Abstract
With rapid urbanization, lifestyle changes, and an aging population, non-communicable diseases (NCDs), including hypertension and diabetes, pose significant public health challenges in Bangladesh and many other low- and middle-income countries. This study used machine learning (ML) approaches to develop predictive models for hypertension and diabetes among Bangladeshi adults. Bangladesh Demographic and Health Survey 2022, a nationally representative cross-sectional survey, data were analyzed. Hypertension was defined as systolic/diastolic blood pressure 140/90 mmHg (or more) or taking any antihypertensive medication. Diabetes was defined as having fasting plasma glucose ≥7.0 mmol/L or using any glucose-lowering drugs. Potential predictors included age, sex, education, wealth quintile, overweight/obesity, rural-urban residence, and division of residence. Descriptive analysis was conducted, and six ML models were applied: artificial neural network (ANN), random forest, adaptive boosting (AdaBoost), gradient boosting, XGBoost, and support vector machine (SVM). Models' performance and feature importance were reported. We included 13,847 adults (females: 55%). Sensitivity was high across models (up to 0.96 and 0.90 for diabetes and hypertension, respectively). However, the overall specificity was low, particularly for diabetes. The prevalence of diabetes and hypertension was 16.3% and 20.5%, respectively. For diabetes, AdaBoost had the highest AUC (0.699), and SVM had the highest accuracy (0.836); for hypertension, AdaBoost had the greatest AUC (0.775) and accuracy (0.799). Hypertension was the most common diabetes predictor, while overweight/obesity was the most common predictor for hypertension, followed by age and diabetes. Wealth and sex were moderately influential, with education and geographic factors less so. Low specificity across models indicated challenges in identifying non-cases. This ML-driven analysis identified the bidirectional relationship of hypertension and diabetes along with several other predictors, including overweight/obesity, older age, and richer household wealth quintiles. Our findings underscore the need for integrated screening and lifestyle interventions targeting high-risk groups to mitigate future NCD burden.