premature death rates age group years from ischemic heart disease vary by nearly a factor of five between the region with the lowest mortality kyzylorda region and the much more rural pavlodar region similarly premature death rates from cerebrovascular disease are nearly three times higher in the mostly rural north kazakhstan region than in the city of astana which recorded the lowest mortality in the country moh overall the three risk factors that account for the greatest disease burden in kazakhstan are tobacco smoking alcohol use and excess weight ihme indeed a recent study kulkayeva et al