Regional differences in cardiovascular mortality in Kazakhstan: further evidence for the 'Russian mortality paradox'?
BACKGROUND
The role of alcohol consumption in patterns of CVD mortality in Central Asia is still largely unexplored. Previous research in Kazakhstan and Kyrgyzstan has found that ethnic Russians have higher adult mortality rates than native ethnic groups, despite their higher socio-economic status. This has been termed the 'Russian mortality paradox'.


METHODS
We calculated age-standardized CVD mortality data by gender and region of Kazakhstan, based on mortality data obtained from the Ministry of Health and population data from the State Agency for Statistics. We analysed data on self-reported alcohol consumption from the nationally representative 5th National Behavior Study.


RESULTS
We found substantial differences in CVD mortality rates across regions, as well as between males and females. With the exception of Almaty and Astana cities, mortality rates are highest in the country's North-Eastern regions and lowest in South-Western regions, despite the fact that North-Eastern regions have higher income levels. Patterns of self-reported alcohol consumption and alcohol sales follow a similar pattern. One explanation could be related to higher self-reported drinking prevalence among ethnic Russians who live predominantly in the country's North-Eastern regions.


CONCLUSIONS
Hazardous alcohol consumption seems to be highest in Kazakhstan's North-Eastern regions, which might be related to different patterns of alcohol consumption among different ethnic groups. However, more detailed analyses are required to corroborate these assumptions. The high overall rates suggest the need for population-based measures, such as increasing taxes on alcohol, in particular spirits such as vodka, and strengthening the capacity of primary health care.
1 Republican Research Institute of Cardiology and Internal Diseases, 050000 Almaty, Aiteke Bi Street 120, Kazakhstan bernd.rechel@lshtm.ac.uk.
Kairat
K
Davletov
2 European Observatory on Health Systems and Policies, London, UK.
Martin
M
McKee
1 Republican Research Institute of Cardiology and Internal Diseases, 050000 Almaty, Aiteke Bi Street 120, Kazakhstan.
Salim
S
Berkinbayev
3 National Healthy Lifestyle Centre, Almaty, Kazakhstan.
Zhamilya
Z
Battakova
4 World Health Organization Country Office Astana, Kazakhstan.
Melita
M
Vujnovic
5 European Observatory on Health Systems and Policies, London, UK.
Bernd
B
Rechel
D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology / Q000208:ethnology; D000437:Alcoholism / Q000453:epidemiology / Q000208:ethnology; D002318:Cardiovascular Diseases / Q000401:mortality*; D005260:Female; D006801:Humans; D007623:Kazakhstan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012426:Russia / Q000208:ethnology; D012737:Sex Factors