Characteristics of the incidence and prevalence of chronic cystitis among the male population in Ukraine

The work is devoted to the dynamics of morbidity and prevalence of chronic cystitis among the male population of Ukraine for 10 years (2008–2017). The primary documents were the reported forms of official statistics. The special feature of the study was a comparative analysis of two periods of five-years. The approach was justified by the possibility to trace the nature and intensity of changes, and was also of interest in terms of known territorial changes in the country. It was found that among the total number of registered as well as first-time patients with chronic cystitis in Ukraine, a quarter of them were men. Over the years there has been a decrease in the number of cases. At the same time its rate among the latter is lower than among those registered, which is more pronounced in the last five years. This finding may suggest that the situation is likely to change in the near future towards an increase in the number of cases among men. The first three places in the number of men with chronic cystitis are occupied by the Southeastern, Western, Southern regions. The incidence and prevalence rates (per 100,000) among men are half as high as the corresponding rates among the adult population as a whole. The values of the latter have been decreasing over the years, while the incidence rate increased between 2013 and 2017. Each region has its own peculiarities, which are manifested both by the levels of width in the regions which make up their structure and by the nature of their dynamics. The first identified men with CC usually accounted for one quarter of the total number of cases. Each region is distinguished by the number of first-time offenders. The situation in Ukraine is defined by the Southeastern, Southern regions and Kiev, where the rates are higher than the Ukrainian average and are increasing.


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А К Т У А Л Ь Н І Т Е М И I nfections of the urinary tract are among the problems that do not become less topical over the years. This is due to its difficulty in treating and the threat to patients in terms of the nature of the pathology's survival with a tendency to relapse, associated with a decrease in physical, psycho-motivational activity up to the loss of employment [1,2]. At the same time the number of publications devoted to an in-depth understanding of the pathogenesis of infectious and flammable diseases taking into account the state is increasing, their diagnosis and, in particular, their treatment, taking into account that urological infections are always potentially contagious with possible transmission of drug-resistant pathogenesis [3,4].
At the same time, universal attention to different aspects of problematic issues cannot but have a positive impact on improving the quality of medical care, as authoritarians point out [5,6]. This is particularly true for chronic cystitis (CC). According to information resources, practical urology has been for a long time proposing and implementing new and improved treatment methods as well as prophylactic measures, including performance-controlled complications in clinical practice [7,8]. It should be noted that there are gender peculiarities that are taken into account in the clinical and diagnostic process.
Under these conditions, it is obvious that it is necessary to assess the impact of interventions aimed at changing the situation. From this perspective, data on the dynamics of prevalence and incidence rates are an objective criterion. The nature of their changes in recent years in comparison with previous years can indicate how effective they have been.
The objective: of the work was to conduct a trend analysis of the incidence and prevalence of chronic cystitis in the male population of Ukraine.

MATERIALS AND METHODS
The primary documents were the reporting forms of official statistics (F.F. № 7 and № 47) for 2008-2017. When analyzing the indicators of the incidence and prevalence of chronic cystitis among the male population of Ukraine, two periods (2008-2012 and 2013-2017) were distinguished. They were of interest in the comparative aspect both in terms of the well-known territorial changes that took place in the country, as well as, based on the essence of the work, to determine the dynamics of changes in the relevant indicators in their combination.
The research was conducted in the context of all regions of Ukraine, taking into account the regions included in their structure. Absolute values and special coefficients per 100,000 inhabitants were studied.
The statistical analysis of the obtained data used standard methods of evaluation of variation series (absolute increase or decrease, the rate of increase or decrease), if necessary, to bring the differences between the two statistical groups used Student's criterion.

RESULTS AND THEIR DISCUSSION
The 10-year (2008-2017) analysis of chronic cystitis patients registered in Ukraine showed their increase by 0.4% up to 65239 in 2017. The process was ambiguous in two periods: the first (2008-2012) saw a net increase (by 3.6%), the second a decrease (by 3.7%). While the number of such patients was low by the year, one quarter of them were men (Fig. 1), the regional distribution of these patients is shown in Table 1. One of the conclusions from Table 1 is that the first three places in the structural distribution were located in the Southeastern, Western and Eastern regions. The next -in a steady decrease of the said contingent, intensified over the years: in the whole of Ukraine for 10 years by 9.7% to 14,149 in 2017, for periods by 3.8% and 8.8% respectively. This process was driven by the Western, Eastern and Northern regions and the capital in the first five years, which were joined by the Central and Eastern regions in the next five years.
The leading region for the number of men with CC is consistently the Southeastern region (35.4-42.3%), and the last one is the Northeastern region (4.0-10.0%). The significant variability of the data resulted in determination of average values for the study periods which clearly indicate the nature of regional changes ( Table 2).
According to Table 2, it was confirmed that in each region, with the exception of the Eastern region, during 2013-2017, the number of registered men with CC was significantly lower than in 2008-2012. Kyiv, where the number of first-time cases of CC in men is the same as in the Central and Western regions. Analyses by region revealed that 56% (9284 out of 16562) in 2008 and 61.3% (9162 out of 14949) in 2017 were in 10 regions. Ten of them, namely Ivano-Frankivsk, Lviv, Chernivtsi in the Western region; Zhytomyr, Kyiv, Cherkasy in the Central region; Poltava in the Northeastern region; Dnipropetrovsk, Kharkiv in the Southeastern and Odessa in the Southern region.
The prevalence of CC among the adult population of Ukraine (per 100,000 people) increased to 187.5 in 2017 compared to 171.5 in 2008. Among the male population, the rate was twice as low -95.1 versus 97.3, respectively, and it appears to have decreased (by 2.3%). The analysis shows its non-stability in Ukraine and its administrative territories. During the first twenty years it
In comparative terms, the Ukrainian average (102.7±8.8 and 94.1±2.4) is higher than the average for Ukraine, which in fact shapes the situation on the whole, the most distinctive feature of the region is the Southeastern, the Southern regions and the capital city which, incidentally, demonstrate an increase in their rates with the same level in the Southern, in Kyiv they are twice as high as in Central Ukraine.
Each region has its own peculiarities, which are manifested both by the levels of width in the regions which make up their structure and by the nature of their dynamics. Thus, the first sign in the West is Chernivtsi region, where indices are two times higher than in other regions (190,0±20,7 and 155,1±3,4  Thus the prevalence of CC among the adult population is almost twice as low as among the adult population in Ukraine and tends to decrease. The highest indicators were found to be in the Southeastern, Southern regions and Kyiv, the first two show their growth. The intra-regional peculiarities are of importance in the form of the defined regions, which form the spread both in the given region and in Ukraine (Chernivtsi, Zhytomyr, Dnipropetrovsk, Kharkiv, Mykolayiv, Odessa).
The first identified men with CC usually accounted for one quarter of the total number of cases. In 2008, a total of 14,703 such cases were reported in Ukraine, of which 3,952 were men (26.2%), in Table 2 Regional dynamics of the number of chronic cystitis cases in males by study periods; М±m Table 3 Regional dynamics of prevalence rates of chronic cystitis in males over study periods (per 100,000 population); М±m Figure 1. Structure of distribution of registered patients with chronic cystitis by gender Note. * -Differences are valid between periods; р<0,05. Note. * -Differences are valid between periods; р<0,05.

А К Т У А Л Ь Н І Т Е М И
2017. 151112 and 3817 (25.2%) respectively. Therefore, in 10 years there was a decrease by 3.4% with the consolidation of the process over the last five years (by 1.7% vs. 6% in the previous year). The average number of cases in Ukraine was 14447±158 and 14819±99 (p<0,05), of males 5118±960 and 3707±130 patients (p<0,05). These data show that on the background of significant increase in the number of patients, the number of males among them is decreasing. With all fluctuations of the data over the years, the above is true for all regions, except for Southern and Kyiv, which is shown in Table 4. The same is true for the averaged values presented in Table 5.
The first three places in the contingent distribution structure belonged to the Southeastern, Western and Southern regions.
Each region is distinguished by the number of first-time offenders. These are matched by those with the highest number of cases. Namely Ivano-Frankivsk, Lviv, Chernivtsi, Zhytomyr, Cherkasy, Poltava, Dnipropetrovsk, Kharkiv, Mykolayiv, Odessa and Kyiv. They accounted for 3001 out of 3817 patients (70.6%) in 2017.
An analysis of the prevalence rates for CC among the male population (per 100,000 people) it was found that, similar to absolute numbers, they are almost twice as low as in Ukraine as a whole; in 2008. 23.2 vs. 38.8, in 2017. 24.3 versus 43.4 respectively. At the same time, indicators grew over 10 years by 4.7%, but only in the last five years (2013-2017) by 5.6% with a decrease in the first 5.6% (from 23.2 to 21.9 in 2012). In order to identify the main trend, their values were averaged over periods.
They show that the situation in Ukraine is shaped by the Southeastern, Southern regions and Kyiv where the indices are higher than in the average Ukrainian; namely: 37.6±73.1 and Thus, with the annual decrease in the number of men with newly diagnosed CC in Ukraine, the largest number of them are concentrated in the Southeastern, Western, and Eastern regions. The incidence rate (per 100,000 people) increased over the last five years (2013-2017) by 5.6% to 24.3. The areas identified in each region that influence the situation there and, in turn, the regions that shape it in Ukraine.
It is worth noting that the rate of decline in first-time occurrences of CC is lower than the rate of decline in the number of cases reported, which has been more pronounced over the past five years. This is alarming as it can be interpreted as already showing a willingness to change the situation in the coming years towards an increase in CC among the male population.

CONCLUSIONS
1. The number of patients with chronic cystitis (CC) and cases with newly diagnosed disease in Ukraine increased in 10 years (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017) and decreased in number of males, with a stable quarter of them. The rate among the latter is inferior to the rate among the number of registered, which has been Table 4 Dynamics of regional distribution of the number of first-time patients with chronic cystitis in males Table 5 Dynamics of the number of men firstly diagnosed with chronic cystitis on a regional basis by study period (М±m) 100,0 Note. * -Difference is valid between the indicators for the periods; р<0,05.
А К Т У А Л Ь Н І Т Е М И more pronounced in the last five years and is worrisome in terms of the likelihood of an increase in CC in this category in the near future. In the structure of their distribution, the first place belongs to the Southeastern, Western and Southern regions. The areas for which the overall situation is shaped are identified.
2. The prevalence and incidence of chronic diseases of CC in males is found to be twice as low as in the adult Ukrainian population. With their decrease over the years, only the incidence of disease increased in 2013-2017. Regional peculiarities were manifested by an increase in the relevant data in the Southeastern, Southern regions and Kyiv.