NCD Risk Profiles and Metabolic Health Determinants across the Adult Life Course in Ethiopia

Abstract Background Non-communicable diseases (NCDs) are rising rapidly in Ethiopia, yet comprehensive national data on the distribution and determinants of metabolic and behavioural risk factors across the adult life course remain limited. Methods We analysed the 2015 Ethiopia STEPS survey (n = 9,800 adults, 95.5% response rate). A multimorbidity risk index was constructed from six behavioural risk factors: tobacco use, khat chewing, harmful alcohol use, physical inactivity, inadequate diet, and overweight/obesity with ≥ 3 factors defined as high-risk clustering. Metabolic outcomes included metabolic syndrome, hypertension, diabetes, and dyslipidaemia. Weighted descriptive statistics and multivariable logistic regression were conducted, accounting for complex survey design. Results Poor fruit/vegetable consumption (98.2%), physical inactivity (66.0%), khat chewing (23.5%), harmful alcohol use (15.0%), tobacco use (5.4%), and overweight/obesity (2.3%) were prevalent. One in seven adults (14.3%) had ≥ 3 risk factors. Metabolic syndrome prevalence was 14.7%; hypertension, 15.6%; diabetes, 3.2%; and low HDL cholesterol, 68.7%. Risks increased with age, peaking at 45–59 years. Urban residence (aOR 1.75 for hypertension, 1.49 for diabetes), male sex (aOR 1.78 for high-risk clustering), and higher income (aOR 1.35 for hypertension) were associated with worse outcomes. Higher education was protective (aOR 0.68 for high-risk clustering). Khat chewing independently raised the odds of hypertension (aOR 1.34) and metabolic syndrome (aOR 1.29). Conclusions Clustering of unhealthy lifestyles and metabolic risks is high across the adult life course in Ethiopia. Khat chewing is a significant but neglected risk factor. Life-course-specific, context-tailored interventions are urgently needed to prevent NCDs and reduce the growing burden of metabolic disease.