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Discordance between simplified traditional screening metrics and multidimensional wellbeing profiles in urban adults without known chronic disease: a cross-sectional study

Year: 2026

Type: article

Abstract: Traditional population-level screening often relies on simplified physiological indicators such as body mass index and blood pressure. These measures are scalable but may not capture functional, behavioral, and lifestyle-related wellbeing domains such as muscle strength, fatigue, sleep quality, pain, physical activity, and screen exposure. To examine whether an exploratory sample-normalized composite wellbeing framework identifies multidimensional low-wellbeing profiles among urban adults without known chronic disease, including individuals classified as low-risk by simplified traditional screening metrics. A cross-sectional study was conducted among 1500 urban adults aged 18–60 years in Hyderabad, India, between April and October 2025. Participants were recruited from workplace health camps, outpatient screening settings, and community outreach programs using convenience sampling. Simplified traditional screening metrics included body mass index category, blood pressure category, and absence of diagnosed chronic disease. Six functional and lifestyle domains were assessed: handgrip strength, fatigue, sleep quality, chronic musculoskeletal pain, physical activity, and daily screen exposure. Domain variables were standardized using z-score normalization after directional alignment so that higher scores reflected better wellbeing. The exploratory Composite Wellbeing Index was calculated as the mean of the six standardized domain scores. Participants were classified into high, intermediate, and low wellbeing groups using k-means clustering. Discordance between simplified traditional screening classification and low multidimensional wellbeing was examined using cross-tabulation. Domain-level characteristics of discordant participants were described. Of 1832 individuals screened, 1500 were included in the final analytic sample. Simplified traditional screening metrics classified 936 participants, or 62.4%, as low-risk. The exploratory composite wellbeing framework classified 399 participants, or 26.6%, as having a low-wellbeing profile. Among participants classified as low-risk by simplified traditional screening metrics, 269 of 936, or 28.7%, demonstrated low multidimensional wellbeing. The discordant low-wellbeing subgroup showed higher frequencies of low handgrip strength, poor sleep quality, physical inactivity, prolonged screen exposure, and chronic musculoskeletal pain compared with concordant low-risk participants. Because these variables were components of the composite framework, this analysis was interpreted as descriptive domain-level decomposition rather than independent risk-factor modelling. In this exploratory cross-sectional study, a sample-normalized multidimensional wellbeing framework identified a subgroup of adults without known chronic disease who had low functional-lifestyle wellbeing despite being classified as low-risk by simplified traditional screening metrics. These findings suggest that functional and lifestyle domains may provide complementary descriptive information in workplace and community health assessments. Longitudinal validation, external replication, and population-specific normative cut-offs are required before this framework can be used for prediction, clinical decision-making, or public-health screening.

Source: Discover Public Health

DOI: 10.1186/s12982-026-02362-7