Disability from cardiovascular diseases at Osh city, Kyrgyz Republic

Cardiovascular diseases (CVDs) are the leading global cause of death, contributing to health deterioration and increased healthcare expenses. Therefore, it is of interest to investigate the disability rates related to cardiovascular diseases at Osh city, Kyrgyz Republic. We report the prevalence of disability in both urban and rural areas, highlighting the impact of regional disparities in medical and social services. Data shows that adult cardiovascular disease impairment in Kyrgyzstan suggests challenges in accessing medical and social support, particularly in rural regions. Thus, the rural-urban divide in critical disability metrics impedes equitable research. Comprehensive assessments and interventions are imperative to mitigate cardiovascular diseases and associated disabilities in both rural and urban populations at Kyrgyz Republic.


Background:
The medical and social significance of cardiovascular diseases (CVD) lies not only in the high rates of morbidity and mortality from this pathology but also in the high level of disability among patients [1-3].In recent years, CVD, mainly ischemic heart disease and arterial hypertension, have been the leading causes of disability in the Russian Federation and several other countries [4][5].Beyond the negative impact on the population's health profile, the disability of patients inflicts serious economic damage.This includes costs associated with social support for disabled individuals and their families, as well as the unemployment of the disabled.It is known that the disability of individuals of working age significantly reduces the labour potential of the state [6][7].Investigating the dynamics of disability indicators and structural alterations resulting from circulatory system diseases facilitates the discernment of patterns in their manifestation, with due consideration given to regional variations [8][9].While it remains imperative to grasp the fundamental physiological determinants underlying mortality, conducting comprehensive evaluations of the principal factors contributing to diseases presents additional avenues to elucidate public policy frameworks.In the Kyrgyz Republic (KR), the UN Convention on the Rights of Persons with Disabilities was ratified in 2019, making the study of various aspects of disability among persons with limited health abilities (LHA) in this territory a current issue [10][11].Therefore, it is of interest to evaluate how common disability caused by cardiovascular disease (CVD) is among the population of the Osh region in the Kyrgyz Republic from 2016 to 2021.

Methodology:
The research undertaken in this study was extensive, spanning the years 2016 to 2021.The study included a detailed examination of individuals with limited health abilities (LHA) under medical supervision in healthcare institutions, as well as primary disability rates attributed to cardiovascular diseases (CVD) in both the adult and paediatric (up to 18 years) populations of the Kyrgyz Republic (KR), with a particular focus on the city of Osh and the Alai and Chon-Alai districts of the Osh region.The major sources of information used were district medical-social expert commission reports and minutes of meetings.The study included a mix of statistical, analytical, and epidemiological methods.All statistical analysis was conducted on SPSS version 23.

Results:
Disability due to diseases of the circulatory system (DCS) from 2016 to 2021 consistently held the leading position in the structure of disability among the adult population of the KR.During this period, there was a steady increase in the number of LHAs from 14,935 cases (38.9 per 10,000 populations) to 16,387 cases (39.4 per 10,000 populations) (Table 1).Compared to the city of Osh, the number of Persons with Limited Health Abilities (LHA) in the Osh region from 2016 to 2021 was significantly lowers (Table 2).In the structure of disability among the child population, disability due to diseases of the circulatory system (DCS) is only in 14th place.However, similar to adults, there is a trend of increasing numbers of Persons with Limited Health Abilities (LHA) under 18 years of age, from 247 cases (1.1 per 10,000 inhabitants) in 2016 to 294 cases (1.2 per 10,000 inhabitants) in 2021 (Table 3).In 2016, among the adult population of the Kyrgyz Republic (KR), 7,530 residents were initially recognized as disabled.By 2021, this number increased to 7,869 residents.Throughout the years of observation, the majority of those newly recognized as disabled were individuals with diseases of the circulatory system (DCS): 1,422 in 2016; 1,474 in 2017; 1,461 in 2018; 1,488 in 2019; 1,205 in 2020; and 1,494 in 2021 (Table 4).
A comparative analysis of persons initially recognized as disabled among urban and rural populations showed that the number of LHAs in the Osh region in 2016 was lower than in the city of Osh (2.4 and 1.7 per 10,000, respectively).In 2017-2019, the numbers were higher; in 2020, the figures were comparable; and in 2021, they were lower again (1.6 and 3.3 cases per 10,000 inhabitants, respectively) (Table 5).Over all the years of observation, the rates of primary disability in the Osh region were lower than in the KR.The number of children initially recognized as disabled in the KR during the period 2016-2021 remained stable, amounting to 0.1 person per 10,000 population.The rates of primary disability among the rural and urban child populations were similar.

Discussion:
Despite advances in the diagnosis and treatment of cardiovascular diseases (CVD), disability due to diseases of the circulatory system (DCS) remains at a high level in the Kyrgyz Republic (KR) and does not show a decreasing trend [12][13][14].In our study, the number of Persons with Limited Health Abilities (LHA) in the Osh region from 2016 to 2021 was lower than in the city of Osh and in the KR as a whole.This trend may indicate less accessibility of medical-social expertise services for residents of remote areas and insufficient accounting of persons with disabilities [15][16][17][18].It might be necessary to revise and optimize the operation of medical organizations in rural areas, especially in directing CVD patients who are eligible for disability determination to medical-social examination.[19][20][21].Rates of primary disability are an important medical-social criterion of public health and reflect the accessibility and effectiveness of regional medical-social programs [22][23][24].In our study, the rates of primary disability in the population of the Osh region over the entire observation period were lower than in the KR [24-28].However, compared to the urban population, they showed unstable dynamics, complicating their objective assessment.Data from elsewhere [29-32] revealed a significant difference in the level of primary disability of the adult and child populations per 10,000 inhabitants for the period 2017-2019 when analyzing the main indicators of the Osh city medical-social expert commission's activities [33][34][35][36].According to the authors, this circumstance may be due to the lack of clear criteria for medicalsocial expertise in this region.
It is known that the majority of disabilities due to cardiovascular diseases (CVD) are found in people over 60 years of age [37][38][39][40].
Considering the global trend of an aging population, an increase in the number of Persons with Limited Health Abilities (LHA) can be expected in the coming years.For example, according to Guzman-Castillo M. et al. (2017), in England and Wales, there is an anticipated 19.4% increase in the population aged 65 and older by 2025, with the number of disabled individuals expected to increase by 25.0% [41-42].In our study, the level of disability due to CVD among children under 18 remained low throughout the observation period, with leading causes of disability being nervous system diseases, congenital anomalies, mental disorders, and behavioural disorders.However, a population cohort study conducted in Sweden in 2020 found a direct correlation between overweight/obesity and low cardiorespiratory fitness in adolescence and an increased risk of disability due to CVD in adulthood [43].Therefore, preventive actions in young age, such as strengthening the cardiorespiratory system and maintaining a healthy body weight, can be considered as way to prevent future CVD-related disabilities.Although there are comparatively few children disabled due to CVD, they require close attention from pediatric services, especially in remote rural areas.As noted by Uzakbaev et al. (2018) [44], children with limited health abilities in the KR currently face a number of medical-social problems, such as insufficient availability of rehabilitation services, lack of a wellorganized system for overcoming environmental barriers by disabled persons, and insufficient effectiveness of psychologicalmedical-pedagogical consultations, which are entirely absent in remote rural areas.

Conclusion:
Diseases of the circulatory system (DCS) remain a significant issue in the Kyrgyz Republic (KR) despite progress in identifying and treating cardiovascular diseases (CVD).Data shows that cardiovascular disease-related impairment is prevalent among adults in Kyrgyzstan, especially in rural areas, posing challenges in accessing medical and social support services.This rural-urban gap in disability indicators hinders efforts to achieve research equity.Global projections underscore the escalating burden of cardiovascular disease (CVD)associated disability, indicating the need for preventive strategies, early interventions during adolescence, targeted legislative reforms, and enhanced healthcare services in Kyrgyzstan.

Table 1 : Number of persons with Limited Health Abilities (LHA)
Note: LHA refers to Persons with Limited Health Abilities, and KR stands for the Kyrgyz Republic.

Table 2 : Number of persons with Limited Health Abilities (LHA) (Adults) due to Cardiovascular Diseases (CVD)
Note: LHA refers to Persons with Limited Health Abilities, and KR stands for the Kyrgyz Republic.

Table 3 : Number of children under 18 years of age with Limited Health Abilities (LHA)
Note: LHA refers to Persons with Limited Health Abilities, and KR stands for the Kyrgyz Republic.

Table 5 : Number of persons with Limited Health Abilities (LHA) Observation years KR Osh city Osh region Absolute number per 10,000 population Absolute number Per 10,000 population Absolute number Per 10,000 population
Note: LHA refers to Persons with Limited Health Abilities, and KR stands for the Kyrgyz Republic.