THE EXPERTISE OF THE CAUSAL RELATIONSHIP BETWEEN THE DEVELOPMENT OF ARTERIAL HYPERTENSION WITH PARTICIPATION IN WORKS FOR LIQUIDATION OF THE CONSEQUENCES OF CHORNOBYL NPP ACCIDENT IN REMOTE POSTACCIDENTAL PERIOD

Abstract

Loss of health and work ability, as well as deaths from diseases of the circulatory system (DCS), first of all arterial hypertension (AH), due to radiation exposure (RE) in the conditions of Chernobyl catastrophe (ChC) in the performance of professional, military or official duties and / or living on radiation-contaminated areas, additional exposure not through their own fault but due to a radiation accident, caused the development of a special form of medical expertise as part of the of medical social protection system for these suffered contingents. Objective: to optimize decision-making criteria for the expert estimation of the casual relationship between development and progression of AH under the influence of RE in clean-up workers of the Chornobyl NPP accident (CWs) in the remote postaccidental period based on the study of odds ratio (OR) of the course of the disease. Material and methods. A retrospective analysis of the structure of 16073 cases of victims of the Chornobyl NPP (ChNPP) accident, considered by the Central Interagency Expert Commission of Ministry of Health of Ukraine for diseases, reason of disability and death causal relationship to ChNPP accident (CIEC) during 2014–2016, allowed to form a group of 401 cases of CW with AH to determine the OR of the course of the disease. The main group consisted of 330 CWs for whom the development of AH has a causal relationship with the participation in the work for liquidation consequences of the Chornobyl NPP accident (WLAc), the comparison group – 71 CWs in respect of whom a negative expert decision was made. There were not significant differences between both groups of CWs in dose of external radiation exposure (DERE) in the main group – (0.155 ± 0.085) Sv, in CWs of the comparison group – (0.135 ± 0.086) Sv (р = 0.868). Results. In the remote postaccidental period, HSC take the second place (39.62 %) in the structure of medical expertise of the causal relationship of the diseases development and progression with RE for all categories of victims of the Chernobyl accident. The share of cases of AH was 28.4% of the total number of cases considered CWs. In the structure of cases of relationship of diseases of CWs that led to death, the share of AH was 17.8 %. In CWs the main group the AH developed in (9.4 ± 6.2) years after participation in WLAc, which is on average 6 years earlier than in the comparison group (р < 0.001). AH in the main group of CWs developed at the age of 5.8 years younger than in the comparison group (р = 0.0005). The need for inpatient treatment come 8.6 years earlier (14.6 ± 7.7 years) than in CWs comparison group (р < 0.001). At DERE 0,05 Sv and over, increases the probability of development and progression of AH that has causal relationship with participation in the WLAc. For medical expertise of the causal relationship of the AH development and progression with WLAc at DERE 0.20 Sv and over the significant evidence value have the next criteria: terms Somatoform Vegetative (autonomic) Dysfunction (SVD) development (within 3,5 years) and its transformation into AH (within 7 years), verification of the AH diagnosis (within 9,5 years), inpatient treatment for SVD or AH (within 15 years), vascular events (Acute Cerebrovascular Accident – Stroke (ACVA) – within 24 years after participation in the WLAc or 11 years after the AH diagnosed, myocardial infarction (MI) – within 22 years after participation in the WLAc or 10.5 years after the AH diagnosed), the establishment of permanent disability. Conclusion: Radiation factor has an evidence influence on the development and progression of AH in CWs. Criteria of the development and progression of AH in CWs can be used for evidence-based medical expertise for estimation of the causal relationship of the disease with the WLAc in the remote post accidental period at DERE more than 0.20 Sv. Key words: ionizing radiation, arterial hypertension, clean-up workers of Chornobyl NPP accident, medical expertise, Chornobyl catastrophe.