Data Sheet 1_Nursing workforce trends in Kazakhstan, 2003–2024: an interrupted time series and joinpoint regression analysis in the context of educational reform.docx

Joinpoint regression placed the structural breakpoint at approximately 2012 (95% CI: 2010 to 2014), 2 years before the reform. Sensitivity analyses confirmed this was not a denominator artifact. The GLS model identified significant coefficients at 2014 (level change: minus 5.45, p = 0.001; slope change: minus 2.16 per year, p < 0.001), but these reflected the proximity of the cut point to the actual trend reversal rather than a causal effect.

The nurse-to-physician ratio declined from 2.62 in 2012 to 2.30 in 2024, below the WHO-recommended 3:1. Regional density ranged from 72.0 to 134.8 per 10,000 in 2024. The forecast projected 111.0 per 10,000 by 2035 (95% prediction interval: 92.6 to 129.4).</p>Conclusions<p>The deceleration of nursing density growth preceded the 2014 reform by 2 years and coincided with the end of post-independence recovery and hospital contraction.

Kazakhstan's density exceeds the WHO European Region average, but the nurse-to-physician ratio has been declining and educational output cannot keep pace with population growth. Expanding programme capacity and setting explicit ratio targets are needed.</p>