Shifting Prevalence and Risk Factors of Non-Communicable Diseases in Bangladesh: A Comparative Multilevel Analysis of Nationally Representative BDHS Data (2017-2022)

Background Non communicable diseases (NCDs) are significant public health concerns in Bangladesh, placing a heavy burden on the healthcare system. While the situation before COVID-19 was well-documented, it is unclear how the pandemic has impacted the prevalence and risk factors of these diseases. This study provides the first comparative assessment of the prevalence and determinants of diabetes mellitus (DM) and hypertension (HTN) before and after the pandemic, utilizing comprehensive multilevel data source and mixed-effects modeling to capture the shifting epidemiological burden. Methods We analyzed biomarker data from two nationally representative Bangladesh Demographic and Health Surveys (BDHS) 2017-18 and 2022. Diagnosis followed WHO guidelines for fasting blood glucose and blood pressure. Mixed-effect logistic regression models were employed to identify risk factors while accounting for the hierarchical survey design. The Intra-class Correlation Coefficient (ICC) was calculated to quantify the proportion of variance attributable to unobserved community-level heterogeneity. Results The study indicates a profound shift in the national burden of NCDs. Diabetes prevalence more than doubled, from 23% in 2017-18 to 49% in 2022, while hypertension prevalence declined from 22% to 15%, a pattern that may reflect survival bias among individuals with severe comorbidities. The previously strong bidirectional association between DM and HTN weakened in the post pandemic period, hypertension continued to predict diabetes (AOR = 1.17), but diabetes was no longer a significant predictor of hypertension. Community-level determinants became substantially more influential, with local environmental factors playing a much larger role in shaping diabetes prevalence compared to the pre-pandemic period. Urban residence emerged as a significant new risk factor for diabetes in 2022 (AOR = 1.62; 95% CI: 1.34-1.96). Furthermore, the socioeconomic gap in diabetes risk narrowed as the disease affected more wealth groups, while higher educational attainment continued to serve as a protective factor against hypertension (AOR = 0.64; 95% CI: 0.54-0.75). Conclusion The post pandemic landscape of NCDs in Bangladesh shows a clear divergence, marked by a rapid increase in diabetes contrasted with a stabilization in hypertension prevalence. Through comparative mixed effects modeling, this study advances beyond simple prevalence comparisons to demonstrate the growing impact of urban environments and community level factors on metabolic health. These evolving patterns underscore the need for integrated public health strategies that address emerging environmental risks and geographically specific vulnerabilities to support progress toward Sustainable Development Goal Target3.4. Keywords: Bangladesh, BDHS, Community-level variability, COVID 19, Diabetes mellitus, Hypertension, Mixed-effects modeling, Non-communicable diseases, Public health