Infrastructure determinants of urban-rural disparities in specialized cardiac care in Kazakhstan: A cross-sectional analytical study
Keywords:
cardiovascular diseases; healthcare accessibility; rural health; digitalization; cardiac rehabilitation; healthcare inequality; KazakhstanAbstract
Background and aim: Urban-rural disparities in cardiovascular healthcare accessibility remain an important public health problem in Kazakhstan despite ongoing healthcare reforms and expansion of specialized cardiac services. This study aimed to evaluate infrastructural determinants associated with accessibility and perceived quality of specialized cardiac care among urban and rural populations in the Almaty region of Kazakhstan.
Methods: A cross-sectional analytical study was conducted between September and December 2025 and included 350 patients with cardiovascular diseases and 152 healthcare professionals involved in cardiac care delivery. Data were collected using structured questionnaires assessing accessibility of specialized cardiac services, pharmaceutical supply, rehabilitation availability, digitalization, and perceived quality of care. Urban-rural differences were analyzed using chi-square and Mann–Whitney tests. Logistic and multivariable linear regression analyses were performed to identify determinants associated with patient dissatisfaction and professional-perceived quality of care.
Results: Rural patients reported significantly lower accessibility of high-technology medical care compared with urban residents (28.7% vs. 46.7%; p=0.019) and lower adequacy of pharmaceutical supply (31.7% vs. 51.1%; p=0.032). Insufficient drug supply was the strongest predictor of dissatisfaction with cardiac care (OR=2.31; 95% CI: 1.48–3.61; p<0.001). Inaccessibility of high-technology medical care (OR=1.89; 95% CI: 1.21-2.95; p=0.005) and rural residence (OR=1.62; 95% CI: 1.08–2.44; p=0.021) were also independently associated with dissatisfaction. Healthcare professionals identified digitalization level (β=0.40; p=0.017) and adequacy of material resources (β=0.35; p=0.002) as major determinants of perceived quality of care.
Conclusions: Substantial urban–rural disparities in specialized cardiac care persist in Kazakhstan and are primarily associated with infrastructural and organizational barriers. Improvement of pharmaceutical accessibility, digital integration, rehabilitation services, and continuity of care may represent key priorities for reducing regional inequalities in cardiovascular healthcare delivery.
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Copyright (c) 2026 Akerke Kassymkhan, Zhanara Buribayeva, Nargiza Nassyrova , Symbat Аbzaliyeva , Erkin Mirrakhimov , Aivar Kenzhebayev, Kenzhebek Bizhanov, Zhanar Ibakova
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