Trends and Outcomes of Traditional Medicine Treatments for Arterial Hypertension and Rheumatic Diseases in Mongolia (2021-2023)

Introduction: we analyzed morbidity, mortality, and inpatient data from 2021 to 2023, obtained from the Center for Health Development in Mongolia. Background: this study analyzes morbidity, mortality, and inpatient data from Mongolian Traditional Medicine Departments (MTMDs) for the years 2021-2023, focusing on patients diagnosed with arterial hypertension (ICD-10 I10) and rheumatoid arthritis (ICD-10 M05), corresponding to traditional diagnoses of “wind and blood ascending disorder” and “rheumatic diseases,” respectively. Method: data were collected from the Center for Health Development Mongolia, encompassing 1 398 cases of “wind and blood ascending disorder” and 175 cases of “rheumatic diseases.” Variables analyzed included patient demographics, hospitalization duration, and disease status. Results: from 2021 to 2023, cases decreased annually (823 in 2021, 404 in 2022, and 171 in 2023). Ulaanbaatar and Zavkhan had the highest prevalence rates (1,5 %), while Orkhon had the lowest (0,1 %). Admissions peaked in winter and decreased in spring, with significant monthly variations (p<0,05). Most patients (73,2 %) were treated in private hospitals, with a mean hospital stay of 7,07±1,73 days. Cases varied across the years (95 in 2021, 34 in 2022, and 46 in 2023). Ulaanbaatar accounted for the majority of hospitalizations (82,1 % in 2021, 64,7 % in 2022, 30,4 % in 2023). Mean hospital stay was 7,3±1,29 days, with significant regional differences (p<0,05). Conclusions: the incidence of “wind and blood ascending disorder” has declined, while admissions to MTMDs have increased. “Rheumatic diseases” showed a variable pattern, with significant regional and temporal differences in hospitalization rates and durations. Further research is needed to understand the underlying causes of these trends and optimize treatment protocols.


INTRODUCTION
Traditional medicine has been an integral part of Mongolia's healthcare system, providing valuable alternatives and complements to conventional medical practices.The Mongolian Traditional Medicine Departments (MTMDs) specialize in treating various chronic diseases using traditional diagnostic and therapeutic approaches. (1,2)mong the prevalent conditions treated are arterial hypertension and rheumatoid arthritis, which correspond to traditional Mongolian diagnoses of "wind and blood ascending disorder" and "rheumatic diseases," respectively.
Arterial hypertension, a major global health issue, is associated with significant morbidity and mortality due to its complications, including heart disease, stroke, and kidney failure.Similarly, rheumatoid arthritis, a chronic inflammatory disorder, leads to severe joint damage and disability if not adequately managed. (3)espite advancements in conventional treatments, many patients seek traditional medicine for its holistic approach and cultural resonance.
This study aims to analyze the trends, outcomes, and demographic characteristics of patients treated for these conditions in MTMDs across Mongolia from 2021 to 2023.By examining morbidity, mortality, and inpatient data, we aim to provide insights into the effectiveness of traditional treatments and identify factors influencing patient outcomes.(4)Understanding these patterns can inform healthcare policy, improve patient care, and integrate traditional and modern medical practices more effectively.
Through this research, we seek to highlight the role of traditional medicine in managing chronic diseases in Mongolia and contribute to the global knowledge of integrative healthcare approaches.

METHOD
A total of 32 683 patients in 2021, 54 440 patients in 2022, and 75,328 patients in 2023 were treated in the Mongolian Traditional Medicine Departments of healthcare institutions across Mongolia.For our study, we selected patients diagnosed according to the ICD-10 codes I10 (arterial hypertension) and M05 (rheumatoid arthritis), which correspond to the traditional diagnoses of "wind and blood asceuding(blood pressure)disorder" (TMA00.36)and "rheumatic diseases" (TMМ.14)respectively. (4,5)ver the past three years, a total of 1 409 patients with "wind and blood asceuding(blood pressure) disorder" and 181 patients with "rheumatic diseases" received inpatient care in Mongolian Traditional Medicine Departments nationwide.From this pool, we excluded minors and those with incomplete data, resulting in a Salud, Ciencia y Tecnología -Serie de Conferencias.2024; 3:.985 2 final sample of 1 398 cases of "wind and blood asceuding(blood pressure)disorder" and 175 cases of "rheumatic diseases" for further analysis (figure 1).

Figure 1. Sample size of the study
We obtained the 2021-2023 inpatient data from the Center for Health Development Mongolia and analyzed the records of patients hospitalized with the diagnoses of I10 (arterial hypertension, equivalent to "wind and blood asceuding(blood pressure)disorder" (TMA00.36)and (TMМ.14)(rheumatoid arthritis, equivalent to "rheumatic diseases") according to ICD-10.

RESULTS
Between 2021 and 2023, 1 398 cases of "wind and blood asceuding(blood pressure)disorder" were reported throughout Mongolia.Over the past three years, 823 cases were reported in 2021, 404 cases in 2022, and 171 cases in 2023, indicating a decreasing trend in reported cases.Conversely, the number of clients admitted to the Mongolian Traditional Medicine Department tended to increase in the coming years (figure 2).Among the total people who received traditional treatment at the Mongolian Traditional Medicine Departments, those treated for wind and blood asceuding(blood pressure)disorder were reported in Darkhan-Uul, Zavkhan, Orkhon, Uvurkhangai, Umnugobi, Sukhbaatar, Hovd, Khuvsgul, Khentii provinces, and Ulaanbaatar city.Ulaanbaatar city and Zavkhan province had the highest rates at 1,5 %, while Orkhon province had the lowest rate at 0,1 % (figure 3).The highest number of patients hospitalized with the diagnosis of wind and blood asceuding(blood pressure) disorder was reported in March (n=225).It was also observed that the number of inpatient admissions tends to increase from the end of autumn (November), peak during the winter months, and decrease from the beginning of spring.The months with the least inpatient admissions were July and September.A statistically significant difference was observed between the admissions in different months (figure 4).In Ulaanbaatar city, 65 % in 2021, 80 % in 2022, and 90 % in 2023 of all patients admitted with wind and blood asceuding(blood pressure)disorder, which is higher compared to other provinces.In Ulaanbaatar, the percentage of inpatients for wind and blood asceuding(blood pressure)disorder tends to increase year by year, but the actual number of patients is decreasing: 534 cases in 2021, 322 cases in 2022, and 154 cases in 2023.Conversely, the actual number of patients hospitalized in the provinces is decreasing year by year. (6,7,8)dditionally, in 2022, Darkhan-Uul, Orkhon, Hovd, and Khuvsgul provinces, and in 2023, Zavkhan, Hovd, and Khuvsgul provinces, there were no reported cases of wind and blood asceuding(blood pressure)disorder (table 1).
As of the last 3 years, among all inpatient admissions of wind and blood asceuding(blood pressure)disorder, 73,2 % of patients were admitted to private hospitals, 7,1 % to Traditional Medicine Centers, 5,4 % to the Institute of Traditional Medicine and Technology, 4,1 % to the Central Hospital of Traditional Medicine of MNUMS, 3,5 % to the Second Central Hospital of Mongolia, 3,4 % to district and provincial hospitals, 1 % to the General Hospital For Special Government Employees, 0,8 % to Regional Diagnostic and Treatment Centers, and 0,7 % to other healthcare organizations (table 2).
Examining patients hospitalized for rheumatic disease by months of hospitalization, the highest were in February(n=29) and March(n=29), October(n=18) and in November(n=18).The lowest were in July(n=3) (figure 8).
Clients diagnosed with rheumatic disease had a mean hospital stay of 7,3 ± 1,29 days (95 % CI 7,11 to 7,5), with a minimum of 5 days and a maximum of 10 days of hospitalization.When examining the age group and average hospital stay of clients with a diagnosis of rheumatic disease, the average bed days are approximate. (12)However, due to certain characteristics of this disease, hospitalization seems to require at least 5 days of medical care (table 6).When examining the duration of hospital stay of people hospitalized for rheumatic disease by province, the following averages were observed: Darkhan-Uul: 7 days, Dornod: 8,3 ± 1,5 days, Uvurkhangai: 7 ± 0,7 days, Salud, Ciencia y Tecnología -Serie de Conferencias.2024; 3:.985 8 Ulaanbaatar: 7,29 ± 1,45 days, Khentii: 7 days, Other provinces: 9,4 ± 1,34 days on average.Clients hospitalized in rural areas are hospitalized for at least 6 days, while in Ulaanbaatar they are hospitalized for 5 days (table 7).

DISCUSSION
Between 2021 and 2023, the cases of "disorders of wind and blood increase" and "rheumatic diseases" treated in Traditional Mongolian Medicine Departments (MTMD) showed divergent trends.Cases of "disorders of wind and blood increase" decreased from 823 in 2021 to 171 in 2023, while hospital admissions for these disorders increased, particularly in Ulaanbaatar.This discrepancy could suggest a higher preference for traditional hospital treatments or improved MTMD capabilities to handle more complex cases previously treated elsewhere. (13,14)he prevalence of "disorders of wind and blood increase" and "rheumatic diseases" varies significantly between regions and seasons.Ulaanbaatar and Zavkhan have the highest prevalence rates, while provinces like Orkhon and Darkhan-Uul have the lowest.These regional differences may be due to variations in access to traditional medical care, cultural acceptance of traditional medicine, or environmental and socioeconomic factors. (15)emporally, hospital admissions for both conditions increase in winter and decrease in spring and summer.This pattern might relate to climatic factors exacerbating symptoms or variations in agricultural and labor activities affecting when people seek treatment.
Most patients were admitted to private hospitals (73,2 % for "disorders of wind and blood increase" and 86,9 % for "rheumatic diseases").This preference could reflect perceptions of better quality care in the private sector or the greater capacity of these hospitals to offer specific traditional treatments.Additionally, the average hospital stay was similar for both conditions, with an average duration of around 7 days, indicating a relatively uniform standard of treatment.The incidence of both conditions increases with age, being more significant in people over 50.This is consistent with medical literature indicating that both hypertension and rheumatoid arthritis are more prevalent in older individuals.The average duration of hospitalization also slightly increases with age, potentially reflecting the greater complexity of cases in older patients.
In contrast, the incidence of "rheumatic diseases" showed variability, with a significant proportion of cases concentrated in Ulaanbaatar.The substantial number of hospitalizations in private facilities and the differences in mean hospital stay across regions emphasize the diverse healthcare landscape and potential disparities in access to traditional medical care.
Overall, the study underscores the importance of traditional medicine in the Mongolian healthcare system, particularly for chronic disease management.The data indicate a need for ongoing monitoring and evaluation of traditional medicine practices to ensure optimal patient outcomes.Future research should explore the integration of traditional and conventional treatments, patient satisfaction, and long-term health impacts to enhance the effectiveness of healthcare delivery in Mongolia.
The insights gained from this study can inform healthcare policy, resource allocation, and the development of comprehensive care models that leverage the strengths of both traditional and modern medicine, ultimately improving the health and well-being of the Mongolian population.

CONCLUSION
This study provides a comprehensive analysis of the trends and outcomes of patients treated for arterial hypertension ("wind and blood ascending disorder") and rheumatoid arthritis ("rheumatic diseases") in Mongolian Traditional Medicine Departments (MTMDs) from 2021 to 2023.The findings reveal significant temporal and regional variations in the incidence and management of these conditions.
For "wind and blood ascending disorder," a notable decrease in the number of cases was observed over the threeyear period, despite an increase in admissions to MTMDs.This trend suggests improvements in early diagnosis and outpatient management or changes in healthcare-seeking behavior.Ulaanbaatar and Zavkhan provinces exhibited the highest prevalence rates, indicating potential areas for targeted public health interventions.The seasonal pattern of admissions, with a peak in winter, underscores the need for increased healthcare resources and patient education during colder months.The predominance of private hospitals in providing care highlights the critical role of the private sector in managing chronic diseases in Mongolia.

Figure 2 .
Figure 2. The total number of clients admitted to the Mongolian Traditional Medicine Department and the actual number of confirmed cases of wind and blood asceuding(blood pressure)disorder by year.

Figure 3 .
Figure 3. Proportion of patients with a diagnosis of wind and blood asceuding(blood pressure)disorder in the Mongolian Traditional Medicine Departments, by province

Figure 4 .
Figure 4. Number of inpatients with wind and blood ascending(blood pressure)disorder by month

Figure 7 .
Figure 7. Percentage of patients hopsitalized due to rheumatic disease in TM departments

Figure 8 .
Figure 8. Number of people admitted to the hospital for rheumatic disease by month

Table 1 .
Patients admitted to the Mongolian Traditional Medicine Department of healthcare organizations due to wind and blood asceuding(blood pressure)disorder by year and province

Table 2 .
Patients admitted to the Mongolian Traditional Medicine Department of the healthcare institutions due to wind and blood asceuding(blood pressure)disorder by healthcare institutions Figure 5. Incidence rate of wind and blood asceuding(blood pressure)disorder per 10 000 population

Table 3 .
Age group and average hospital stay of clients diagnosed with wind and blood asceuding(blood pressure) disorder

Table 4 .
Mean hospital stay of patients hospitalized for wind and blood asceuding(blood pressure)disorder by province Figure 6.Number of actual cases of rheumatic diseases, by year Salud, Ciencia y Tecnología -Serie de Conferencias.2024; 3:.985 6

Table 5 .
Number of patients admitted to Mongolian Traditional Medicine Department by year and province

Table 6 .
Age group and mean hospital stay of clients with a diagnosis of asthma

Table 7 .
Duration of hospital stay due to the rheumatic disease by province