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UDC 613.1:614.2:610.63
HEALTH PROBLEMS OF POPULATION LIVING NEAR TEST SITES
K.Z. Sakiev, O.V. Grebeneva, M.B. Otarbayeva, N.M. Zhanbasinova, E.Y. Ivanova
National center of Industrial hygiene and Occupational diseases of the Ministry of
health and Social development of the republic of Kazakhstan, Karaganda
The morbidity estimation was conducted among adult population of Bokey Orda district and Zhanakala district of West Kazakhstan region, living in close proximity to the test site «Kapustin Yar». Morbidity levels of 7-11 disease classes, higher than in Kazakhstan and in control areas, reflect ecologically unfavorable situation of residence regions.
Key words: morbidity, healthcare, test sites (polygons), and ecology
Relevance. Ecology and human health are ones of the problems of current interest to which attention of the entire world community is focused at the present time. The republic of Kazakhstan represents a unique place in the world by the presence of various facilities (mining camps and quarries for the mining operations, test sites, spaceport), which determines the complexity, diversity and territorial uniqueness of modern environmental problems. A large number of anthropogenic ecological landscapes, artificial provinces, adverse for the population are already formed due to the intensive manufacturing, and chemicalization in agriculture.
One of these regions is the area adjacent to the test site «Kapustin Yar», which occupies an area up to 1,5 million hectares on the territory of Bokey Orda district and Zhanakala district of West Kazakhstan region. Over 65 years of its operation, missiles have been launched from its sites, military equipment has been tested on its platforms, and ammunition has been destroyed. As a result, the environment in these areas is contaminated by rocket fuel and products of its decomposition, nitrogen compounds and heavy metals [1]. Medical and biological influence of the components of RF (rocket fuel) is extremely similar to the effects of ionizing radiation exposure (hair loss, nose bleeds, hyperplasia of the thyroid gland, anemia, asthenia, neurocirculatory dystonia and other symptoms and syndromes) [2]. Explosions of medium-range missiles (SS-20) in the region of Kapustin Yar test site in 1988-91 years caused serious health problems among the population of some areas of Astrakhan region. The negative consequence of blowing up the silo launchers of the intercontinental ballistic missiles in Vladimir and Ivanovo regions of Russia has been displayed in the growth of oncological diseases among population [3].
But the studies of health condition of the population in the regions, adjacent to the test sites, are essentially fragmented, and uncoordinated. The diseases of individual
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organs and systems, revealed in these regions are not associated with specific adverse factors in the residential areas of the population [4,5]. Thus, it was found that the morbidity rates on seeking medical care among the population exposed to the test site «Kapustin Yar», in general and in most disease classes were 1.4 - 11.6 times higher than the benchmarks, and the data. The relative risk (RR) of the total morbidity was 1.8, and by disease classes - from 1.1 to 10.5, which primarily concerned classes «congenital malformations, deformations and chromosomal abnormalities» (10.5) «diseases of blood and blood-forming organs» (10.2), «endocrine, nutritional and metabolic disorders» (5.3), and others [6]. The proximity of Zhanakala district and Bokey Orda district to the nuclear missile test site «Kapustin Yar» determines, according to the authors, the fact that 84% of the students of West Kazakhstan Medical College suffer from some symptoms of hypochromic anemia. At the same time, the lowest hemoglobin is registered in Zhanakala district and Bokey Orda district (60 g/l and 80-90 g/l, respectively) [7].
It is known that the combined effect of chemical and radiation factors could lead to chronic intoxication of people, and their combination in small doses can be a modifier of long-term effects (carcinogenic risk, congenital abnormalities, autoimmune processes). The targeted research in these regions has not been carried out yet, which would help to confirm about the dangers of test sites’ operation for the health of the resident population.
Without sufficient data, the implementation of regional programs on the improvement of environmental situation and population rehabilitation, as well as on the creation of conditions for the successful functioning of the regional economy and the provision of social assistance are not possible. Until now there has been no systematic work on the study of the environment and public health.
The aim of the study was to evaluate the morbidity among the adult population living in close proximity to the test site «Kapustin Yar».
Research methods. Studies were organized as the momentary transversal investigations; the retrospective accounted 10 years (2004-2013). The data obtained from the regional center of electronic Health (RCEH) has been used for the analysis. The analysis has been conducted on the basis of newly diagnosed morbidity average values for 10 years and per 100 thousand of the adult population in general level of morbidity, as well as in classes and nosological forms (ICD-10).
The object of the study were represented by the population of two rural areas (Bokey Orda district, Zhanakala district) of West Kazakhstan region, and the control zone was Shetsk district and Zhanaarka district of Karaganda and Burabay regions of Akmola oblast.
Results. During the analysis it was found that the overall level of average annual morbidity among the adult population in Zhanaarka district did not differ, and in Bura-bay and Shetsk districts the morbidity was almost 2 times lower than the national average levels (Figure 1).
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45000
40000
0 35000
1 30000 о.
о. 25000
О 20000 о
о 15000 о
ё 10000 а
5000
0
districts
■ RK □ Burabay districts □ Shetsk districts ■ Zhanaarka districts
Burabay Shetsk Zhanaarka
Figure 1 - The comparative levels of general morbidity among adult population of Burabay, Shetsk and Zhanaarka districts
The indicators of the primary morbidity among the adult population of Burabay, Shetsk and Zhanaarka districts for all disease classes were lower than the average republican level (Table 1).
Table 1 - The primary average annual morbidity among adult population of control areas (Burabay, Shetsk and Zhanaarka districts)
№ Disease classes RK Regions
1 m Shetsk 03 la 03 Ы Control
1 2 3 4 5 6 7
General morbidity 42101,1 25064,6 19229,6 37447,7 27247,3± 446,1
I Infectious and parasitic diseases 1485,7 556,5 308,6 432,0 432,4± 5,9
II Neoplasms 649,1 521,9 396,9 472,8 463,9± 3,0
III Diseases of blood, blood-forming organs and immune system 1285,0 240,1 538,6 1461,0 746,5± 30,5
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Continuation of Table 1
1 2 3 4 5 6 7
IV Endocrine diseases, nutritional and metabolic disorders 745,3 305,1 370,2 1106,2 593,9± 21,3
V Mental and behavioral disorders 110,4 64,3 77,3 147,0 96,2± 2,1
VI Diseases of the nervous system 1628,3 655,5 793,2 1437,4 962,0± 20,0
VII Diseases of eye and its appendages 2322,8 1172,1 669,1 1511,1 1117,5± 20,3
VIII Diseases of the ear and mastoid process 1266,3 1556,2 258,2 1226,9 1013,8± 32,4
IX Diseases of the circulatory system 2703,6 1385,1 1144,4 2862,1 1797,2± 44,6
X Respiratory diseases 10717,5 7402,6 6070,6 5488,6 6320,6± 47,0
XI Diseases of the digestive system 2510,4 910,5 511,8 1713,9 1045,4± 29,4
XII Diseases of the skin and subcutaneous tissue 2770,7 1380,4 627,3 1747,7 1251,8± 27,4
XIII Diseases of the musculoskeletal system 1851,9 1444,1 340,0 1942,6 1242,2± 39,3
XIV Diseases of the genitourinary system 4925,9 2265,5 1584,3 4335,9 2728,5± 68,7
XV Complications of pregnancy, childbirth and the postpartum period 6058,8 1372,0 2695,6 3539,5 2535,7± 52,4
XVII Congenital malformations and chromosomal abnormalities 41,6 20,9 7,6 31,2 19,9± 0,6
XIX Injuries and poisonings 3953,7 3223,3 2714,5 4284,5 3407,4± 38,4
Among all disease classes of adult population of Burabay district the following diseases prevailed: respiratory diseases (30.2%), injuries and poisoning (13.2%), diseases of the genitourinary system (9.3%), diseases of the ear and mastoid process (6.4%), diseases of the musculoskeletal system (5.9%), which accounted for 59% of all diseases.
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The most widespread diseases among adult population of Shetsk district were: respiratory diseases (31.8%), injuries and poisoning (14.2%), complications of pregnancy, childbirth and the postpartum period (14.1%), diseases of the genitourinary system (8.3%) and cardiovascular diseases (6.0%).
According to the results of ranking for the newly revealed morbidity among adult population of Zhanaarka district the following diseases prevailed: respiratory diseases (16,3%), diseases of the genitourinary system (12,9%), injuries and poisoning (12,7%), complications of pregnancy, childbirth and the postpartum period (10,5%) and diseases of the circulatory system (8,5%).
The overall morbidity among the adult population in Bokey Orda district compared to the national average level was 1.8 times higher, and in Zhanakala district -34% higher (Table 2). Two-time reduction of the total average annual morbidity on diseases of blood, blood forming organs and the immune system, and 40% decrease of digestive system diseases have been registered over the past ten years in Bokey Orda district.
Table 2 - The primary average annual morbidity among adult population of the studied areas of West Kazakhstan region for the period of 2004-2013 (per 100 thousand of population)
№ Disease classes RK Regions
| Й о U Bokey Orda ■a § л Ы
1 2 3 4 5 6
General morbidity 42101,1 27247,32 77842,12 56594,25
I Infectious and parasitic diseases 1485,7 432,3749 1824,71 747,96
II Neoplasms 649,1 463,8625 1487,47 898,52
III Diseases of blood, bloodforming organs and immune system 1285,0 746,5478 3974,81 7318,40
IV Endocrine diseases, nutritional and metabolic disorders 745,3 593,8542 2459,30 1372,73
V Mental and behavioral disorders 110,4 96,20369 2083,48 2036,67
VI Diseases of the nervous system 1628,3 962,0209 5454,57 1492,84
VII Diseases of eye and its appendages 2322,8 1117,452 4376,02 6218,17
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Continuation of Table 2
1 2 3 4 5 6
VIII Diseases of the ear and mastoid process 1266,3 1013,764 1358,73 964,91
IX Diseases of the circulatory system 2703,6 1797,228 13100,17 15552,17
X Respiratory diseases 10717,5 6320,558 10915,46 15471,83
XI Diseases of the digestive system 2510,4 1045,406 10385,74 8812,18
XII Diseases of the skin and subcutaneous tissue 2770,7 1251,788 5216,58 2258,91
XIII Diseases of the musculoskeletal system 1851,9 1242,212 2979,82 2721,08
XIV Diseases of the genitourinary system 4925,9 2728,538 6780,78 6219,94
XVII Congenital malformations and chromosomal abnormalities 6058,8 19,8727 243,22 676,87
XIX Injuries and poisonings 41,6 3407,448 1954,63 1608,68
But at the same there was a tendency to an increase in morbidity of mental and behavioral disorders (40%), and diseases of the circulatory system (17%). It was found that among adults in Bokey Orda district the diseases in class of injury and poisoning, diseases of the circulatory system and the digestive system, diseases of the nervous system and the endocrine system, diseases of blood, blood-forming organs and the immune system are registered more often than in the Republic of Kazakhstan.
In Zhanakala district on the background of a general increase in morbidity in 2013 compared to 2004, there has been a decline in the primary morbidity of the digestive system (37%) and a similar increase in mental disorders and diseases of the circulatory system. Therefore, in Zhanakala district the rates of primary morbidity among the adult population were registered above the national level on the following disease classes: injuries and poisoning, mental disorders, diseases of blood, bloodforming organs and the immune system, and digestive system.
A more higher level of general morbidity among adult population was detected in Bokey Orda district and Zhanakala district compared to control areas (2.9 and 2 times) (Table 2).
Thus, the most widespread disease classes registered among adult population of two districts represent the same classes as in the control areas: diseases of the circulatory system, respiratory diseases, diseases of the digestive system, and diseases of the genitourinary system, diseases of blood, blood-forming organs and the immune system. According to the percent volume, these diseases accounted for more than a half of all
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cases, as well as on the control areas: in Bokey Orda district area 60.6%, and in Zhanakala district 70,4% of total number of diseases.
It should be noted that although the morbidity rates for the most widespread disease classes among the adult population in Bokey Orda district and Zhanakala district did not differ a lot from the morbidity in the control areas, we have identified the classes which have more noticeable differences. Thus, in Bokey Orda district morbidity level excess over the control region was identified for mental disorders, congenital malformations and chromosomal abnormalities, and diseases of the skin and subcutaneous tissue tumors. In Zhanakala district morbidity level among adults compared to the control areas exceeded on the following classes: congenital malformations, nutritional and metabolic disorders, diseases of eye and its appendages, and others.
Increased morbidity levels among the adult population in these classes may indicate direct or indirect influence of adverse environmental factors on the health of population in the region. However, in order to affirm this fact the targeted research is required, and specific diseases etiologically dependent on the nature of territory contamination, can be detected only according the results of the special experimental scientific work.
Conclusion:
1. In Bokey Orda district and Zhanakala district of West Kazakhstan region morbidity rates are higher for newly diagnosed pathology than in Kazakhstan and in the control zones.
2. According to the higher morbidity values on 7-11 disease classes and increased prevalence of oncological morbidity, these areas can be considered as areas of ecological unfavorable situation.
3. Specific diseases etiologically related to the nature of area contamination, as well as the levels of total mutagenic effects in the samples of air, water and other components of the environment, can be detected only according to the results of the special experimental research.
References
1. Polyakov A.I., Gaytinov A.S. Radiological studies in areas of nuclear missile test site «Kapustin Yar» and the nuclear test site «Azgeer» // Ecological methodology of human and planet Earth revival: Materials of 1st Intern. Congress, Almaty, 1997.
2. Kuznetsov A.N., Bolysov A.I., Shatrov Y.T. Overview of decade-long efforts to ensure environmental safety of rocket and space technology activities // Double technologies. - 2001. - №3. Access to the site: http://www.sipria.ru/dt21 03.html.
3. Lupandin V.M. Environmental pollution and health of the population in the areas of space-rocket activity // Social and environmental impacts of the rocket and space activities. Proceedings of the workshop. - Moscow, 1998.
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4. Tezekbaeva J.G. Hygienic bases of integrated assessment of environmental pollution and children's health, development of estimated indicators in the regions adjacent to the missile and nuclear test sites: Synopsis of diss. MD - Almaty, 2002. - 49 p.
5. Kenesariev U.I., Bekmagambetova J.D., Zhakashov N.J., Tezekbaeva J.G. On the problem of environmental determinacy of health in the territories of the Republic of Kazakhstan in proximity to nuclear and missile and nuclear test sites // Bulletin of the Kazakh National University (dedicated to the 75th anniversary of the Kazakh National Medical University named after S.D. Asfendiyarov). - 2006. - Application to №1. -P.83-92.
6. Sultanaliev E.T. Hygienic assessment of the risk of contamination of agricultural products by xenobiotics to public health in the region of nuclear-missile test sites of western Kazakhstan. Synopsis of diss. cand. of medical sciences. - Almaty, 2009. - 23 p.
7. Baybulatova S.A., Uteulieva D.Z. Ecology and health of students of West Kazakhstan Medical College // Laboratory Medicine -2012. -№12.- from website: http: //labmed.kz/archive/2012/12/practical/224-ekologiya-i-zdorove-uchaschihsya-zapadno-kazahstanskogo-medicinskogo-kolledzha.html
Тұжырым
Батыс Қазақстан облысының Бөкейорда, Жаңғала аудандарының «Капустин Яр» полигонына тікелей жақын маңында тұратын ересек тұрғындардардың аурушаңдығына бағалау жүргізілді. ҚР және бақылау аймақтарына қарағанда, ау-рудың 7-11 класы бойынша аурушаңдықтың неғұрлым жоғары деңгейлері өмір сүру аймақтарының экологиялық қолайсызыдығын көрсетеді.
Түйінді сөздер: аурушаңдық, денсаулықты сақтау, полигондар, экология
Резюме
Проведена оценка заболеваемости взрослого населения Бокейординского, Жангалинского районов Западно-Казахстанской области, проживающего в непосредственной близости к полигону «Капустин Яр». Более высокие, чем в РК и в контрольных районах, уровни заболеваемости по 7-11 классам болезни отражают экологическое неблагополучие регионов проживания.
Ключевые слова: заболеваемость, охрана здоровья, полигоны, экология
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