Regional differences in cardiovascular mortality in Kazakhstan: further evidence for the ‘Russian mortality paradox’?

Davletov, Kairat; Berkinbayev, Salim; Battakova, Zhamilya; Vujnović, Melita; Rechel, Bernd

doi:10.1093/eurpub/ckv019

Cited by 17 publications

(18 citation statements)

References 13 publications

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“…Higher consumption of alcohol in men might partly explain the difference in IHD burden between men and women in these countries. [36] , [37] For example, a study in Uzbekistan, showed that males drink six times as much as females and 1 in 9 male drinkers binged. [38] As for tobacco use and physical activity, findings of the 2014 WHO STEPwise approach to surveillance (STEPS) survey indicated that tobacco was of concern in Uzbekistan as 25% of Uzbek men smoke, and 1 in 6 adults was insufficiently active [38] .…”

Section: Discussionmentioning

confidence: 99%

Burden of Ischemic Heart Disease in Central Asian Countries, 1990–2017

Lui

Safiri

Mereke

et al. 2021

IJC Heart & Vasculature

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Background The burden of ischemic heart disease (IHD) is high. There is limited information on the burden of IHD in identified high risk areas like Central Asia (CA) which is comprised of Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Turkmenistan, Mongolia, Uzbekistan and Tajikistan. This study addresses the burden of IHD in CA at the regional and country levels. Methods Using data from the latest iteration of the Global Burden of Disease Study (GBD), this study provides age-adjusted mortality, prevalence, and Disability Adjusted Life Years (DALYs) of IHD by sex in the CA region, and national levels for countries in this region from 1990 to 2017. Results The CA region has a higher IHD burden than the rest of the world over the studied period. Amongst the countries within this region, age-standardized mortality and DALY rates in Uzbekistan are the highest not only in CA but worldwide, while Armenia consistently has the lowest IHD burden in CA. Unhealthy diet, high systolic blood pressure and LDL-cholesterol are the risk factors with the highest attributable IHD DALYs. Conclusion Increasing burden of IHD over time in CA can be partially explained by the economic crisis in the 1990 s. There is considerable variation in IHD DALY rates among countries in the CA region. The reasons for such differences are likely multifactorial such as differences in risk factors distribution, health care effectiveness, political, social and economic factors.

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Section: Discussionmentioning

confidence: 99%

Burden of Ischemic Heart Disease in Central Asian Countries, 1990–2017

Lui

Safiri

Mereke

et al. 2021

IJC Heart & Vasculature

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“…The study reported that despite having higher levels of education and socioeconomic status than Kazakhs, ethnic Russians in Kazakhstan appear to have a higher mortality rate than other ethnicities. Destructive lifestyle such as alcohol consumption, heavy smoking, high-fat diet and lack of physical activity, are claimed to be the major contributing factors for the higher mortality rate amongst Russians [ 23 ]. However, the important question, whether there are other contributing factors besides lifestyle warrants further investigation.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of dialysis-treated end-stage renal disease patients in Kazakhstan: data from nationwide large-scale registry 2014–2018

et al. 2020

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Background The epidemiology of dialysis patients has been little studied in developing countries and economies in transition. We examined the prevalence, incidence and mortality rate of dialysis patients in Kazakhstan, via aggregation and utilization of large-scale administrative healthcare data. Methods The registry data of 8898 patients receiving dialysis therapy between 2014 and 2018 years were extracted from the Unified National Electronic Health System (UNEHS) and linked with the national population registry of Kazakhstan. We provide descriptive statistics of demographic, comorbidity and dialysis-related characteristics. Results Among all patients undergoing maintenance dialysis for end-stage renal disease (ESRD), there were 3941 (44%) females and 4957 (56%) males. 98.7% of patients received hemodialysis and 1.3% peritoneal dialysis. The majority of the patients (63%) were ethnic Kazakhs, 18% were Russians and 19% were of other ethnicities. The prevalence and incidence rate in 2014 were 135.2 and 68.9 per million population (PMP), respectively, which were different in 2018 [350.2 and 94.9 PMP, respectively]. Overall mortality rate among dialysis patients reduced from 1667/1000 patient-years [95%Confidence Interval (CI): 1473–1886] (PY) in 2014 to 710/1000PY [95%CI: 658–767] in 2018. We observed 13% lower crude survival probability in females compared to males and in older patients compared to younger ones. Russian ethnicity had 58% higher risk of death, while other ethnicities had 34% higher risk of death compared to in those of Kazakh ethnicity. Conclusion We describe for the first time in Kazakhstan an increase in the prevalence and incidence of ESRD on dialysis, while mortality rate decreased over time, during 2014–2018. We observed statistically significant lower survival probability in female dialysis patients compared to males, in older patients compared to younger ones, and in patients of Russian ethnicity compared to Kazakh.

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“…While many studies worldwide reported geographic differences within countries in macrovascular disease or in cardiovascular mortality in the general population [ 42 – 49 ], only few studies reported the regional variations among people with type 2 diabetes. The data from the French national mortality registry from 2002 showed that the burden of diabetes-related mortality was higher in the Northeast than in the West of France [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

Regional differences of macrovascular disease in Northeast and South Germany: the population-based SHIP-TREND and KORA-F4 studies

et al. 2018

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BackgroundPrevious studies found regional differences in the prevalence and incidence of type 2 diabetes between Northeast and South of Germany. The aim of this study was to investigate if regional variations are also present for macrovascular disease in people with type 2 diabetes and in the general population. A further aim was to investigate if traditional risk factors of macrovascular complications can explain these regional variations.MethodsData of persons aged 30–79 from two regional population-based studies, SHIP-TREND (Northeast Germany, 2008–2012, n = 2539) and KORA-F4 (South Germany, 2006–2008, n = 2932), were analysed. Macrovascular disease was defined by self-reported previous myocardial infarction, stroke or coronary angiography. Multivariable logistic regression was performed to estimate odds ratios (OR) and 95% confidence intervals (CI) for prevalence of macrovascular disease in persons with type 2 diabetes and in the general population.ResultsThe prevalence of macrovascular disease in persons with type 2 diabetes and in the general population was considerably higher in the Northeast (SHIP-TREND: 32.8 and 12.0%) than in the South of Germany (KORA-F4: 24.9 and 8.8%), respectively. The odds of macrovascular disease in persons with type 2 diabetes was 1.66 (95% CI: 1.11–2.49) in the Northeast in comparison to the South after adjustment for sex, age, body mass index, hypertension, hyperlipidemia and smoking. In the general population, SHIP-TREND participants also had a significantly increased odds of macrovascular disease compared to KORA-F4 participants (OR = 1.63, 95% CI: 1.33–2.00). After excluding coronary angiography (myocardial infarction or stroke only), the ORs for region decreased in all models, but the difference between SHIP-TREND and KORA-F4 participants was still significant in the age- and sex-adjusted model for the general population (OR = 1.34, 95% CI: 1.01–1.78).ConclusionsThis study provides an indication for regional differences in macrovascular disease, which is not explained by traditional risk factors. Further examinations of other risk factors, such as regional deprivation or geographical variations in medical care services are needed.

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Regional differences in cardiovascular mortality in Kazakhstan: further evidence for the ‘Russian mortality paradox’?

Cited by 17 publications

References 13 publications

Burden of Ischemic Heart Disease in Central Asian Countries, 1990–2017

Burden of Ischemic Heart Disease in Central Asian Countries, 1990–2017

Epidemiology of dialysis-treated end-stage renal disease patients in Kazakhstan: data from nationwide large-scale registry 2014–2018

Regional differences of macrovascular disease in Northeast and South Germany: the population-based SHIP-TREND and KORA-F4 studies

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