Risk factors for population health in urbanized regions on industrial example of Zaporizhia and region

  • Authors: I.A. Sokolovska
  • UDC: 364.122.5:616.517:477.64
  • DOI: 10.33273/2663-9726-2018-49-2-13-17
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Zaporizhia State Medical University, Zapоrіzhia, Ukraine

SUMMARY. Relevance. Psoriasis in all its various clinical forms is one of the most common chronic inflammatory skin diseases. For most patients, the disease means long-term constraints in various aspects of everyday life with huge personal costs, and sometimes severe stigma and discrimination. Socio-economic consequences of psoriasis associated with its chronization, reduced labor productivity and significant costs of treatment. The disease can occur both in children and in adulthood, characterized by long-term relapse, total or partial loss of disability, high levels of disability and socio-psychological maladaptation of patients. The risk and complexity of the flow increases significantly under adverse environmental conditions.

Purpose: on the basis of social and hygienic monitoring, to study the peculiarities of the psoriasis incidence of the population of the Zaporizhia region under the conditions of adverse ecological environmental factors. Methods of Research: hygienic, clinical-laboratory, functional, epidemiological, statistical.

The results obtained and their novelty: for the first time, a systematic approach to the analysis of the incidence of psoriasis with regard to environmental factors has been used. Research results can be used in the implementation of modern technologies of social and hygienic monitoring to assess the state of health of the population with the identification of general patterns of prevalence of psoriasis.

Conclusions. Human health is determined by the interaction of a number of factors: the quality of the environment, lifestyle, heredity, the presence of bad habits, socio-economic and psychological well-being, availability of medical care. The airspace occupy the first place (66,7 %), the second — food products (13,5 %) and the third — noises (12,6 %).

Key Words: social-hygienic monitoring, psoriasis, research methods, ecological factors, disease prevention.

Rationale. As of today, the methodology for the assessment of risks related to environmental factors and population health is generally recognized, primarily in the constant impact of industrial pollution. Methods of analytical epidemiology of the non-infectious disease (epidemiology of risk factors) are currently widely used. These methods aim not only at the qualitative characterization of disease risks but also at detection of factors that define the level of disease under specific conditions [3].

Evaluations of population health hazards related to chemicals in the ambient air of large industrial cities of Ukraine have found region-specific features of the environmental and hygienic situation and the need for a comprehensive assessment of the impact of chemicals on human health in every region, taking into consideration the multifaceted effects of these chemicals in the human body.

Two mutually appending approaches are used to assess how population health depends on environmental factors: ecological-epidemiological studies and risk assessments. The basis for ecological-epidemiological studies includes retrospective assessments of connections between detectable problems of population health and the effects of specific harmful factors or their combinations. The preconditions to conduct ecological-epidemiological studies usually include the following: the presence within the medium of a factor/factors potentially harmful to humans as informed by animal experimentation or by tests in other populations; the results of assessment for the predictive risk(s) of population health under certain conditions; detection of cases of disease in people subject to cases of disease in people exposed to aforementioned factor(s) albeit at much higher levels (e.g. occupational disease); detection in one of the populations of significant quantities of cases of rare diseases, high levels of morbidity (mortality) or prevalence of routine disease as informed by descriptive epidemiology or by sporadic observations [5].

Risk factors. These factors may be of any nature and may under certain conditions trigger or increase the risk for human health problems [Grebnyak, 2007].

Comparative assessment of the risks caused by certain factors and in various ways of impact on the population and for any groups within the population creates the basis for ranging of these risks. However, the methodology of risk assessment is not an alternative to environmental characterization based on the current system of hygienic standards and regulations (e.g. Threshold Limit Values [TLV], Safe Reference Level of Impact [SRLI] and Maximum Permissible Level [MPL]). Rather, this methodology is a valuable addition [2].

High-priority risk factors of population health in the city of Zaporizhzhia

Anthropogenic pollution of the atmosphere constitutes high-priority health-related risk factors.  In particular, this includes changes in the composition and properties of ambient air due to environmental pollution of chemical, physical and biological compounds/factors that adversely affect human health. The level of atmospheric pollution depends on the bulk of pollutants, the magnitude and the height of the discharge, the distance from the source of emissions and weather conditions. [Grebnyak, 2007]

Multiple ecological and hygienic studies have shown environmental pollution to affect the health of people adversely; the paediatric population is the most susceptible group. One of the most dangerous criteria of such pollution is the contents of hazardous substances in the atmospheric air. Manmade pollutants increase the incidence and prevalence of a wide array of disease, from common cold and allergy to chronic neurological and cardiovascular disease.

However, it should be admitted that under current conditions the intensity of environmental pollution in a number of regions in the country has reached the level of adverse impact on population health parameters. In many regions of Ukraine, ecological and epidemiological studies have been conducted to assess the correlation between environmental pollution (mainly pollution of atmospheric air) and health problems in the population.

There have not been enough studies to assess the relationship between adverse environmental conditions and the risk for psoriasis. Objective the study. To assess risk factors for occurrence and prevalence of psoriasis in the population of metropolitan Zaporizhzhia and Zaporizhzhia administrative region in a setting of influence of negative environmental factors.Methods of study: hygienic, clinical and laboratory methods; functional, epidemiological and statistical methods.The results obtained in the study have been widely discussed. This is the first instance when an integrated approach was used to assess psoriasis morbidity with consideration for environmental impact. The findings of the study can be used for the implementation of modern technologies of socio-hygienic monitoring to assess population health and detect the general patterns of risks for and the prevalence of psoriasis.

Results and discussion. Assessments of environmental pollution in Zaporizhzhia were performed as required by Section 8 of ДСП-201-97 Regulation “State sanitary rules for protection of atmospheric air in populated areas (from pollution by chemical and biological substances)” by comparing total pollution index (Σ PI) for a mixture of substances with the index of maximum permissible contamination (MPC). Therefore, the level of atmospheric air pollution is deemed “unacceptable” in terms of contamination level and “moderately hazardous” in terms of hazard level. To assess the quality of atmospheric air, drinking water and soil, we have reviewed relevant annual reports and research protocols of the centres of public health and epidemiological surveillance, as well as the reports by departmental laboratories.

In addition to that, we have assessed environmental footprints in a particular territory and detected the industry-specific fractional inputs within the total footprint. To conduct this assessment, we have generalized the data characterizing the number of point-type (technological wells, storerooms, warehouses, etc.), area-type (factories, sewage pumping stations, commodity parks, car fleets, etc.) and linear (pipelines of oil, gas, sewage, brine, process water, etc.) sources of environmental pollution.

To assess for causative relationships between population health and environmental factors, we have used modern statistical methods, such as component analysis, assessment of derived values, mean errors, the significance of differences of values, standard indexes and pair correlation analysis.

To assess the multidirectional influence of environmental factors, we have used an approach based on a comparison of average district values for individual parameters with the relevant region averages accepted as standards (references). This allows operating dimensionless parameters expressed as standard (conventional) scores.

The characteristics of psoriasis prevalence in metropolitan Zaporizhzhia and in Zaporizhzhia administrative region

Across the overall population, the highest prevalence rates were documented in metropolitan Zaporizhzhia and in Guliaipilskii, Veselivskii, Kuibyshevskii, Primorskii and Vasilivskii districts. In these administrative units, the prevalence of psoriasis was within 269.6 to 513.8 cases/100,000. In part, higher than the regional average (р < 0.05) prevalence of psoriasis were found in metropolitan Zaporizhzhia (the difference of 146.1 to 180.6 cases/100,000), in Guliaipilskii district (the difference of 96.1 to 141.9 cases/100,000) and in Veselivskii district (the difference of 84.9 to 105.9 cases/100,000). Significantly lower levels (р < 0.05) were documented in Vilnianskii district (the difference of 314.5 to 324.7 cases/100,000) and in Berdiansk district (274.9 to 294.2 cases/100,000).

At that, the prevalence of psoriasis in 2012–2013 has been on a stable level. Thus, in Zaporizhzhia, it was 497.9 to 513.8 cases/100,000, while in the provincial areas it was 443.6 to 475.1 cases/100,000 in Guliaipilskii district and 417.5 to 438.0 cases/100,000 in Veselivskii district.


  1. Human health depends on a number of factors, such as environment, lifestyle, heredity, unhealthy habits (if any), socio-economic and psychological well-being and availability of healthcare services. Within the structure of the factors, which are shaping health hazards, the primary role is played by environmental conditions, including aerial environment (66.7 %), followed by the quality of food products (13.5 %) and noise (12.6 %).
  2. In regions with poor public health and epidemiological standing, residents are 2–4 times more likely to seek medical attention due to respiratory, cardiovascular or dermatological problems. In Ukraine, such environmentally disadvantaged region is metropolitan Zaporizhzhia and Zaporizhzhia administrative region due to the concentration of production sites, which pollute the environment with their noxious emissions. This is the exact cause of the mass prevalence of various skin problems. The integrated approach pioneered by this study has proven this premise convincingly.
  3. Psoriasis is a widely spread chronic, often recurrent systemic polyaetiological and multifactorial disease with special prevalence in Ukraine in metropolitan Zaporizhzhia and in Zaporizhzhia administrative region.
  4. Two mutually appending approaches were used to assess how population health in this region depended on environmental factors: ecological-epidemiological studies and risk assessments. Eco-epidemiology studies, as well as retrospective studies, have found a connection between impairments of population health under the effect of specific noxious factors or combinations thereof, causing skin disease, including psoriasis, in the population of the Zaporizhzhia region.



1. Abdeiev R. M. The impact of environmental factors on the prevalence of psoriasis / R. M. Abdeiev //Epidemiology and infectious diseases. ‒ 2008, No. 6. ‒ P. 27‒29.

2. Avetikian S. S. The peculiarities of clinical presentation, course and therapy of psoriasis in men / S. S. Avetikian // Author’s abstract of Cand. Sci. Med. (PhD) Thesis: 14.00.11. 2008. ‒ 23 pgs.

3. Adaskevych V. P. Diagnostic indices in Dermatology / V. P. Adaskevych // Medical Book, 2004, 165 p.

4. Bakulev A. L. Psoriasis as a systemic disease / A. L. Bakulev, Yu. V. Shagova, I. V. Kozlova // The Bulletin of Saratov Medical University. ‒ 2008, No. 8. ‒ P. 13‒20.

5. Batkaiev E. A. Pathogenetic mechanisms of proliferative processes in psoriasis / E. A. Batkaiev, T. V. Abramova // Bulletin of Postgraduate Medical Education. ‒ 2006, No. 2. ‒ P. 56‒58.

6. Bergstrom K. G. Psoriasis / K. G. Bergstrom // Practica, 2007. 152 pgs.

7. Vladimirov V. V. Psoriasis: etiopathogenesis, clinical presentation, treatment and prevention. Quality of life / V. V. Vladimirov, E. V. Vladimirova // Skin Diseases. ‒ 2006, No. 6 (17). ‒ P. 47‒49.

8. Gerasimov O. M. Medical Statistics / О. М. Gerasimov // Мoscow, ‒ 2007. ‒ 480 pgs.

9. Golubchikov M. V. Performance indicators of medical and preventive care for patients with skin and venereal diseases in Ukraine / M. V. Golubchikov // Centre for Medical Statistics of the Ministry of Health of Ukraine. Kyiv. ‒ 2009. ‒ 110 pgs.

10. Grebniak M. P. Preventive medical ecology / M. P. Grebniak, S. V. Grishchenko, V. I. Agarkov // Dnipropetrovsk: Porogi. ‒ 2013. ‒ 196 pgs.

11. Proceedings of scientific works of the 2nd All-Russian Dermatovenereology Congress / V. S. Dmytruk, V. S. Sokolova, L. V. Stryga et al. //Saint-Petersburg ‒ 2007. ‒ P. 51.

12. Ecopaediatrics / M. P. Grebnyak, S. A. Schudro, O. B. Iermanchenko et al.// Dnipropetrovsk: Porogi. ‒ 2011. ‒ 299 pgs.

13. Zaitseva O. V. Analysis of monitoring-related metabolic parameters in patients with extended psoriasis / O. V. Zaitseva, N. V. Zhukova Ie. G. Tatuzian // Experimental and Clinical Medicine (Kharkiv). ‒ 2009. ‒ No. 1. ‒ P. 89‒93.

14. Katunina O. R. Immune system of the skin and its role in the pathogenesis of psoriasis / O. R. Katunina // Ukr. J. Dermatology and Venereology. ‒ 2005. ‒ No. 1. ‒ P. 19‒22.

15. Komartseva V. V. Measurement of quality of life indicators in patients with psoriasis / V. V. Komartseva // Russian Journal of Skin and Venereal Diseases. ‒2009. ‒ No. 5. ‒ P. 20‒23.

16. Konovalenko A. A. Peculiarities of the course of complicated forms of psoriasis at the present stage / A. A. Konovalenko // Medical News. ‒ 2009. ‒ No. 5. ‒ P. 100‒104.

17. Kubanova A. A. The concept and the assessment of the quality of life in dermato-venereological patients / A. A. Kubanova, A. A. Martynov // Bulletin of Dermatology and Venereology. ‒ 2004. ‒ No. 4. ‒ P. 16‒19.


Надійшла до редакції: 11.06.2018 р.