Urban-rural differences in cardiovascular health among young adults in the Turkestan region of Kazakhstan.

The majority of young adults in the Turkestan region had intermediate cardiovascular health according to the LE8 framework.

• Total sample size was 843 young adults aged 18-44 years (urban: 432; rural: 411).
• 67.6% of participants had intermediate cardiovascular health.
• 28.9% had high cardiovascular health and 3.4% had poor cardiovascular health.
• The sample was 34.3% male (289) and 65.7% female (554).
• The LE8 overall score was calculated as the arithmetic mean of eight standardized component scores ranging 0-100.

Urban participants achieved higher overall LE8 scores than rural participants, largely due to lower tobacco exposure.

• The study compared urban (n=432) and rural (n=411) PHC facility attendees.
• Rural participants had substantially higher smoking prevalence compared to urban participants.
• Tobacco exposure was identified as the primary driver of the urban-rural difference in overall LE8 scores.
• Statistical comparisons used independent-samples t-tests for continuous variables and chi-square tests for categorical variables.

Rural participants reported healthier diet, higher physical activity, and longer sleep duration compared to urban participants.

• Despite these behavioral advantages, rural participants also had substantially higher smoking prevalence and obesity rates.
• These mixed findings indicate that rural participants had better scores on some LE8 components but worse scores on others.
• The net effect of these differences resulted in lower overall LE8 scores for rural participants compared to urban participants.

Rural participants had substantially higher smoking prevalence and obesity compared to urban participants.

• Higher smoking prevalence in rural areas was a key factor driving lower overall cardiovascular health scores for rural participants.
• Obesity was also more prevalent among rural participants.
• These factors offset the rural advantages in diet, physical activity, and sleep.

Females, particularly in urban areas, had more favorable cardiovascular health profiles than males.

• Female participants had better smoking scores and sleep scores compared to male participants.
• Females had higher overall LE8 scores than males.
• The gender difference in cardiovascular health was especially pronounced in urban areas.
• PHC nurses confirmed in qualitative interviews that cardiovascular risk factors were more common among men.

PHC nurses identified that cardiovascular risk factors increased after the age of 40 and were influenced by cultural, behavioral, and economic factors.

• Seven PHC nurses were interviewed using semi-structured interviews in the qualitative component.
• Interviews continued until thematic saturation was achieved and were analyzed using conventional thematic content analysis.
• Nurses noted cardiovascular risk factors were more common among men.
• Cultural, behavioral, and economic factors were identified as determinants of cardiovascular health.
• Nurses emphasized the need to strengthen workplace- and community-based cardiovascular prevention programs.

A mixed-methods study design combining quantitative LE8 assessment and qualitative nurse interviews was used to evaluate cardiovascular health and PHC prevention strategies.

• The quantitative component assessed cardiovascular health using an adapted Life's Essential 8 (LE8) approach developed by the American Heart Association.
• Participants were young adults aged 18-44 years attending urban and rural PHC facilities in the Turkestan region of Kazakhstan.
• The qualitative component involved semi-structured interviews with PHC nurses involved in preventive and screening programs.
• Continuous variables were analyzed using independent-samples t-tests and categorical variables using chi-square tests.