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Kamilla Mussina,1 Shirali Kadyrov,2 Ardak Kashkynbayev,3 Sauran Yerdessov,1 Gulnur Zhakhina,1 Yesbolat Sakko,1 Amin Zollanvari,4 Abduzhappar Gaipov1 1Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan; 2Department of Mathematics and Natural Sciences, Suleyman Demirel University, Kaskelen, Kazakhstan; 3Department of Mathematics, Nazarbayev University, Astana, Kazakhstan; 4Department of Electrical and Computer Engineering, School of Engineering and Digital Sciences, Nazarbayev University, Astana, KazakhstanCorrespondence: Abduzhappar Gaipov, Department of Medicine, Nazarbayev University School of Medicine, Kerey and Zhanibek Street 5/1, Astana, 010000, Kazakhstan, Tel +77172706297, Email abduzhappar.gaipov@nu.edu.kzBackground: HIV is a growing public health burden that threatens thousands of people in Kazakhstan. Countries around the world, including Kazakhstan, are facing significant problems in predicting HIV infection prevalence. It is crucial to understand the epidemiological trends of infectious diseases and to monitor the prevalence of HIV in a long-term perspective. Thus, in this study, we aimed to forecast the prevalence of HIV in Kazakhstan for 10 years from 2020 to 2030 by using mathematical modeling and time series analysis.Methods: We use statistical Autoregressive Integrated Moving Average (ARIMA) models and a nonlinear epidemic Susceptible-Infected (SI) model to forecast the HIV infection prevalence rate in Kazakhstan. We estimated the parameters of the models using open data on the prevalence of HIV infection among women and men (aged 15– 49 years) in Kazakhstan provided by the Kazakhstan Bureau of National Statistics. We also predict the effect of pre-exposure prophylaxis (PrEP) control measures on the prevalence rate.Results: The ARIMA (1,2,0) model suggests that the prevalence of HIV infection in Kazakhstan will increase from 0.29 in 2021 to 0.47 by 2030. On the other hand, the SI model suggests that this parameter will increase to 0.60 by 2030 based on the same data. Both models were statistically significant by Akaike Information Criterion corrected (AICc) score and by the goodness of fit. HIV prevention under the PrEP strategy on the SI model showed a significant effect on the reduction of the HIV prevalence rate.Conclusion: This study revealed that ARIMA (1,2,0) predicts a linear increasing trend, while SI forecasts a nonlinear increase with a higher prevalence of HIV. Therefore, it is recommended for healthcare providers and policymakers use this model to calculate the cost required for the regional allocation of healthcare resources. Moreover, this model can be used for planning effective healthcare treatments.Keywords: HIV, prevalence, forecasting, ARIMA model, SI model

Gulzhanat Aimagambetova,1,* Yesbolat Sakko,2,* Arnur Gusmanov,2 Alpamys Issanov,2,3 Talshyn Ukybassova,4 Gauri Bapayeva,4 Aizada Marat,5 Aiymzhan Nurpeissova,6 Abduzhappar Gaipov2 1Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan; 2Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan; 3School of Population and Public Health, University of British Columbia, Vancouver, Canada; 4Clinical Academic Department of Women’s Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan, Kazakhstan; 5Department of Obstetrics and Gynecology #1, NJSC “Astana Medical University”, Nur-Sultan, Kazakhstan; 6Department of Medical Information Analysis of Outpatient and Polyclinic Care, The Republican Center of Electronic Healthcare, The Ministry of Healthcare of the Republic of Kazakhstan, Nur-Sultan, Kazakhstan*These authors contributed equally to this workCorrespondence: Gulzhanat Aimagambetova, Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Kerey and Zhanibek Khan’s Street 5/1, Nur-Sultan, 010000, Kazakhstan, Tel +7 7172 694645, Email gulzhanat.aimagambetova@nu.edu.kzPurpose: Peripartum hysterectomy is a surgical procedure performed as a life-saving surgery to manage severe postpartum hemorrhage. The prevalence of peripartum hysterectomy in high‐resource settings is relatively low. However, maternal mortality due to postpartum hemorrhage and after peripartum hysterectomy remains high in developing countries. To date, there is a lack of information about the rates of peripartum hysterectomy and its common indications in Kazakhstan. Objectives were to study the prevalence, indications, and outcomes of peripartum hysterectomy using nationwide large-scale health-care data from the national registry.Patients and Methods: We performed a descriptive, population‐based study among women who underwent a peripartum hysterectomy in any health-care setting of the Republic of Kazakhstan during the period of 2014– 2018. Data were collected from the Unified Nationwide Electronic Health System (UNEHS).Results: Data included 3838 medical records of women who had a peripartum hysterectomy performed due to specific indications for the period of 5 years (2014– 2018). The median age of the participants was 33 years old, with 60.7% of women aged between 18 and 34 years. The leading indications for peripartum hysterectomy were intrapartum hemorrhage (IPH) and postpartum hemorrhage (PPH) reported in 60% of the cases analyzed. The second most common indication was placental pathology – placental abruption and placenta previa in 9.6% and 7.9% of cases, respectively. In 1633 cases (42.4%), total abdominal hysterectomy was performed, while subtotal hysterectomy was done in 2195 cases (57.0%). Based on these data, the estimated prevalence of peripartum hysterectomies was calculated: overall weighted mean prevalence 1.93 per 1000 deliveries.Conclusion: IPH and PPH are the commonest indications for peripartum hysterectomy followed by placental pathology. Appropriate maternal care during labor and delivery should be reinforced to decrease the incidence of peripartum hysterectomy in Kazakhstan.Keywords: postpartum hemorrhage, maternal mortality, peripartum hysterectomy, epidemiology, Kazakhstan

Tuberculosis (TB) is a highly contagious disease that remains a global concern affecting numerous countries. Kazakhstan has been facing considerable challenges in TB prevention and treatment for decades. This study aims to understand TB transmission dynamics by developing and comparing statistical and deterministic models: Seasonal Autoregressive Integrated Moving Average (SARIMA) and the basic Susceptible-Infected-Recovered (SIR). TB data from 2014 to 2019 were collected from the Unified National Electronic Health System (UNEHS) using retrospective quantitative analysis. SARIMA models were able to capture seasonal variations, with Model 2 exhibiting superior predictive accuracy. Both models showed declining TB incidence and revealed a notable predictive performance evaluated by statistical metrics. In addition, the SIR model calculated the basic reproduction number ([Formula: see text]) below 1, indicating a receding epidemic. Models proved the capability of each to accurately capture trends (SARIMA) and provide mathematical insights (SIR) into TB transmission dynamics. This study contributes to the general knowledge of TB transmission dynamics in Kazakhstan thus laying the foundation for more comprehensive studies on TB and control strategies., (© 2024. The Author(s).)

Background: Peripheral artery disease (PAD) is a global health concern associated with arterial narrowing or blockage, leading to significant morbidity and mortality. The aim of this study is to assess the disease burden and trends in mortality utilizing nationwide administrative health data., Methods: This retrospective study utilized data from the Unified National Electronic Healthcare System (UNEHS) from 2014 to 2021. Patients meeting PAD criteria were included, with demographic and clinical data analyzed. Cox regression and Competing Risk Analysis assessed mortality risks., Results: Between 2014 and 2021, 19,507 individuals were hospitalized due to PAD, with 8,332 (43%) being women and 11,175 (57%) men. The incidence of PAD increased markedly over the observation period, rising from 79 individuals per million population (PMP) in 2014 to 309 PMP in 2021. Concurrent heart failure (HF), acute myocardial infarction (AMI), diabetes, and essential hypertension were prevalent in 50%, 27%, 27%, and 26% of the PAD patients, respectively. Competing Risk Analysis showed a subdistribution hazard ratio (SHR) of 6.53 [95% CI: 4.65-9.19] for individuals over 80 years. Heart failure was associated with lower all-cause HR [0.80, 95% CI: 0.76-0.86, p < 0.001] but higher SHR [1.30, 95% CI: 1.18-1.44, p < 0.001]. Comorbidities such as heart failure, stroke, and acute myocardial infarction significantly increased mortality risks, while essential hypertension was associated with lower risk of death., Conclusion: The significant rise in the incidence rate of PAD underscores the growing burden of the disease, highlighting the urgent need for targeted preventive and management strategies in Kazakhstan., (© 2024. The Author(s).)

Chronic kidney disease (CKD) presents a significant global health challenge, often progressing to end-stage renal disease (ESRD) necessitating renal replacement therapy (RRT). Late referral (LR) to nephrologists before RRT initiation is linked with adverse outcomes. However, data on CKD diagnosis and survival post-RRT initiation in Kazakhstan remain limited. This study aims to investigate the impact of late CKD diagnosis on survival prognosis after RRT initiation. Data were acquired from the Unified National Electronic Health System (UNEHS) for CKD patients initiating RRT between 2014 and 2019. Survival post-RRT initiation was assessed using the Cox Proportional Hazards Model. Totally, 211,655 CKD patients were registered in the UNEHS databases and 9,097 (4.3%) needed RRT. The most prevalent age group among RRT patients is 45-64 years, with a higher proportion of males (56%) and Kazakh ethnicity (64%). Seventy-four percent of patients were diagnosed late. The median follow-up time was 537 (IQR: 166-1101) days. Late diagnosis correlated with worse survival (HR = 1.18, p  < 0.001). Common comorbidities among RRT patients include hypertension (47%), diabetes (21%), and cardiovascular diseases (26%). The history of transplantation significantly influenced survival. Regional disparities in survival probabilities were observed, highlighting the need for collaborative efforts in healthcare delivery. This study underscores the substantial burden of CKD in Kazakhstan, with a majority of patients diagnosed late. Early detection strategies and timely kidney transplantation emerge as crucial interventions to enhance survival outcomes.

According to the Global Burden of Disease (GBD) study, chronic kidney disease (CKD) was prevalent in 697.5 million individuals worldwide in 2017. By 2040, it is anticipated that CKD will rank as the fifth most common cause of death. This study aims to examine the epidemiology of CKD in Kazakhstan and to project future trends in CKD prevalence and mortality by 2030. The retrospective analysis was performed on a database acquired from the Unified National Electronic Health System for 703,122 patients with CKD between 2014 and 2020. During the observation period, 444,404 women and 258,718 men were registered with CKD, 459,900 (66%) were Kazakhs and 47% were older than 50. The incidence rate notably decreased: 6365 people per million population (PMP) in 2014 and 4040 people PMP in 2020. The prevalence changed from 10,346 to 38,287 people PMP, and the mortality rate increased dramatically from 279 PMP to 916 PMP. Kazakhstan's central regions, Turkestan and Kyzylorda were identified as the most burdensome ones. The ARIMA model projected 1,504,694 expected prevalent cases in 2030. The predicted mortality climbed from 17,068 cases in 2020 to 37,305 deaths in 2030. By 2030, the prevalence and mortality of CKD will significantly increase, according to the predicted model. A thorough action plan with effective risk factor management, enhanced screening among risk populations, and prompt treatment are required to lessen the burden of disease in Kazakhstan.

Introduction: Spontaneous pregnancy loss (SPL) is a common health problem that affects 1:10 of childbearing women, and is linked with physical and psychological complications. As the number of nationwide studies on the incidence of SPL is few, especially from middle-income countries, in this study we investigated the epidemiology, complications and outcomes of SPL before 22 weeks of gestation by analyzing large-scale healthcare data from the Unified Nationwide Electronic Healthcare System (UNEHS) in Kazakhstan., Material and Methods: A population-based study among women who experienced SPL in any healthcare setting of the Republic of Kazakhstan during the period of 2014-2019. The International Classification of Diseases (ICD) 10th edition and ICD 9th edition's procedural codes were utilized to retrieve data using relevant diagnostic and procedural codes., Results: In total, 207 317 records of women who have experienced an SPL before 22 weeks of gestation were analyzed from all Kazakhstani regions. The estimated prevalence of SPL was 8.7%, with a 20% decline over a 6-year period. The SPL cases ratio comprises on average 6.2 per 1000 reproductive-age women. Incomplete miscarriage (ICD-10 code "O03.4") was the most common type (37.8%), followed by blighted ovum (ICD-10 code "O02.0"; 34.1%) and missed abortion (ICD-10 code "O02.1"; 13.5%). The most common management methods were dilation and curettage of the uterus (ICD-9 code "69.0"; 84.7%) and aspiration curettage of the uterus (ICD-9 code "65.0"; 15%), whereas medical management was rarely performed (2.6%)., Conclusion: The information available in UNEHS adequately identifies types of miscarriages and treatment methods. Although the prevalence of SPL before 22 weeks of gestation is decreasing, management of miscarriages requires closer attention., (© 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

Objectives: This study aims to estimate tuberculosis (TB) incidence, mortality rates and survival HRs in Kazakhstan, using large-scale administrative health data records during 2014-2019., Design: A retrospective cohort study., Settings: Data for patients with TB in Kazakhstan during 2014-2019, reported in the Unified National Electronic Healthcare System., Participants: Patients with TB in Kazakhstan (ICD-10 (The International Classification of Diseases, 10th revision) codes: A15-A19)., Outcome Measures: Demographic factors, diagnoses and comorbidities were analysed using descriptive, bivariate and multivariable statistical analyses. TB incidence and mortality rates were calculated, and Cox regression and Kaplan-Meier survival analysis were performed to assess risk factors for survival rates., Results: Of the 149 122 patients with TB, 91 437 (61%) were males, and 139 931 (94%) had respiratory TB. From 2014 to 2019, TB incidence declined from 227 to 15.2 per 100 000 individuals, while all-cause mortality increased from 8.4 to 15.2 per 100 000. Age-specific TB incidence was lowest for 0-10 years of age and highest for 20 years of age. Being older, man, urban residence versus rural, retired versus employed, having HIV and having diabetes versus no comorbidities were associated with lower survival rates., Conclusion: To date, this is the largest TB published study for Kazakhstan, characterising TB incidence and mortality trends by demographic factors, and risk factors for survival rates. The findings highlight the need for targeted interventions to address the growing burden of TB, particularly among older adults, men, urban residents and those with HIV and diabetes. The study underscores the importance of using administrative health data to inform policy and health system responses to TB in Kazakhstan., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Cardiovascular diseases contribute to premature mortality globally, resulting in substantial social and economic burdens. The Global Burden of Disease (GBD) Study reported that in 2019 alone, heart attack and strokes accounted for the deaths of 18.6 million individuals. Ischemic heart diseases, including acute myocardial infarction (AMI), accounted for 182 million disability-adjusted life years (DALYs) and it is leading cause of death worldwide., Aim: The aim of this study is to present the burden of AMI in Kazakhstan and describe the outcome of hospitalized patients., Methods: The data of 79,172 people admitted to hospital with ICD-10 diagnosis I21 between 2014 and 2019 was derived from the Unified National Electronic Health System and retrospectively analyzed., Results: The majority of the cohort (53,285, 67%) were men, with an average age of 63 (±12) years, predominantly of Kazakh (38,057, 48%) and Russian (24,583, 31%) ethnicities. Hypertension was the most common comorbidity (61,972, 78%). In males, a sharp increase in incidence is present after 40 years, while for females, the morbidity increases gradually after 55. Throughout the observation period, all-cause mortality rose from 101 to 210 people per million population (PMP). In 2019, AMI account for 169,862 DALYs in Kazakhstan, with a significant proportion (79%) attributed to years of life lost due to premature death (YLDs). Approximately half of disease burden due to AMI (80,794 DALYs) was in age group 55-69 years. Although incidence is higher for men, they have better survival rates than women. In terms of revascularization procedures, coronary artery bypass grafting yielded higher survival rates compared to percutaneous coronary intervention (86.3% and 80.9% respectively) during the 5-year follow-up., Conclusion: This research evaluated the burden and disability-adjusted life years of AMI in Kazakhstan, the largest Central Asian country. The results show that more effective disease management systems and preventive measures at earlier ages are needed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Zhakhina, Gaipov, Salustri, Gusmanov, Sakko, Yerdessov, Bekbossynova, Abbay, Sarría-Santamera and Akbilgic.)

Background and Objectives: Although global HIV pandemic has stabilized, it continues to rise in Eastern Europe and Central Asia due to exponential growth of newly acquired cases. Based on UNAIDS, there are currently 35,000 people living with HIV (PLWH) in Kazakhstan. This alarming HIV epidemiologic situation mandates urgent investigation of causes, routes of transmission and other characteristics in order to halt the epidemic. We aimed to analyze the data of all hospitalized patients for the period of 2014-2019 who tested positive for HIV from the Unified National Electronic Health System (UNEHS) of Kazakhstan., Methods: This cohort study extracted data for all HIV positive patients during 2014-2019 from UNEHS of Kazakhstan to apply descriptive, Kaplan-Meier estimation, and Cox proportional hazards regression model. Crosscheck of the target population data was conducted with tuberculosis, viral hepatitis, alcohol abuse and intravenous drug user (IDU) cohorts in order to create a comprehensive database. All survival functions and factors associated with mortality were tested for significance., Results: The cohort population ( n  = 2,213) mean age was 33.3 ± 13.3 years with 1,375 males (62.1%) and 838 females (37.9%). Incidence rate decreased from 2.05 in 2014 to 1.88 in 2019, however, prevalence and mortality continues to escalate every year, the mortality raised significantly from 0.39 in 2014 to 0.97 in 2019. People aged >50 years, males, retired people, patients from tuberculosis hospital profile had much lower survival probabilities than the corresponding groups. Adjusted Cox regression model death hazard showed strong association of HIV patients with tuberculosis coinfection (HR 1.4, 95% CI 1.1; 1.7, p  < 0.001)., Conclusion: The results of this study demonstrate high rates of HIV mortality, strong association of HIV with TB coinfection, regional, age specific, gender, hospital profile and social status differences that significantly affect HIV prevalence. Since the prevalence of HIV is continuing to increase, more information is necessary for evaluation and implementation of prevention procedures., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Mussina, Abbay, Sakko, Syssoyev, Gusmanov, Abdrakhmanova, Ashimkhanova and Gaipov.)

Diabetes mellitus (DM) affects the quality of life and leads to disability, high morbidity, and premature mortality. DM is a risk factor for cardiovascular, neurological, and renal diseases, and places a major burden on healthcare systems globally. Predicting the one-year mortality of patients with DM can considerably help clinicians tailor treatments to patients at risk. In this study, we aimed to show the feasibility of predicting the one-year mortality of DM patients based on administrative health data. We use clinical data for 472,950 patients that were admitted to hospitals across Kazakhstan between mid-2014 to December 2019 and were diagnosed with DM. The data was divided into four yearly-specific cohorts (2016-, 2017-, 2018-, and 2019-cohorts) to predict mortality within a specific year based on clinical and demographic information collected up to the end of the preceding year. We then develop a comprehensive machine learning platform to construct a predictive model of one-year mortality for each year-specific cohort. In particular, the study implements and compares the performance of nine classification rules for predicting the one-year mortality of DM patients. The results show that gradient-boosting ensemble learning methods perform better than other algorithms across all year-specific cohorts while achieving an area under the curve (AUC) between 0.78 and 0.80 on independent test sets. The feature importance analysis conducted by calculating SHAP (SHapley Additive exPlanations) values shows that age, duration of diabetes, hypertension, and sex are the top four most important features for predicting one-year mortality. In conclusion, the results show that it is possible to use machine learning to build accurate predictive models of one-year mortality for DM patients based on administrative health data. In the future, integrating this information with laboratory data or patients' medical history could potentially boost the performance of the predictive models., (© 2023. The Author(s).)

Background: Although there are numerous sources of epidemiologic information on breast cancer in Kazakhstan, none of them have specifically examined the burden of this disease. Therefore, this article aims to provide an overview of the breast cancer prevalence, incidence, mortality, and distribution and changes over time in Kazakhstan based on nationwide large-scale healthcare data from the National Registry in order to encourage more research on the impact of various diseases at the regional and national levels., Methods: The study cohort included all adult women older than 25 years who were diagnosed with breast cancer in any clinical setting of the Republic of Kazakhstan during the period of 2014-2019. The data were extracted from the Unified Nationwide Electronic Health System (UNEHS) to get an overview of descriptive statistics, incidence, prevalence, and mortality rate calculations and the Cox proportional hazards regression model. All survival functions and factors associated with mortality were tested for significance., Results: The cohort population ( n = 55,465) comprised subjects with the age at the diagnosis of breast cancer from 25 to 97 years, with a mean of 55.7 ± 12.0 years. The majority of the study population belonged to the age group 45-59 years, which is 44.8% of the cohort. The all-cause mortality rate of the cohort is 16%. The prevalence rate increased from 30.4 per 10,000 population in 2014 to 50.6 in 2019. The incidence rate varied from 4.5 per 10,000 population in 2015 to 7.3 in 2016. Mortality rates were stable and high in the senile age patients (75-89 years old). Breast cancer mortality was positively associated with women who had been diagnosed with diabetes, HR 1.2 (95% CI, 1.1-2.3), whereas it was negatively associated with arterial hypertension, HR 0.4 (95% CI, 0.4-0.5)., Conclusion: Overall, Kazakhstan is experiencing an increase in the incidence of breast cancer cases, but the mortality rate has started to decline. The switch to population mammography screening could reduce the breast cancer mortality rate. These findings should be utilized to help Kazakhstan determine what cancer control priorities should be utilized, including the need to implement efficient and affordable screening and prevention programs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Midlenko, Mussina, Zhakhina, Sakko, Rashidova, Saktashev, Adilbay, Shatkovskaya and Gaipov.)

Introduction: A 'learning healthcare system', based on electronic health records and other routinely collected healthcare data, would allow Real World Data (RWD) to be continuously fed into the system, ensuring that with every new patient treated, we know more overall about the practice of medicine. A judicious use of RWD would complement the traditional evidence from clinical research, for the benefit of all stakeholders involved in healthcare. Lack of data on disease epidemiology in Kazakhstan resonates with lower life expectancy and poorer health indicators compared to countries with analogous income per capita. Usage of primary data collection methods to fill these gaps require additional financial and human resources. Usage of big data, which is routinely collected though healthcare information systems, is considered as a competitive alternative in described circumstances., Objective: Development of the Unified National Electronic Healthcare System (UNEHS) in Kazakhstan allowed the creation of research databases to investigate epidemiology of numerous diseases. UNEHS research databases endorse extensive research activities due to a prospective follow-up, coverage of the whole Kazakhstani population and relatively lower expenses to conduct epidemiological studies. This review paper aims to introduce the content and descriptive data on research databases on population-based registries of UNEHS and to discuss opportunities and limitations of its usage., Results and Discussion: UNEHS databases include medical data on 36.4% of an adult population of Kazakhstan. Research databases presented in this paper contain critical variables that can be utilized for investigation of disease epidemiology, effectiveness of provided medical procedures and infectious disease epidemiology. A few examples accompany a detailed elaboration on the possibilities of research database utilization in epidemiological research., Conclusion: Considering numerous advantages, the UNEHS research databases are expected to greatly contribute to healthcare in Kazakhstan by providing critical data on disease epidemiology. To warrant long-term usage and high research output several concerns and limitations should be addressed as well., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

A Global Burden of Disease (GBD) study reported that 9.6 million years lived with disability (YLDs) were lost due to hip and knee osteoarthritis (KOA) in 2017. Although the GBD study presents the disease burden at the global level, there is no information on any Central Asian country. This study aims to investigate the epidemiology of knee osteoarthritis in Kazakhstan. The data of 56,895 people with KOA between 2014-2020 was derived from the Unified National Electronic Health System of Kazakhstan and retrospectively analyzed. The majority of the cohort (76%) were women, of Kazakh ethnicity (66%), and older than 50 years of age (87%). The risk of gonarthrosis escalated for women after 50 years and peaked at 75 years with a rate of 3062 females admitted to hospital per 100,000 women in the population. This observation is approximately three times higher than for men of the same age group. A geographical analysis showed that the Jambyl oblast, West Kazakhstan, North Kazakhstan, and the Akmola oblast have the highest burden of disease. During the observation period, 127,077 age-adjusted YLDs were lost due to knee osteoarthritis. This is the first study in Kazakhstan to investigate the burden of knee osteoarthritis. This research recognizes age and sex-based differences, and regional disparities in the incidence of knee osteoarthritis. This knowledge can lead to the development of more specific diagnostic approaches and gender-personalized therapy protocols for patients.

Background: The comprehensive epidemiology and impact of climate on viral meningitis (VM) in Kazakhstan are unknown. We aimed to study the incidence, in-hospital mortality and influence of climatic indicators on VM from 2014 to 2019., Methods: Nationwide electronic healthcare records were used to explore this study. ICD-10 codes of VM, demographics, and hospital outcomes were evaluated using descriptive statistics and survival analysis., Results: During the 2014-2019 period, 10,251 patients with VM were admitted to the hospital. 51.35% of them were children, 57.85% were males, and 85.9% were from the urban population. Enteroviral meningitis was the main cause of VM in children. The incidence rate was 13 and 18 cases per 100,000 population in 2014 and 2019, respectively. Case fatality rate was higher in 2015 (2.3%) and 2017 (2.0%). The regression model showed 1°C increment in the daily average temperature might be associated with a 1.05-fold (95% CI 1.047-1.051) increase in the daily rate of VM cases, 1hPa increment in the average air pressure and 1% increment in the daily average humidity might contribute to a decrease in the daily rate of VM cases with IRRs of 0.997 (95% CI 0.995-0.998) and 0.982 (95% CI 0.981-0.983), respectively. In-hospital mortality was 35% higher in males compared to females. Patients residing in rural locations had a 2-fold higher risk of in-hospital death, compared to city residents. Elderly patients had a 14-fold higher risk of in-hospital mortality, compared to younger patients., Conclusion: This is the first study in Kazakhstan investigating the epidemiology and impact of climate on VM using nationwide healthcare data. There was a tendency to decrease the incidence with outbreaks every 5 years, and mortality rates were higher for Russians and other ethnicities compared to Kazakhs, for males compared to females, for elder patients compared to younger patients, and for patients living in rural areas compared to city residents. The climatic parameters and the days of delay indicated a moderate interaction with the VM cases., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Yerdessov, Zhunussova, Imanova, Gusmanov, Sakko, Zhakhina, Mussina, Syssoyev, Alimbayev, Abbay, Sarria-Santamera and Gaipov.)

Background: We aimed to explore descriptive epidemiology of T1 and T2 Diabetes Mellitus (DM) and to investigate demographic factors and comorbidities associated with all-cause mortality by aggregating and utilizing large-scale administrative healthcare data from the Unified National Electronic Health System (UNEHS) of Kazakhstan for 2014-2019 years period., Methods: A total of 475,539 individuals were included in the analyses. The median years of follow-up for Type 1 DM patients accounted for 4.7 years and 4.5 years in Type 2 DM patients. We used Kaplan-Meier and log-rank test to calculate failure function and differences in survival by age, sex, ethnicity, and comorbidities with all-cause mortality for Type 1 and Type 2 DM. Cox proportional hazards regression analysis was used to obtain crude and adjusted hazard ratios., Results: Prevalence of Type 1 and Type 2 DM increased 1.7 times from 2014 to 2019. Mortality of Type 1 and Type 2 DM also increased 4 times and 6 times from 2014 to 2019, respectively. Male sex, older age and Kazakh ethnicity were associated with a higher risk of all-cause death compared to females, younger age and other nationalities than Kazakh in patients with Type 1 and Type 2 DM. Coronary artery disease, diabetic nephropathy, stroke, amputations and neoplasms were associated with a higher risk of all-cause death., Conclusion: The prevalence and mortality rate of Type 1 and Type 2 DM increased during the years 2014-2019 in Kazakhstan. Male sex, older age and Kazakh ethnicity were associated with a higher risk of all-cause death compared to females, younger age and other nationalities than Kazakh. Coronary artery disease, diabetic nephropathy, stroke, amputations and neoplasms were associated with a higher risk of all-cause death., (© 2022. The Author(s).)

Objectives: Major gynecological surgeries are indicated for the treatment of female genital pathologies. It is key to examine trends in gynecologic surgical procedures and updated recommendations by international gynecological societies to find opportunities for improvement of local guidelines. To date, a very limited number of reports have been published on the epidemiology of gynecological surgeries in Kazakhstan. Moreover, some local guidelines for gynecological conditions do not comply with the international recommendations. Thus, this study aims to investigate the prevalence, indications, and outcomes of the most common major gynecological surgeries by analyzing large-scale Kazakhstani healthcare data, and identifying possible opportunities for improvement of the local public health and clinical practice., Methods: A descriptive, population-based study among women who underwent a gynecological surgery in healthcare settings across the Republic of Kazakhstan during the period of 2014-2019 was performed. Data were collected from the Unified Nationwide Electronic Health System (UNEHS)., Results: In total, 80,401 surgery cases were identified and analyzed in the UNEHS database for a period of 6 years (2014-2019). The median age of the participants was 40 years old, with 61.1% in reproductive age. The most prevalent intervention was a unilateral salpingectomy-29.4%, with 72.6% patients aged between 18-34 years. The proportion of different types of hysterectomies was 49.4%. In 20% of cases, subtotal abdominal hysterectomy was performed due to uterine leiomyoma. The proportion of laparoscopic procedures in Kazakhstani gynecological practice is as low-11.59%., Conclusions: The Kazakhstani public health and gynecological care sector should reinforce implementation of contemporary treatment methods and up-to-date policies and guidelines. The overall trends in surgical procedures performed for gynecological pathologies, including uterine leiomyoma and ectopic pregnancy treatment, should be changed in favor of the minimally invasive methods in order to adopt a fertility-sparing approach.

There is a lack of information on the epidemiology of acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) in developing countries. This research presents incidence and mortality rates of stroke patients based on hospital admission and discharge status in one of the Central Asian countries by analysis of large-scale healthcare data. The registry data of 177,947 patients admitted to the hospital with the diagnosis of stroke between 2014 and 2019 were extracted from the National Electronic Health System of Kazakhstan. We provide descriptive statistics and analyze the association of socio-demographic and medical characteristics such as comorbidities and surgical treatments. Among all stroke patients, the incidence rate based on hospital admission of AIS was significantly higher compared to SAH and ICH patients. In 5 year follow-up period, AIS patients had a better outcome than SAH and ICH patients (64.7, 63.1 and 57.3% respectively). The hazard ratio (HR) after the trepanation and decompression surgery was 2.3 and 1.48 for AIS and SAH patients; however, it was protective for ICH (HR = 0.87). The investigation evaluated an increase in the all-cause mortality rates based on the discharge status of stroke patients, while the incidence rate decreased over time., (© 2022. The Author(s).)

The in-depth epidemiology of hypertension has not been studied in Kazakhstan (KZ) yet. We aimed to investigate the crude; age and sex standardized prevalence, incidence, and all-cause mortality rate among hypertensive patients in Kazakhstan using a large-scale Unified National Electronic Health System (UNEHS) for the period 2014-2019. Hypertension was defined based on the ICD-10 codes (ICD-code: I10; I11; I12; I13). Of 1,908,419 patients, 1,186,706 (62.18%) were females and 721,713 (37.82%) were males. The majority of the patients (56.3%) were ethnic Kazakhs, 26.6% were Russians, and 16.2% were of other ethnicities. In 2014, the crude rates of prevalence, incidence, and mortality were 3661, 1396.1, and 33.1 per 100,000 population, respectively. The overall prevalence, incidence, and mortality rates among hypertension patients had a gradual increase over the period 2014-2019. The sex and age adjusted rates demonstrate the same trend throughout the entire period. We observed 71% higher risk of crude death in males comparing to females (Hazard ratio (HR): 1.71 [95%CI: 1.69-1.72]); Russian and other ethnicities had 1.56-fold (95%CI: 1.54-1.58 and 1.43-fold (95%CI: 1.41-1.45) higher risk of all-cause death compared to Kazakhs, and the elderly group had the highest risk of death (Hazard ratio (HR): 35.68 [95%CI: 28.11-45.31]) comparing to the younger generation, which remained significant after adjustment to age and sex. Overall, these findings show statistically significant lower survival probability in male patients compared to female, in older patients compared to younger ones, and in patients of Russian and other ethnicities compared to Kazakh.

Background: During the spike of COVID-19 pandemic in Kazakhstan (June-2020), multiple SARS-CoV-2 PCR-test negative pneumonia cases with higher mortality were reported by media. We aimed to study the epidemiologic characteristics of hospitalized PCR-test positive and negative patients with analysis of in-hospital and post-hospital mortality. We also compare the respiratory disease characteristics between 2019 and 2020., Methods: The study population consist of 17,691 (March-July-2020) and 4600 (March-July-2019) hospitalized patients with respiratory diseases (including COVID-19). The incidence rate, case-fatality rate and survival analysis for overall mortality (in-hospital and post-hospital) were assessed., Results: The incidence and mortality rates for respiratory diseases were 4-fold and 11-fold higher in 2020 compared to 2019 (877.5 vs 228.2 and 11.2 vs 1.2 per 100,000 respectively). The PCR-positive cases (compared to PCR-negative) had 2-fold higher risk of overall mortality. We observed 24% higher risk of death in males compared to females and in older patients compared to younger ones. Patients residing in rural areas had 66% higher risk of death compared to city residents and being treated in a provisional hospital was associated with 1.9-fold increased mortality compared to those who were treated in infectious disease hospitals., Conclusion: This is the first study from the Central Asia and Eurasia regions, evaluating the mortality of SARS-CoV-2 PCR-positive and PCR-negative respiratory system diseases during the peak of COVID-19 pandemic. We describe a higher mortality rate for PCR-test positive cases compared to PCR-test negative cases, for males compared to females, for elder patients compared to younger ones and for patients living in rural areas compared to city residents.

Introduction: In Kazakhstan, a post-Soviet country in Central Asia, salt intake is estimated as high, potentially contributing to the morbidity and mortality from cardiovascular diseases. The aim of this study was to explore salt intake in residents of the capital of Kazakhstan, Nur-Sultan., Methods: An online cross-sectional survey of knowledge, attitudes, and behaviors on salt intake among young adult residents of the capital city of Kazakhstan was conducted ( n = 237). Bivariate and multivariate linear regression analyses were performed., Results: Although 95% (n=225) reported knowledge on the adverse health effects of high salt intake, older respondents were more aware of its association with high blood pressure (p = 0.007), heart disease (p = 0.037), and heart attack (p = 0.002). Only one-third (n=79) correctly identified the recommended level of daily salt intake. Females reported more awareness of Kazakhstani people consuming salt more than recommended (p = 0.0027) and that processed products constituted the major source of salt in diet (p = 0.007). General dietary concern (p < 0.001), high self-assessmen of salt intake (p < 0.001), and older age (p = 0.012) were found to be adjusted predictors of salt-reducing behavior., Conclusions: Lack of reported knowledge on salt-health relationship is of concern, especially among young males. A greater dietary concern and individual awareness of the excessive salt consumption is likely to assist in reducing salt intake. Further studies are required to validate the findings of this pilot study on a bigger population level in order to provide a basis for future salt related interventions and policy changes in Kazakhstan., (Copyright © 2020 Mina Aubakirova, Marat Sultanov, Aidarkhan Izimov, Yesbolat Sakko, Torekhan Bex, Anuar Mussagazin, Raushan Alibekova.)