Risk factor clusters for non-communicable diseases in adolescents in Eastern Cape, South Africa

Background: The increasing prevalence of non-communicable diseases (NCDs) among adolescents in South Africa is a growing public health concern. Aim: To examine the clustering of NCD risk factors, with a focus on gender, socio-economic status (SES) and perceived stress among adolescents. Setting: The study involved adolescents from eight schools in Buffalo City Metropolitan Municipality and Amatole district, Eastern Cape. Methods: A stratified random sample of 266 adolescents (aged 12 years–18 years) was assessed for anthropometric, physiological, and perceived stress measures. Data included body mass index (BMI), blood pressure (BP), cholesterol, glucose levels, and perceived stress (via the Perceived Stress Scale). Analysis involved descriptive statistics, Chi-square tests, t-tests, and k-means clustering. Results: Females (n = 155) showed a higher prevalence of NCD risk factors, with 80.2% classified as overweight or obese compared to 19.8% of males, and 77.2% had elevated cholesterol versus 22.8% of males. Perceived stress was higher in affluent schools (59.8%) despite fewer metabolic risks. K-means analysis identified four health profiles with significant SES and health differences (p < 0.001). Cluster 1 (high SES) showed elevated BP, BMI, and stress, while Clusters 2–4 (low SES) varied in risks, with Cluster 4 showing the highest BP and metabolic risks despite low stress. Conclusion: These results highlight unique health profiles and risk factors across socio- economic contexts, with female adolescents from lower socio-economic backgrounds facing greater metabolic risks. Contribution: This Study provides original insights into the interplay between gender, SES and perceived stress in shaping NCD risk among South African adolescents.