Recent Trends in Cardiovascular Disease Mortality in Kazakhstan.

Introduction: Cardiovascular diseases (CVD) are the leading cause of mortality in Kazakhstan. In the last decade, Kazakhstan has carried out a number of reforms in the healthcare sector, in particular, to reduce mortality from significant diseases, including CVD. This study aimed to provide the trend of avoidable mortality from CVD in Kazakhstan. Methods: We extracted data from the Bureau of National Statistics of the Agency for Strategic Planning and Reforms of the Republic of Kazakhstan on population by age; mortality rates from chronic rheumatic heart disease (I05-I09); hypertensive diseases (I10-I15); ischaemic heart disease (I20-I25); cerebrovascular diseases (I60-I69) from 2011 to 2021, by gender and 5-year age group (0, 1-4, 5-9, 74). We applied join point regression to calculate the average annual percentage change (AAPC). In addition, crude mortality and trends were calculated per 100,000 population. Results: The avoidable mortality rates, including treatable and preventable mortality decreased between 2011 and 2019 and then increased in the last two years (2020 and 2021) in all four studied disease groups. The AAPC showed that total avoidable mortality rates decreased between 2011 and 2021-6.0 points (-10.6 to - 1.1) (p = 0.017), whereas in males -4.2 (-8.3 to 0.1) and females - 5.1 (-8.8 to -1.3) (p = 0.009). Avoidable mortality rates from ischemic heart disease, cerebrovascular and hypertensive disease has been reduced stronger in male compared to female. The crude mortality declined over the period given; however, among young people mortality is still high. Discussion: Our findings showed that avoidable mortality from CVD decreased over the last years, which could be related to the policy on strengthening the primary care on early diagnosis and detection of CVD and its risk factors. However, primary healthcare facilities need to improve activities on health literacy (drug adherence, risk factors) of the population, including the prevention of CVD.

Prevalence of Impaired Fasting Glucose and Type 2 Diabetes in Kazakhstan: Findings From Large Study.

Type 2 diabetes mellitus (T2DM) is a serious public health problem. A large proportion of patients with T2DM are unaware of their condition. People with undiagnosed T2DM are at a greater risk of developing complications, whereas prediabetes has an elevated risk of becoming T2DM. The aim of this study is to estimate the prevalence of impaired fasting glucose (IFG), undiagnosed and prior-diagnosed T2DM in Kazakhstan. A cross-sectional study was conducted in four geographically remote regions using the WHO STEP survey instrument. The status of T2DM of 4,753 participants was determined using the WHO diagnostic criteria based on fasting plasma glucose (FPG) level. As a result, the survey-weighted prevalence of IFG was 1.9% (95% CI 1.1%; 3.5%) and of T2DM was 8.0% (95% CI 3.8; 15.9). A total of 54% of T2DM have been newly diagnosed with T2DM. Being 55-64 years old (OR = 2.71, 95% CI 1.12; 6.60) and having lowered HDL-C level (OR = 3.72, 95% CI 1.68; 8.23) were found to be independent predictors for IFG. Being older than 45 years, a female (OR = 0.57, 95% CI 0.39; 0.83), having high waist circumference, was associated with newly diagnosed T2DM. Whereas, the age older than 45 years, high waist circumference, and family history of diabetes (OR = 2.42, 95% CI 1.64; 3.54) were associated with preexisting T2DM. This study shows a high prevalence of IFG and a high proportion of newly diagnosed T2DM in Kazakhstan. A series of risk factors identified in the study may be used to strengthen appropriate identification of IFG or undiagnosed patients in healthcare settings to deliver either preventive or therapeutic interventions aimed to reduce the incidence of T2DM or the delay of their complications. Further longitudinal studies are needed to confirm these associations in our population.

Seroprevalence and risk factors for hepatitis B and hepatitis C in three large regions of Kazakhstan.

BACKGROUND & AIMS: Kazakhstan has implemented comprehensive programs to reduce the incidence of Hepatitis B and Hepatitis C. This study aims to assess seroprevalence and risk factors for HBsAg and anti-HCV positivity in three large regions of Kazakhstan. METHODS: A cross-sectional study was conducted in three regions geographically remote from each other. Participants were randomly selected using a two-stage stratified cluster sampling and were surveyed by a questionnaire based on the WHO STEP survey instrument. Blood samples were collected for HBsAg and anti-HCV testing. RESULTS: A total of 4,620 participants were enrolled. The seroprevalence was 5.5% (95%CI: 3.6%-8.4%) for HBsAg and 5.1% (95%CI: 3.5%-7.5%) for anti-HCV antibodies. Both were more prevalent in the western and northern regions than in the southern. A history of blood transfusion was significantly associated with anti-HCV presence, with odds ratios (ORs) of 2.10 (95%CI: 1.37-3.21) and was borderline associated with HBsAg 1.39 (95%CI: 0.92-2.10), respectively. Having a family member with viral hepatitis was also borderline associated (2.09 (95%CI: 0.97-4.50)) with anti-HCV positivity. CONCLUSIONS: This study found a high-intermediate level of endemicity for HBsAg and a high level of endemicity for anti-HCV antibodies in three large regions of Kazakhstan. We found that history of surgery was not associated with HbsAg neither with anti-HCV seropositivity rates. Blood transfusion was associated with anti-HCV seropositivity, however, to investigate effectiveness of the introduced comprehensive preventive measures in health care settings, there is a need to conduct further epidemiological studies.