.5% of participants (95% CI: 1.10–1.90), and hematuria in 2.6% (95% CI: 2.10–3.20). Hematuria was more prevalent among females (3.3%, 95% CI: 2.60–4.10) than males (1.6%, 95% CI: 1.00–2.40; p = 0.002) (Table 3).

Table 3.

Distribution of other medical conditions by sociodemographic characteristics among participants in the NCD screening program in South Sharqiyah, Oman, 2023–2024.

Participant characteristics	High waist circumference n (%) (n = 1999)	Proteinuria n (%) (n = 3538)	Hematuria n (%) (n = 3538)	Any NCD n (%) (n = 4223)	Multimorbidity n (%) (n = 4223)
Total	1491 (74.6)	52 (1.5)	91 (2.6)	2807 (66.5)	1006 (23.8)
Gender
Male	405 (53.8)	23 (1.5)	91 (2.6)	1156 (65.7)	402 (22.9)
Female	1086 (87.2)	29 (1.4)	67 (3.3)	1651 (67.0)	604 (24.5)
p-value	< 0.001	0.765	0.002	0.383	0.212
Wilayat
Jaalan Bani Bu Ali + Masirah	627 (76.7)	23 (1.6)	38 (2.7)	1206 (66.6)	454 (25.1)
Sur	384 (70.5)	5 (0.5)	31 (3.2)	662 (63.2)	212 (20.2)
Al-Kamil and Al-Wafi	103 (66.0)	15 (2.4)	12 (1.9)	450 (64.0)	141 (20.1)
Jaalan Bani Bu Hassan	377 (78.4)	9 (1.6)	10 (1.8)	489 (74.0)	199 (30.1)
p-value	0.992	0.016	0.251	< 0.001	< 0.001
Year of participation
2023	875 (74.6)	31 (1.5)	63 (3.0)	1650 (65.9)	581 (23.2)
2024	616 (74.6)	21 (1.5)	28 (2.0)	1157 (67.3)	425 (24.7)
p-value	0.001	0.971	0.065	0.318	0.247

Chi-square test: significant p-values in bold.

Prevalence of “any NCD” and “multimorbidity”

The prevalence of any NCD was 66.5% (95% CI: 65.00–67.90). Differences among wilayats were statistically significant (p < 0.001). The highest prevalence was observed in Jaalan Bani Bu Hassan (74.0%, 95% CI: 70.50–77.30), followed by Jaalan Bani Bu Ali + Masirah (66.6%, 95% CI: 64.30–68.70) and Al-Kamil and Al-Wafi (64.0%, 95% CI: 60.30–67.60), whereas the lowest prevalence was observed in Sur (63.2%, 95% CI: 60.20–66.20) (Table 3).

Multimorbidity was observed in 23.8% of the study population (95% CI: 22.50–25.10). The most frequent multimorbidity pattern was the co-occurrence of hypercholesterolemia and obesity, followed by hypercholesterolemia with elevated blood pressure, and the combination of hypercholesterolemia, obesity, and elevated blood pressure (Figure 2). Across wilayats, multimorbidity was most prevalent in Jaalan Bani Bu Hassan (30.1%, 95% CI: 26.60–33.80) and least prevalent in Al-Kamil and Al-Wafi (20.1%, 95% CI: 17.20–23.20), with a statistically significant difference between wilayats (p < 0.001) (Table 3).

Figure 2.

Multimorbidity patterns among participants in the NCD screening program in South Sharqiyah, Oman, 2023–2024.

According to the logistic regression model, male sex and family history of dyslipidemia were significantly associated with multimorbidity. Males had more than twice the odds of multimorbidity compared with females (adjusted odds ratio (aOR) = 2.22, 95% CI: 1.54–3.22). Participants with a family history of dyslipidemia also had higher odds of multimorbidity (aOR = 1.83, 95% CI: 1.17–2.88) (Table 4).

Table 4.

Multivariate logistic regression analysis of associations between multimorbidity and patient factors among participants in the NCD screening program in South Sharqiyah, Oman, 2023–2024.

Patient factors	Multimorbidity (n = 4223) aOR (95% CI)	p-value
Sociodemographic features
Age (Ref: 39 years)	1.13 (1.01–1.26)	0.040
Male gender (Ref: Female)	2.22 (1.54–3.22)	0.000
Clinical features
High waist circumference (Ref: Normal)	1.06 (0.65–1.74)	0.810
Personal history
Physical activity (Ref: No)	1.57 (0.64–3.82)	0.325
Smoking status (Ref: No)	0.63 (0.14–2.94)	0.557
Family history
Obesity (Ref: No)	1.06 (0.62–1.82)	0.000
Diabetes (Ref: No)	0.92 (0.58–1.44)	0.712
Hypertension (Ref: No)	1.05 (0.67–1.62)	0.843
Dyslipidemia (Ref: No)	1.83 (1.17–2.88)	0.009
Chronic kidney disease (Ref: No)	0.66 (0.15–2.93)	0.587
Ischemic heart disease (Ref: No)	0.65 (0.34–1.23)	0.186
Cardiac death (Ref: No)	3.76 (0.50–28.28)	0.198

Chi-square test: significant p-values in bold, aOR = adjusted odds ratio, CI = confidence interval, multimorbidity is defined as the co-occurrence of ≥2 chronic diseases within an individual, Ref = reference.

NCD-associated factors

Crude analysis of factors associated with hyperglycemia showed that 25.3% of participants with hyperglycemia were from Jaalan Bani Bu Hassan, compared with 16.9% of those without hyperglycemia (odds ratio (OR) = 1.71, 95% CI: 1.09–2.69; p = 0.025). Obesity was associated with higher odds of hyperglycemia (OR = 2.15, 95% CI: 1.52–3.05; p < 0.001), and elevated blood pressure (OR = 1.79, 95% CI: 1.23–2.62; p = 0.002). Participants with a family history of diabetes also had higher odds of hyperglycemia (OR = 2.11, 95% CI: 1.32–3.37; p = 0.002) (Table 5).

Table 5.

Crude associations between NCDs and patient factors among participants in the NCD screening program in South Sharqiyah, Oman, 2023–2024.

Patient factors	Hypercholesterolemia (n = 962)	Obesity (n = 962)	Elevated blood pressure (n = 1007)	Hyperglycemia (n = 980)
OR (95% CI)
Sociodemographic features
Age (Ref: 39 years)
35	0.68 (0.56–0.82)	0.80 (0.65–0.99)	0.71 (0.54–0.94)	0.68 (0.40–1.16)
36	0.73 (0.60–0.89)	0.72 (0.58–0.90)	0.77 (0.58–1.01)	1.08 (0.67–1.75)
37	0.80 (0.66–0.98)	0.80 (0.64–0.99)	0.81 (0.61–1.06)	1.05 (0.64–1.71)
38	0.84 (0.69–1.03)	0.94 (0.75–1.17)	0.97 (0.74–1.26)	1.11 (0.69–1.78)
p-value	0.001	0.027	0.063	0.364
Gender (Ref: Female)
Male	1.56 (1.37–1.77)	0.47 (0.41–0.54)	1.15 (0.96–1.37)	1.40 (1.03–1.91)
p-value	< 0.001	< 0.001	0.127	0.032
Wilayat (Ref: Sur)
Al Kamil Wa Al Wafi	0.87 (0.72–1.06)	1.16 (0.92–1.46)	0.77 (0.58–1.04)	0.81 (0.46–1.44)
Jaalan Bani Bu Ali + Masirah	0.83 (0.71–0.97)	1.86 (1.54–2.24)	1.0 (0.80–1.25)	1.12 (0.74–1.68)
Jaalan Bani Bu Hasan	1.35 (1.11–1.65)	1.54 (1.23–1.93)	1.13 (0.86–1.48)	1.71 (1.09–2.69)
p-value	< 0.001	< 0.001	0.124	0.025
Clinical features
Waist circumference classification (Ref: Normal)
High	1.10 (0.90–1.36)	10.07 (7.31–13.87)	1.29 (0.95–1.76)	1.26 (0.76–2.09)
p-value	0.349	< 0.001	0.102	0.373
Obesity (Ref: No)
Yes	1.23 (1.07–1.41)	–	2.0 (1.64–2.44)	2.15 (1.52–3.05)
p-value	0.004	–	< 0.001	< 0.001
Hyperglycemia (Ref: No)
Yes	1.43 (1.04–1.96)	2.15 (1.52–3.05)	1.79 (1.23–2.62)	–
p-value	0.027	< 0.001	0.002	–
Hypercholesterolemia (Ref: No)
Yes	–	1.23 (1.07–1.41)	1.38 (1.15–1.65)	1.43 (1.04–1.96)
p-value	–	0.004	< 0.001	0.027
Reduced kidney function (Ref: No)
Yes	0.75 (0.13–4.49)	2.21 (0.37–13.26)	–	–
p-value	1.000	0.400	–	–
Elevated blood pressure (Ref: No)
Yes	1.38 (1.15–1.65)	2.0 (1.64–2.44)	–	1.79 (1.23–2.62)
p-value	< 0.001	< 0.001	–	0.002
Personal history
Physical activity (Ref: No)
Yes	2.03 (1.16–3.55)	0.96 (0.54–1.71)	1.43 (0.73–2.80)	1.11 (0.34–3.65)
p-value	0.011	0.897	0.296	0.751
Smoking status (Ref: No)
Yes	1.03 (0.56–1.91)	–	2.19 (1.12–4.28)	1.20 (0.28–5.12)
p-value	0.917	–	0.020	0.685
Family history
Obesity (Ref: No)
Yes	1.24 (0.85–1.80)	1.80 (1.24–2.63)	–	–
p-value	0.263	0.002	–	–
Diabetes (Ref: No)
Yes	1.18 (0.94–1.47)	1.11 (0.89–1.40)	0.90 (0.65–1.23)	2.11 (1.32–3.37)
p-value	0.145	0.358	0.493	0.002
Hypertension (Ref: No)
Yes	1.11 (0.89–1.37)	0.93 (0.74–1.16)	1.28 (0.96–1.71)	1.79 (1.23–2.62)
p-value	0.352	<0.001	0.097	0.694
Dyslipidemia (Ref: No)
Yes	1.46 (1.13–1.89)	0.69 (0.53–0.90)	0.90 (0.62–1.30)	–
p-value	0.004	0.007	0.559	–
Ischemic heart disease (Ref: No)
Yes	1.17 (0.79–1.72)	–	0.71 (0.39–1.32)	–
p-value	0.438	–	0.282	–
Cardiac death (Ref: No)
Yes	1.51 (0.34–6.78)	–	2.42 (0.47–12.53)	–
p-value	0.712	–	0.263	–

Chi-square test: significant p-values in bold, OR = unadjusted odds ratio, CI = confidence interval, Ref = reference.

After adjustment for all study factors, hyperglycemia remained independently associated with obesity (aOR = 2.30, 95% CI: 1.27–4.16; p = 0.006), elevated blood pressure (aOR = 2.61, 95% CI: 1.41–4.82; p = 0.002), and family history of diabetes (aOR = 2.77, 95% CI: 1.40–5.48; p = 0.003) (Table 6).

Table 6.

Multivariate logistic regression analysis of associations between NCDs and patient factors among participants in the NCD screening program in South Sharqiyah, Oman, 2023–2024.

Patient factors	Hypercholesterolemia (n = 962)	Obesity (n = 962)	Elevated blood pressure (n = 1007)	Hyperglycemia (n = 980)
aOR (95% CI)
Sociodemographic features
Age (Ref: 39 years)
35	0.65 (0.4–0.10)	1.10 (0.70–1.72)	0.40 (0.20–0.78)	0.96 (0.37–2.47)
36	0.64 (0.42–0.10)	0.74 (0.48–1.16)	0.78 (0.46–1.47)	1.77 (0.75–4.16)
37	0.73 (0.48–1.11)	0.73 (0.47–1.14)	0.87 (0.49–1.54)	1.58 (0.67–3.76)
38	0.99 (0.66–1.48)	0.82 (0.54–1.27)	1.38 (0.81–2.32)	1.07 (0.45–2.58)
p-value	0.047	1.098	0.007	0.924
Gender (Ref: Female)
Male	1.80 (1.34–2.42)	0.83 (0.60–1.14)	1.63 (1.09–2.43)	0.10 (0.54–1.83)
p-value	< 0.001	0.239	0.018	0.990
Wilayat (Ref: Sur)
Al Kamil Wa Al Wafi	0.80 (0.49–1.31)	0.93 (0.54–1.61)	1.06 (0.49–2.26)	0.98 (0.35–2.77)
Jaalan Bani Bu Ali + Masirah	1.07 (0.72–1.60)	1.68 (1.10–2.57)	1.37 (0.76–2.45)	0.58 (0.25–1.36)
Jaalan Bani Bu Hasan	1.28 (0.89–1.84)	1.25 (0.85–1.84)	1.51 (0.87–2.61)	1.33 (0.65–2.70)
p-value	0.366	0.016	0.888	0.974
Clinical features
Waist circumference classification (Ref: Normal)
High	1.15 (0.81–1.63)	6.62 (4.23–10.38)	0.10 (0.61–1.63)	0.85 (0.40–1.85)
p-value	0.428	< 0.001	0.992	0.688
Obesity (Ref: No)
Yes	1.32 (0.99–1.75)	–	1.60 (1.08–2.38)	2.30 (1.27–4.16)
p-value	0.057	–	0.020	0.006
Hyperglycemia (Ref: No)
Yes	1.489 (0.86–2.57)	2.20 (1.22–3.98)	2.73 (1.48–5.04)	–
p-value	0.154	0.009	0.001	–
Hypercholesterolemia (Ref: No)
Yes	–	1.31 (0.99–1.74)	0.90 (0.62–1.30)	1.52 (0.88–2.62)
p-value	–	0.059	0.575	0.136
Elevated blood pressure (Ref: No)
Yes	0.89 (0.61–1.29)	1.60 (1.08–2.39)	–	2.61 (1.41–4.82)
p-value	0.533	0.021	–	0.002
Personal history
Physical activity (Ref: No)
Yes	1.85 (0.87–3.97)	1.50 (0.67–3.36)	0.91 (0.33–2.55)	0.49 (0.10–2.31)
p-value	0.112	0.321	0.859	0.364
Smoking status (Ref: No)
Yes	1.20 (0.40–3.66)	–	1.34 (0.35–5.17)	1.02 (0.12–8.84)
p-value	0.744	–	0.670	0.988
Family history
Obesity (Ref: No)
Yes	0.84 (0.53–1.34)	1.63 (0.10–2.65)	–	–
p-value	0.463	0.052	–	–
Diabetes (Ref: No)
Yes	0.84 (0.58–1.22)	1.54 (1.03–2.30)	0.57 (0.34–0.96)	2.77 (1.40–5.48)
p-value	0.367	0.034	0.350	0.003
Hypertension (Ref: No)
Yes	1.04 (0.72–1.50)	0.75 (0.51–1.11)	1.66 (1.03–2.68)	0.61 (0.30–1.23)
p-value	0.850	0.154	0.039	0.166
Dyslipidemia (Ref: No)
Yes	1.51 (1.04–2.20)	0.76 (0.50–1.13)	0.90 (0.52–1.54)	–
p-value	0.029	0.172	0.694	–
Ischemic heart disease (Ref: No)
Yes	1.02 (0.61–1.71)	–	0.77 (0.35–1.69)	–
p-value	0.941	–	0.518	–
Cardiac death (Ref: No)
Yes	0.48 (0.07–3.19)	–	5.44 (0.75–39.41)	–
p-value	0.447	–	0.094	–

Chi-square test: significant p-values in bold, aOR = adjusted odds, CI = confidence interval, Ref = reference.

Crude analysis of factors associated with elevated blood pressure showed that obesity was associated with higher odds of elevated blood pressure (OR = 2.00, 95% CI: 1.64–2.44; p < 0.001). Hyperglycemia was also associated with higher odds of elevated blood pressure (OR = 1.79, 95% CI: 1.23–2.62; p = 0.002), as was smoking (OR = 2.19, 95% CI: 1.12–4.28; p = 0.020) (Table 5).

After adjustment for all study factors, elevated blood pressure was independently associated with male sex, obesity, hyperglycemia, and family history of hypertension. Males had higher odds of elevated blood pressure than females (aOR = 1.63, 95% CI: 1.09–2.43; p = 0.018). Obese participants had higher odds than non-obese participants of elevated blood pressure (aOR = 1.60, 95% CI: 1.08–2.38; p = 0.020), and participants with hyperglycemia had higher odds than those without hyperglycemia (aOR = 2.73, 95% CI: 1.48–5.04; p = 0.001). Participants with a family history of hypertension also had higher odds of elevated blood pressure (aOR = 1.66, 95% CI: 1.03–2.68; p = 0.039) (Table 6).

Crude analysis of factors associated with obesity showed that males had lower odds of obesity than females (OR = 0.47, 95% CI: 0.41–0.54; p < 0.001). Wilayat was also significantly associated with obesity (p < 0.001). Compared with Sur, participants from Jaalan Bani Bu Ali + Masirah had higher odds of obesity (OR = 1.86, 95% CI: 1.54–2.24), as did participants from Jaalan Bani Bu Hassan (OR = 1.54, 95% CI: 1.23–1.93). High waist circumference was independently associated with obesity (OR = 10.07, 95% CI: 7.31–13.87; p < 0.001). Hyperglycemia (OR = 2.15, 95% CI: 1.52–3.05; p < 0.001), elevated blood pressure (OR = 2.00, 95% CI: 1.64–2.44; p < 0.001), and family history of obesity (OR = 1.80, 95% CI: 1.24–2.63; p = 0.002) were also associated with higher odds of obesity (Table 5).

After adjustment for all study factors, obesity remained independently associated with wilayat, high waist circumference, hyperglycemia, elevated blood pressure, and family history of diabetes. Compared with Sur, participants from Jaalan Bani Bu Ali + Masirah had higher odds of obesity (aOR = 1.68, 95% CI: 1.10–2.57; p = 0.016). High waist circumference was linked with obesity (aOR = 6.62, 95% CI: 4.23–10.38; p < 0.001). Hyperglycemia (aOR = 2.20, 95% CI: 1.22–3.98; p = 0.009), elevated blood pressure (aOR = 1.60, 95% CI: 1.08–2.39; p = 0.021), and family history of diabetes (aOR = 1.54, 95% CI: 1.03–2.30; p = 0.034) were also significantly associated with obesity (Table 6).

Crude analysis of factors associated with hypercholesterolemia showed that males had higher odds than females (OR = 1.56, 95% CI: 1.37–1.77; p < 0.001). Age was associated with hypercholesterolemia (p = 0.001). Compared with participants aged 39 years, those aged 35 years (OR = 0.68, 95% CI: 0.56–0.82), 36 years (OR = 0.73, 95% CI: 0.60–0.89), and 37 years (OR = 0.80, 95% CI: 0.66–0.98) had lower odds of hypercholesterolemia, whereas the odds for participants aged 38 years (OR = 0.84, 95% CI: 0.69–1.03) were not significantly different. Participants who reported physical activity had higher odds of hypercholesterolemia (OR = 2.03, 95% CI: 1.16–3.55; p = 0.011). Family history of dyslipidemia was also associated with higher odds of hypercholesterolemia (OR = 1.46, 95% CI: 1.13–1.89; p = 0.004) (Table 5).

After adjustment for all study factors, hypercholesterolemia remained independently associated with male sex and family history of dyslipidemia. Male participants had higher odds of hypercholesterolemia than females (aOR = 1.80, 95% CI: 1.34–2.42; p < 0.001). Participants with a family history of dyslipidemia also had higher odds of hypercholesterolemia (aOR = 1.51, 95% CI: 1.04–2.20; p = 0.029) (Table 6).

Discussion

This cross-sectional study identified a substantial burden of NCDs and multimorbidity among individuals aged 35–39 years who participated in the national NCD screening program in South Sharqiyah, Oman, during 2023–2024. The prevalences of hypercholesterolemia, obesity, elevated blood pressure, hyperglycemia, and reduced kidney function were 47.0%, 40.6%, 14.1%, 5.0%, and 0.1%, respectively. Multimorbidity was observed in 23.8% of the study population. The interpretations of the associated factors relative to each NCD are discussed in the following.

Hypercholesterolemia was the most prevalent NCD in the study population. In the 2025 Oman STEPS survey, the prevalence of high cholesterol was 30% among individuals aged 35 years and older.⁷ Another study conducted in Sohar between January and December 2024 reported that the prevalence of dyslipidemia was 76.6% in Omanis aged 36–40 years.⁷ Although the study populations were not identical, these findings collectively highlight the high prevalence of hypercholesterolemia among young adults in Oman, which could be explained by the dietary habits of the adult Omani population. A study conducted in 2023 of fat-related knowledge, attitudes, and practices found that 73% of Omani adults aged ≥18 years had a low composite score for knowledge of dietary fat, 25% found reducing fat intake difficult, and fewer than 5% achieved a high score for fat-related practices.¹¹ In addition, physical inactivity may contribute to this burden as 28% of the Omani population was reported to have insufficient physical activity.⁷

Obesity was the second most prevalent NCD in the study population and was linked with high waist circumference. In 2019, the Omani national NCD screening program reported that the prevalence of obesity was 32.5% among individuals aged 40 years and older in South Sharqiyah Governorate.¹² In the same year, 42.29% of participants aged 18 years and older were classified as obese in Qatar's annual checkup program.⁵ Moreover, 37.7% of Emiratis aged 18–39 years were reported to have obesity in the 2021 annual checkup program.⁴ Despite differences in the study populations, these findings are consistent with the high prevalence of obesity observed across the Gulf region. High waist circumference, which reflects abdominal obesity, is a recognized component of metabolic syndrome. Regardless of whether it is measured by body mass index or waist circumference, previous research has shown that obesity is associated with increased risks of hypertension, diabetes, and dyslipidemia across age groups.^13,14

Elevated blood pressure was also common in the study population and associated with hyperglycemia and male sex. In the Oman STEPS survey, hypertension was found in 40% of individuals aged 35 years and older.⁷ In 2019, the age-standardized prevalence of hypertension among adults aged 30–79 years in Oman was higher in males (48%) than females (39%).¹⁵ Evidence from Qatar also showed that the odds of elevated blood pressure were 2.28 times higher in males than females.⁵

Hyperglycemia, a diagnostic feature of diabetes, was identified in 5.0% of the study population, and correlated with elevated blood pressure and a first-degree family history of diabetes mellitus. Hypertension and diabetes are well recognized to co-occur, and both form part of metabolic syndrome^16,17. In the Oman STEPS survey, diabetes was reported in 20% of individuals aged 18 years and older.⁷ Hyperglycemia has also been reported more frequently among individuals with a first-degree family history of diabetes.¹⁸ The heritability of diabetes has been estimated to range from 30% to 70%.^19,20

Reduced kidney function was the least prevalent NCD, affecting 0.1% of participants. Further analysis of associated factors was not feasible due to the very low number of cases. In 2023, the age-standardized prevalence of chronic kidney disease was reported as 17.3% among adults aged ≥20 years in Oman.²¹ The marked difference between that estimate and the current findings may be explained by differences in age group, exclusion of previously diagnosed cases of chronic kidney disease, and the use of a screening-based approach that primarily captured previously undiagnosed cases.

Multimorbidity was another important finding on this study. Multimorbidity refers to the simultaneous presence of two or more chronic diseases in a single person.²² It represents a major public health concern because of its associations with reduced quality of life, greater functional disability, increased healthcare expenditure, and higher mortality.^22,23 In the present study, nearly one-quarter of participants had multimorbidity, and 66.5% had at least one NCD. The most common multimorbidity pattern was the co-occurrence of hypercholesterolemia and obesity. Multimorbidity was also associated with a family history of dyslipidemia and male sex. Dyslipidemia may contribute to multimorbidity through chronic inflammation, oxidative stress, metabolic dysfunction, and systemic vascular damage.²⁴ In addition, a study conducted in the UAE found that the likelihood of cardiovascular disease was higher among individuals with a positive family history,²⁵ consistent with the long-recognized hereditary contribution to these conditions.¹ Furthermore, it has been that reported males have a higher likelihood of multimorbidity across age groups.²⁶ A systematic review published in 2023 also identified several modifiable contributors to multimorbidity, including obesity, smoking, and physical inactivity.²³ These findings highlight the need for integrated prevention strategies, healthy lifestyle promotion, and patient-centered models of care to effectively address multiple NCDs.

This study had several strengths. First, a large data set derived from real-world programmatic data was used, enhancing its relevance to public health planning and policy development. Comprehensive assessments of multiple NCDs and their associated factors were also conducted. To our knowledge, this study obtained the first data available for this age group in both South Sharqiyah and Oman more broadly. In addition, the present study contributes novel information on multimorbidity within this population. The use of both manual and electronic records may also have improved completeness and overall reliability of the data.

Despite these strengths, the present study had several limitations. First, the cross-sectional design prevented the establishment of temporal relationships and causal inferences between the identified factors and outcomes. Second, the retrospective use of program data resulted in missing or incomplete information for some variables. Little's MCAR test did not provide evidence against the MCAR assumption, but substantial amounts of data were missing in this study. The use of complete-case analysis reduced the effective sample size, potentially decreasing the statistical precision, and it may also have introduced selection bias if the missingness mechanism was not fully captured by the observed variables. Third, selection bias may have occurred because the study only included individuals who attended screening services, and the extent to which participants represented the overall target population could not be fully assessed because an accurate denominator was not available for the eligible population aged 35–39 years. Some potentially important confounding factors, such as dietary habits, were not captured in the screening program, and thus could not be evaluated. Furthermore, the inclusion of multiple covariates in the multivariable models may have resulted in overadjustment, particularly for variables that may have been on the causal pathway or closely related to the outcomes. Misclassification bias could also have occurred because diagnoses were based on single measurements in the screening program, which may not have fully reflected an individual's usual or clinically confirmed status. In addition, behavioral variables such as smoking and alcohol use were self-reported, and thus could have been subject to information bias. The exclusion of individuals with previously diagnosed diabetes, hypertension, and chronic kidney disease may have resulted in underestimating the prevalence of these conditions in the broader population. Due to the very low prevalence of reduced kidney function, its associated factors could not be examined, limiting the interpretation of findings for this outcome. Finally, the findings may have limited generalizability beyond South Sharqiyah Governorate and to populations with different demographic or healthcare characteristics.

Conclusion

In the present study, a substantial burden of selected NCDs was found among Omanis aged 35–39 years who attended the national NCD screening program in South Sharqiyah Governorate. Hypercholesterolemia was the most prevalent condition, followed by obesity, elevated blood pressure, hyperglycemia, and reduced kidney function. The strongest associations were observed between obesity and high waist circumference, hyperglycemia and family history of diabetes, elevated blood pressure and hyperglycemia, and hypercholesterolemia and male sex. Multimorbidity was found in nearly one-quarter of the study population, and was associated with male sex and a family history of dyslipidemia. Hypercholesterolemia and obesity was the most common multimorbidity pattern. These findings provide evidence of a considerable NCD burden in this age group and support the importance of early screening and identifying individuals with a higher prevalence of NCDs and multimorbidity within primary healthcare settings.

Recommendations

• -NCD screening and preventive services for adults aged 35–39 years should continue to be supported within primary healthcare settings, with early identification and follow-up of abnormal findings.
• -Consistent measurement of waist circumference should be maintained during screening, with appropriate follow-up for individuals with high measurements.
• -The strongest observed associations, including high waist circumference with obesity, family history of diabetes with hyperglycemia, and male sex with hypercholesterolemia and multimorbidity, could be considered in routine health assessments.
• -Follow-up of individuals with coexisting NCDs could include assessment of commonly observed combinations, particularly obesity and hypercholesterolemia.
• -Public health education could emphasize the importance of regular health screening and early identification of NCDs among younger adults.
• -Data completeness and quality should be improved within the electronic NCD screening program through routine monitoring of missing information, particularly for variables.

Longitudinal studies are needed to clarify temporal relationships and assess the development and long-term outcomes of NCDs and multimorbidity.

Declaration of generative AI and AI-assisted technologies in the manuscript preparation process

During the preparation of this work, the authors used Consensus to identify and locate relevant scientific literature and evidence related to the research topic. The author also used ChatGPT to improve the language clarity, structure, and organization of part of the manuscript. After using these tools, the authors reviewed and edited the content as needed and take full responsibility for the content of the published article.

Ethical approval

Ethical approval was obtained from the Oman Ministry of Health, Health Studies and Research Approval Committee (Proposal ID: MoH/CSR/25/29828) on May 7, 2025. The study used secondary data, so informed consent was not required, and no direct risk to participants was anticipated. All data were anonymized before analysis and stored securely.

Authors contributions

MMAO: Conceptualization, Methodology, Investigation, Data Curation, Formal Analysis, Writing – Original Draft. EEA-E: Supervision, Validation, Writing – Review & Editing. All authors have critically reviewed and approved the final draft and are responsible for the content and similarity index of the manuscript.

Source of funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Conflict of interest

The authors have no conflicts of interest to declare.