EPIDEMIOLOGIA OSTREGO ZAWAŁU SERCA NA UKRAINIE, JAK I W REGIONIE POŁTAWY

Viacheslav M. Zhdan, Grigory А. Oksak, Oleh V. Radomskyi, Denis I. Shaposhnikov

Higher state educational institution of Ukraine “Ukrainian Medical Stomatological Academy”, Poltava, Ukraina

Abstract

Introduction: The number of elderly people in society is increasing. Alike in all European countries, ageing population in Ukraine is observed, which affects the structure and dynamics of morbidity and mortality of the population towards the increase of chronic non-communicable diseases, which is the epidemic of the 21st century civilization. In 2010 in Ukraine, the proportion of people over the age of 60 was 20.6% of the total. The prevalence of all diseases among the elderly in 2010 amounted to 283522,8, and among the general population – 186746,4. The first place among them is circulatory system diseases (CSD), a specific weight of which is 52.1%

The aim: Aim of the study was to do an epidemiological analysis of acute myocardial infarction among the population in the Poltava region and Ukraine in the age group of 25-64 years, depending on gender, age on the basis of the WHO standard program “Register of acute myocardial infarction”.

Materials and methods: For the analysis of the morbidity and disability of the MI (myocardial infarction) the data of the statistical collections of the population of Ukraine for 2004-2015 were used. The incidence of the MI was analyzed according to the indicator “registered patients: adults (with the diagnosis established for the first time in life) in terms of 10 thousand population”.

Review and conclusions: The incidence of AMI prevails among residents of urban areas, both in Ukraine and in the Poltava region, does not depend on the distance from the regional center, where the regional hospital and the higher educational institution are located, this indicator is significantly prevalent among people of retirement age, prevails in men.

 

Wiad Lek 2018, 71, 3 cz. II, -756

 

Introduction

The number of elderly people in society is increasing. Alike in all European countries, ageing population in Ukraine is observed, which affects the structure and dynamics of morbidity and mortality of the population towards the increase of chronic non-communicable diseases, which is the epidemic of the 21st century civilization. In 2010in Ukraine, the proportion of people over the age of 60 was 20.6% of the total. The prevalence of all diseases among the elderly in 2010 amounted to 283522,8, and among the general population – 186746,4. The first place among them is circulatory system diseases (CSD), a specific weight of which is 52.1% [1].

Overall, about 13 million people have been watched for 10 years. 166,000 patients with myocardial infarction were registered, more than 300,000 men and women were selected and tested for their cardiovascular risk factors and many other medical data. In western countries, where the reduction in mortality from coronary heart disease was an average of 2-3% per year, two thirds of this decrease can be explained by a decrease in the incidence of coronary heart disease and one-third decrease in CVD (cardiovascular diseases) mortality. When changes in risk factors for changes in the frequency of IHD (Ischemic heart disease) events were analyzed in men over a period of 10 years in all MONICA (Monitoring trends and determinants in cardiovascular disease) populations, it turned out that the greatest contribution to the reduction of coronary heart disease was due to the reduction of smoking. On a global scale, seven study countries, Framingham Heart Study, and the WHO (World Health Organization) MONICA project have made a major contribution to the development of epidemiology and the prevention of cardiovascular disease [2].

The incidence of coronary heart disease has decreased over time in developed countries. Several messages have shown this tendency. First, in the National Health and Nutrition Data (NHANES) analysis of the I Epidemiological Survey, which compared with 1971 to 1982 (10869 patients), as well as from 1982 to 1992 (9,774 patients) – two cohorts of subjects, the incidence of coronary heart disease decreased from 133 to 114 cases per 10,000 people per year. [3].

A further decrease was observed in the whole of cardiovascular disease (from 294 to 225 cases per 10,000 people a year). Scientific research into the incidence of coronary heart disease for a long time was also held at the Mayo Clinic Olmsted County, Minnesota [4].

However, in Ukraine in general, the prevalence and incidence of CSD in the period 2000-2011 among the entire population increased by 57.5% and 10.4% respectively, the largest (almost 2 times) – in Poltava region. But disability has increased most in Vinnytsia (16.0), Cherkasy (14.6) oblasts, the city of Sevastopol (17.6), and in Ukraine the same – it was 11.2 per 10 thousand population [1].

Worldwide, 11% of the total burden of the illness, which is measured with useful years associated with disability, is due to IHD and heart attack [5].

Despite the fact that in 2013 there was a positive tendency to reduce the proportion of primary disability in the population due to diseases of the blood circulation system that has emerged in recent years, cardiovascular diseases continued to play a leading role in the formation of negative medical and demographic tendencies in Ukraine and significantly affect the main health indicators: morbidity, mortality, disability, duration and quality of life of the population. Recently, the most widespread illnesses leading to disability are diseases of the circulatory system (24,4%); neoplasms (20.0%); diseases of the bone and muscular system and connective tissue (11,1%); eye diseases and adnexa (3.7%); endocrine diseases, nutritional disorders and metabolic disorders (4.2%). [6].

The Aim

Aim of the study was to do an epidemiological analysis of acute myocardial infarction among the population in the Poltava region and Ukraine in the age group of 25-64 years, depending on gender, age on the basis of the WHO standard program “Register of acute myocardial infarction”.

Materials and methods

Observation (descriptive) research was conducted. For the analysis of the morbidity and disability of the MI (myocardial infarction) the data of the statistical collections of the population of Ukraine for 2004-2015 were used. The incidence of the MI was analyzed according to the indicator “registered patients: adults (with the diagnosis established for the first time in life) in terms of 10 thousand population”.

Review and discussion

According to the international classification of diseases (ICD 10), acute myocardial infarction belongs to the IX class: diseases of the circulatory system.

During the investigated period, the incidence of AMI (acute myocardial infarction) tended to increase in the Poltava region, while in Ukraine – to decrease (Fig. 1).

In the study of morbidity separately in the areas determined that the ranked indicators of the place were distributed as follows: the lowest number of morbidity in AMI was in Grebinkivsky district and was 4.8 ±0.8, while the highest was in Chernukhino district – 23.8 ± 0, 9 (p≤ 0.001). These two districts are among the most distant from the regional center and have uncomfortable traffic. The incidence rate for AMI in the Grebinkivsky district is 3.2 times less than in Poltava 15.5 ± 0.5 (p≤ 0.001), while in the Chernukhino district it is 1.53 times more (p≤ 0.001) (Fig. 2).

Poltava region is ranked 19th in the 28 districts and cities of the Poltava region, with a sufficient network of centers for primary health care (3 centers, which include 28 outpatient clinics). The work of a family doctor is aimed at the early detection and prevention of AMI. In addition, the network of ambulance supplements the Emergency Medical Center, which includes: 4 emergency medical care stations (Poltava, Kremenchug, Lubny, Mirgorod), which have 24 substations, 23 points of temporary and permanent brigade deployment; Department of Emergency Medical Aid and Disaster Medicine. The task of the Center is to diagnose and provide emergency medical care when detecting AMI. In Poltava, the Ukrainian State Medical Academy “The Ukrainian Medical Dental Academy” has a training base for physicians, family physicians and ambulance doctors. In determining the correlation between the distance to the regional center and the incidence of AMI, no reliable link was found. Each district center has a central district hospital, a primary health care center and an appropriate number of outpatient clinics. In the analysis of the incidence of HIV infection, the population of cities in the Poltava region and Ukraine found that this indicator in the Poltava region is significantly higher than in Ukraine. So, in the cities of the region, this indicator is 181.7 ± 7.2 versus 144.9 ± 4.9 in Ukraine (p = 0.002). In comparison with 2010, the incidence rate in the cities of the Poltava region decreased by 6% (base growth rate – 0.06). As for the Ukrainian cities, this indicator decreased by 13% (base growth rate – 0.13). Comparing indicators of morbidity in rural areas of the Poltava region and Ukraine, it was found that this indicator is 1.2 times higher in the Poltava region (113 ± 3.01) than in Ukraine (92.3 ± 1.7) (p≤ 0.001). According to our study, we found 6 years that the incidence of AMI in the villages of the Poltava region increased by 2% (the base rate of growth was 0.02). In the villages of Ukraine, this indicator also increased by 6% (base rate of growth is 0.06). Between villages and cities of Poltava oblast, the increase is 1.3 times more than in cities 181.7 ± 7.2 versus 113.9 ± 3.0 in villages (p≤0,001). As for urban and rural areas of Ukraine, we see a similar picture as in the Poltava region. The incidence of AMI in cities of Ukraine is 1.6 times higher than in villages: 144.9 ± 4.9 versus 92.3 ± 1.2 (p <0.001) (Fig. 3).

The next step of our study was to determine the adequacy of the morbidity rate for AMI, depending on the age in the Poltava region and Ukraine. The incidence of AMI in the population of retirement age was significantly higher than that of the working age population. Thus, in the Poltava region, this indicator for the able-bodied population – 66.9 ± 2.7 was 5.3 times less than that for the population of retirement age of 353.1 ± 8.4 (p <0.001). A similar situation was observed in Ukraine: the figure was 5.6 times significantly higher in the population of retirement age than in the able-bodied 301.1 ± 11.7 versus 53.5 ± 1.4 (p <0.001) (Fig. 4).

The study of the incidence of AMI in terms of gender made it possible to state that this indicator is significantly higher in men than in women, both in the Poltava region and in Ukraine. Thus, for men of the Poltava region, during the study period, there were 213 ± 7.5 versus 164.9 ± 6.2 in women (p = 0.001) and 164.9 ± 6.2 cases of MI in men of Ukraine as a whole versus 105.4 ± 8.5 in of women (p = 0.009) (Fig. 5).

Thus, the incidence of AMI predominates among residents of urban areas, does not depend on the distance from the regional center, where the regional hospital and higher educational institution are located. This indicator is significantly higher in people of retirement age and prevails in men. Since the causes of high myocardial infarction rate are widespread prevalence of cardiovascular risk factors, our promising research was their study.

The analysis of the structure of primary disability by groups of disability indicates that there was a decrease in the proportion of the disability group I from 13.0% to 12.3%; the share of Group II increased from 34.9% to 37.1% in comparison with the previous year; the share of Group III decreased to 50.6% versus 52.1% (in Ukraine – Group I – 11.9%; Group II – 35.6%; Group III – 52.5%).

In the structure of primary disability in the region, the first places occupy the first place (an indicator for 10 thousand able-bodied population) (Fig. 6).

The high prevalence of diseases of the circulatory system, especially among the able-bodied population, causes the first place in the structure of primary disability. At the same time, the index of disability due to circulatory system diseases for 10 thousand able-bodied population in the oblast amounted to 10.6 in 2016 and 9.8 in 2015 (9.7 in Ukraine).

Significantly exceeding the regional level in the Reshetylivsky district – 15.3; Lubny – 14,7; Kobelyatsky district – 14,4.

New formations took II place in the nosological structure of primary disability. Their index made 10.0 cases against 10.2 for the same period last year (Ukraine – 10.1).

The regional indicators in Novosanzharsky exceed 15,1; V.Baghachanskogo – 14,5 and Orzhitsky districts – 13,6.

The third place in the structure of the nosology of disability among persons of working age occupy diseases of the bone and muscular system. Their index amounted to 8.2 cases against 9.8 for the same period last year (Ukraine – 5.7).

The dynamics of population disability in relation to ischemic heart disease (for the first-time revealed disability) shows a tendency towards a decrease in disability both in Ukraine and residents of the Poltava region (Fig. 7).

CONCLUSIONS

The incidence of AMI:

• prevails among residents of urban areas, both in Ukraine and in the Poltava region;

• does not depend on the distance from the regional center, where the regional hospital and the higher educational institution are located;

• this indicator is significantly prevalent among people of retirement age;

• prevails in men.

REFERENCES

1. Zozulia I. S. Epidemiologiia tserebrovaskularnyh zahvoriuvan w Ukraini. Ukrainskyi medychnyi chasopys. 2011.5 (85):38-41.

2. Contributions of risk factors and medical care to cardiovascular mortality trends. Ezzati M, Obermeyer Z, Tzoulaki I, Mayosi BM, Elliott P, Leon DA. Nat Rev Cardiol. 2015 Sep;12(9):508-30. doi: 10.1038/nrcardio.2015.82. Epub 2015 Jun 16 [PubMed] [Cross Ref].

3. Ergin A, Muntner P, Sherwin R, et al. Secular trends in cardiovascular disease mortality, incidence, and case fatality rates in adults in the United States. Am J Med 2004;117:219-27. 10.1016/j.amjmed.2004.03.017[PubMed] [Cross Ref].

4. Arciero TJ, Jacobsen SJ, Reeder GS, et al. Temporal trends in the incidence of coronary disease. Am J Med 2004;117:228-33. 10.1016/j.amjmed.2004.04.008 [PubMed] [Cross Ref].

5. Permanent work disability before and after ischaemic heart disease or stroke event: a nationwide population-based cohort study in Sweden. Ervasti J, Virtanen M, Lallukka T, Friberg E, Mittendorfer-Rutz E, Lundström E, Alexanderson K.BMJ Open. 2017 Sep 29;7(9):e017910. doi: 10.1136/bmjopen-2017-017910. [PubMed] [Cross Ref].

6. Lysunets O.M. et al. Analiz pervynnoi invalidnosti vnaslidik hvorob systemy krovoobigu w Ukraini. Simeina medytsyna. 2014.2:15-17.

 

ADDRESS FOR CORRESPONDENCE

Viacheslav M. Zhdan

Higher state educational institution of Ukraine

“Ukrainian Medical Stomatological Academy”

Shevchenko str., 23, 36011, Poltava, Ukraina

 tel: +380532602051

e-mail: mail@umsa.edu.ua

Received: 10.03.2018

Accepted: 11.05.2018

Poltava region (city)

Ukraine (city)

Poltava region (rural)

Ukraine (rural)

Fig. 1. Incidence of acute myocardial infarction among the population of the Poltava region and Ukraine as a whole for 2005-2015 (per 10,000

population).

Fig. 2. Incidence of acute myocardial infarction among the population of the Poltava region for 2015.

Fig. 3. Incidence of AMI of urban and rural residents of the Poltava

region for 2010-2015

Fig. 4. Incidence of AMIs of urban and rural residents of Ukraine and the Poltava region correspondingly for the years 2010-2015.

Fig. 5. Incidence of AMI of the inhabitants of Ukraine and the

Poltava region respectively sex 2013-2015

Diseases of the circulatory system Diseases of the musculoskeletal system Diseases of the nervous system

Neoplasm

Injuries

Poltava region (adult)

Poltava region (able-bodied age)

Ukraine (adult)

Ukraine (able-bodied age)

Fig. 6. Structure of primary disability in the nosology of the

inhabitants of Ukraine and the Poltava region

Fig. 7. Distribution for the first time recognized by the disabled as an ischemic heart disease among the population of Ukraine and the Poltava region for 2006-2016