📖 ABSTRACT/OVERVIEW
Non-communicable diseases are rapidly reshaping Nigeria's disease burden, with urban environments generating complex social, economic, and behavioural risk exposures that are inadequately captured by single-factor analytical models. This study constructs and tests a structural equation model of social determinants and non-communicable disease risk accumulation among urban adults in four purposively selected cities representing Nigeria's geopolitical zones: Lagos, Kano, Port Harcourt, and Enugu. A cross-sectional multi-city survey is conducted with 2,400 adults aged 25 to 65 years, applying validated instruments to measure income, educational attainment, employment precarity, residential environment quality, social connectedness, dietary patterns, physical inactivity, tobacco use, and alcohol consumption. Biomarkers including fasting blood glucose, blood pressure, total cholesterol, and body mass index are collected. Structural equation modelling in AMOS and confirmatory factor analysis in R are used to examine direct and indirect pathways through which distal social determinants produce proximal behavioural risks that cluster into cumulative non-communicable disease risk scores. The study draws on the Commission on Social Determinants of Health framework and life-course epidemiology theory. Original contributions include a tested structural model calibrated to the Nigerian urban context and the identification of critical intervention points along the causal pathway. Findings will advance theoretical understanding of non-communicable disease aetiology in African cities and inform multi-sectoral prevention policy. Keywords: social determinants, non-communicable diseases, structural equation modelling, urban Nigeria, risk accumulation.
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