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UDC 616.6-022:616.9(571.15)
EPIDEMIOLOGICAL PECULIARITIES OF URINARY TRACT INFECTIONS IN ALTAI KRAI
Altai State Medical University, Barnaul K.I. Sursyakova, T.V. Safyanova
The research objective is the assessment of the current epidemiological situation on urinary tract infections (UTI) of child and adult population of Altai Krai in 2007-2016. The conducted retrospective analysis of UTI infections revealed, that the current nosology presents a considerable problem for the region, as since 2007, the level of UTI morbidity in Altai Krai (AK) has exceeded the morbidity level in Russia. The UTI morbidity among adults prevailed over the analogous morbidity among children both in A and in the Russian Federation. Key words: urinary tract infections, epidemiological peculiarities, retrospective analysis.
In the Russian Federation, urinary tract infections (UTIs) are among the most common, accounting for 6-70% of all urinary tract diseases (UT), and are one of the leading causes of decreased quality of life and disability [1, 4, 8]. A high level of recurrence of UTIs is a particular problem. In this case, the disease takes on a chronic character with frequent and prolonged exacerbations [2, 7]. Urinary tract infections are more common in women, more than half of whom have at least once in their lifetime been diagnosed with such [6, 10]. Quite high is the incidence of acute cystitis, which in women aged 20-40 years is 25-35% of all registered UTIs. Each year, about 10% of women become ill with this disease [3]. According to American researchers, the incidence of UTIs in the United States is more than 7 million cases per year, of which more than 2 million cases are associated with acute cystitis [9, 10].
According to many foreign authors, more than 100,000 hospitalizations a year are associated with pyelonephritis, which WHO (World Health Organization) refers to problems of social importance, as it develops in persons of working age and often causes disability. [6] In Russia, up to 1.3 million cases of acute pyelonephritis are recorded annually [5]. It should be noted that it accounts for at least 40% of all nosocomial infections, which in most cases are due to catheterization of the bladder [9]. The epidemiological features of these infections in the region have not been adequately studied, despite this, the frequency of occurrence of UTIs among the population of Altai Krai (AK) occupies one of the leading positions.
The aim of the study was to assess the current epidemiological situation in the incidence of UTI among adults and children in Altai Krai in 20072016.
Materials and methods
A retrospective analysis of the incidence of glomerular, tubulointerstinal diseases of kidneys and ureter (UTI) according to Form No. 12 "Information on the number of diseases registered
in patients living in the area of care of a medical organization." In this form in a retrospective study there was implemented the section "Diseases of the genitourinary system, including: glomerular, tubulointerstitial diseases of the kidneys, and other diseases of kidneys and ureter." The total number of reported cases of diseases with these nosologies constituted 704,520 thousand in 2007-2016.
The study materials were subjected to statistical processing. The statistical analysis was carried out with the help of programs "STATISTICA 10.0" and "MS Excel 2010". The average sample values of the quantitative characteristics are given in the text in the form M ± m, where M is the mean sample, m is the standard error of the mean. To estimate the reliability of the difference (p), there was used Student t-test. In all statistical analysis procedures, the critical level of significance was assumed to be 0.05.
Results and discussion
Данные представлены (рисунок 1). In order to study the development of the epidemiolog-ical process of UTIs, an analysis of the dynamics of the morbidity rates of the studied infections in AK for the period from 2007 to 2016 was carried out. The data are presented (Figure 1).
The period from 2007 to 2013 is characterized by consistently high incidence rates (3001,54±11,17-3065,47±11,50±11.50 per 100 thousand population). Since 2014, there has been a certain tendency to reduce the incidence of UTIs. So, in 2016 it constituted 2718.69±10.6 per 100 thousand of population, which is 1.10 times (p=0.001) less than the analogous indicator of 2007 (3001,54±11,17 per 100 thousand of the population), which is probably associated with an improvement in the quality of medical care for the urological profile and diagnosis of these nosologies. The peak incidence fell in 2009 and amounted to 3,065.47±11.50 per 100 thousand of the population. During the studied period, the rate of decline in morbidity is 1.11% (p = 0.001). Since 2007, the level of morbidity of UTIs in AK has exceeded the incidence rate in the Rus-
sian Federation by 1.6 times (p = 0.001). The analysis of the dynamics of the incidence of UTIs in children and adults in 2007-2016 was carried out. (Figure 2).
According to the comparison of the average multi-year incidence rate of UTIs among children
(0-17 years) and adults in AK in 2007-2016, the average multi-year incidence rate among children (1,824.8±11.02 per 100,000 of the corresponding population) is 1.69 times less than the corresponding figure among adults (p = 0.001).
Figure 1. Dynamics of incidence of UTIs in the Russian Federation and Altai Krai in 2007-2016 with trend lines
(indicator per 100 thousand population)
Figure 2. Dynamics of incidence of UTIs in the Russian Federation and Altai Krai in children (0-17 years) and adults in 2007-2016 with trend lines (indicator for 100 thousand of the corresponding contingent)
When comparing the average multi-year incidence of UTIs among children (0-17 years) and adults in the Russian Federation in 20072016, the average multi-year incidence rate among children (1,570.07±2.74 per 100,000 of the corresponding population) is 1.03 times higher than the corresponding indicator among adults (p = 0.001). Despite the positive trends in the incidence of UTIs in AK, the growth rate outstripped the all-Russian indicators. So, for the studied period, the incidence among adults in the region exceeded the level of morbidity in the RF by 1.6% (p = 0.001). In the year of the greatest increase in 2009 - by 1.7% (3112.3±10.65 per 100 thousand population, p = 0.001).
The incidence of UTIs among children in AK during the analyzed period exceeded that of the RF by 1.16% (p = 0.001). In the year of the greatest increase in 2011, - by 1.7% (2161±4.34 per 100 thousand population, p = 0.001). The dynamics of the incidence of UTIs in AK in 2007-2016 was analyzed in children by age composition (Figure 3).
The indicator of the average annual multi-year morbidity among adolescents (15-17 years) (3510.9±5.4 per 100 thousand of the corresponding population) exceeded the average annual number of years of illness among children (0-14 years) (1985.59±8.7 per 100 thousand of the corresponding population) in 1,76 times ^ = 0,001). The rate of decline in the incidence of UTIs among adolescents
was 1% (from 3,892.3±6.75 per 100,000 of the corresponding population in 2007 to 2,888.1±5.62 per 100,000 of the population in 2016). The dynamics
of the incidence of UTIs among the urban and rural population of AK for the same period was studied (Figure 4).
Figure 3. The dynamics of the incidence of UTIs by the age composition of children (0-17 years)
in AK in 2007-2016 with trend lines (indicator per 100 thousand of the corresponding contingent)
Figure 4. Dynamics of incidence of UTIs among urban and rural population in AK in 2007-2016 with trend lines
(indicator per 100 thousand population)
The average annual incidence rate of urban population 3284,08±18,22 per 100 thousand population (the peak of the incidence of morbidity in 2007 was 3864,83±15,67 per 100 thousand of the population) exceeded that of the rural population in 1.3 times (2501,53±12,78 per 100 thousand of population, the peak of the incidence of the incidence in 2011 was 2756,73±15,78 per 100 thousand of population, p = 0.001), which is probably due to insufficient level of diagnosis of these infections in rural medical organizations of AK. For the studied in Altai Krai, the rate of decline in morbidity among the urban population is 0.4%, rural - 0.3% (p = 0.001).Concl-susions
1. Within the framework of the retrospective analysis of the incidence of UTIs in 2007-2016, it was revealed that the data of nosology represent a significant problem for the region, since, in spite of the improvement in the quality of medical care for the urological profile and diagnosis of nosol-
ogy data, since 2007, the level of morbidity with UTIs in AK has exceeded the level of the incidence in the Russian Federation by 1.6 times (p = 0.001).
2. The average multi-year incidence rate among children in AK is less than the corresponding figure among adults in 1.69 times (p = 0.001). The incidence among the adult population in the Russian Federation and AK has tended to decrease, but the average incidence of UTIs among adults in AK has exceeded the level of morbidity in the RF by 2.06 times (p = 0.001). The incidence among children by age composition had a decline rate in 20072016 by 1% (p = 0.001). The indicator of the average annual multi-year morbidity among adolescents (15-17 years) exceeded that of children (0-14 years) by 1.76 times (p = 0.001).
3. When assessing the incidence of urban and rural population of Altai Krai, the average annual incidence of urban population exceeded this
incidence among the rural population by 1.3 times (p = 0.001).
4. When analyzing the dynamics of morbidity by nosological forms among urological departments of the Ministry of Health, the average annual incidence of acute pyelonephritis exceeded the average annual incidence of chronic pyelonephritis by a factor of 1.5 (p = 0.001). The average annual incidence of acute cystitis was below the average annual incidence of chronic cystitis by a factor of 2.6 (p = 0.001).
References
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Contacts
Corresponding author: Sursyakova Kseniya Iva-novna, postgraduate student of the Department of Epidemiology, Microbiology and Virology of the Altai State Medical University, Barnaul. 656056, Barnaul, ul. Papanintsev, 126. Tel.: (3852) 566924. E-mail: boydika@yandex.ru
Safyanova Tatyana Viktorovna, Doctor of Medical Sciences, Head of the Department of Epidemiology, Microbiology and Virology of the Altai State Medical University, Barnaul. 656056, Barnaul, ul. Papanintsev, 126. Tel.: (3852) 566924. E-mail: tvsafyanova@yandex.ru
