[The alteration of the structure of mortality of endocrine system diseases, nutrition disorders and metabolic disturbances in individuals of able-bodied age and older in conditions of pandemic].

The elderly age and endocrine diseases are among death risk factors at contamination with new coronavirus infection. To reply the question of how the influence of these risk factors is summing up, differences were determined concerning patterns of changes in structure of mortality of endocrine system diseases, nutrition disorders and metabolic disturbances in individuals of able-bodied age and older against the background of COVID-19 pandemic. on the basis of information from the Moscow database of deaths of endocrine system diseases, nutrition disorders and metabolic disturbances, the changes in contribution of individual diseases to the death causes structure in 2019-2021 were analyzed. The groups of individuals of able-bodied age and older were compared. It was established that in both groups rate of indicating SARS-CoV-2 virus infection as concomitant disease decreased while rate of indicating concomitant diseases at death of COVID-19 increased. The group differences in changes of structure of death causes were established in 2021. The percentage of undetermined forms of diabetes and obesity in structure of death causes increased in the elderly, while in individuals of able-bodied age increased. The percentage of obesity as concomitant disease of death of COVID-19 in individuals of able-bodied age increased and did no change were detected in the elderly group. The input of poly-glandular dysfunction as consequence of old infection into mortality is five times higher among individuals of able-bodied age. On the basis of received results, assumption was made SARS-CoV-2 virus contamination ruinously affects development of pathological process under endocrine diseases regardless of age, while age affects spreading of endocrine diseases and degree of resistance to development of infectious process directly. The differences in patterns of changes of structure of death causes of population of able-bodied age and older are associated with low quality of diagnostics of death causes in individuals of elder age groups.

[ELDERLY CARDIAC PATIENTS: SELF-REPORTED HEALTH STATUS].

INTRODUCTION: Thanks to advances in science and medicine, the threshold age of a patient who can undergo open surgery on the valves of the heart or coronary arteries is increasing every year. Elderly patients constitute a special group in this regard. AIM: Determine how elderly cardiac patients assess their health status and highlight the factors influencing it. MATERIALS AND METHODS: The results of a survey of 107 patients who are in the Department of cardiac rehabilitation of the A. N. Bakulev National Medical Research Center for Cardiovascular Surgery in 2020-2021 after surgical or endovascular treatment of cardiac pathology. The survey is carried out by a cardiologist using a questionnaire that allows you to characterize the patient's health status on the basis of self-esteem. Statistical data processing was carried out in Microsoft Office Excel 2003 and Statistica v. 6.0 programs. RESULTS: The majority of respondents (63.6%) assessed their state of health as satisfactory. No correlation was found between the state of health and the level of education. On average, the patients had 3.7 ± 1.8 chronic diseases. Obesity was observed in 29.4% of men and 68.8% of women. The body mass index did not correlate with the self-reported health status of the respondents, but it did correlate with the number of accumulated diseases (r = 0.42, t-statistic = 2.58). CONCLUSIONS: Recovery of elderly patients after cardiac surgery is progressing rapidly. In women, the recovery process is slower due to the greater number of associated pathologies. Old age is not a direct contraindication for cardiac surgery. When self-assessing their health status, elderly patients do not associate it with risk factors.

[Mortality of people over working age in the context of COVID-19 pandemic.]

The mortality of people over working age (women 55+ and men 60+) was analyzed in the context of COVID-19 pandemic in order to determine the potential for its prevention. The information from the Moscow mortality database for 2019, 2020 and 2021 (up to June 15) was used. Against the background of more correct accounting of death causes associated with SARS-CoV-2 virus infection in 2021, the contributions of mental disorders and endocrine diseases to the structure of death causes (excluding deaths from COVID-19) for people over working age are more than in 2019. The increase in mortality from diseases of these classes is largely a consequence of exogenous stress associated with a pandemic, isolation of people older 64 years and a decrease in the effectiveness of medical care. It was concluded that indirect losses from COVID-19 include avoidable mortality of elderly caused by shortcomings in organization of social assistance for them, the weak introduction of new information technologies and wearable electronic devices into the practical work of health care, small scale of public initiatives in the field of social assistance.

[Evolution of loss due to event of undetermined intent among the Moscow working-age population in the 2000s].

Accuracy of statistical registration of mortality in Russia, especially in times of crisis, is a pressing and relevant issue; this problem was challenging Moscow in the 2000s: until recently, the capital was a complete outsider in terms of accuracy of statistical registration of mortality. The purpose of the study was to identify peculiar features of evolution and the structure of mortality from an event of undetermined intent among Moscow working-age population in the 2000s against the background of the processes taking place in Russia. The article analyzes mortality from an event of undetermined intent among Moscow population of young and old working age in the 2000s, as well as its nosological aspects in 2011-2018, when certain events of undetermined intent were separated as individual nosological units. A sharp decline in indicators in 1999-2000 and their growth in 2015-2017 have been identified. It is shown that these shifts were due to all leading events of undetermined intent (falls/jumps from a high place, hanging/strangulation/suffocation, medicament, alcohol and drug poisoning as well as specified and unspecified events). As a result, the structure of mortality after 2015 has significantly changed due to a sharp increase in the significance of alcohol, medicament and especially drug poisoning. It should be emphasized that in the 2010s the significance of latent suicide in all age and gender groups of Moscow working-age population is significantly higher than in Russia.

[Quality of accounting of death causes for elderly people].

Programs to increase the life expectancy of old people are becoming increasingly relevant in an aging society. Their adequacy depends on the quality of accounting death causes. Objective: To evaluate the quality of accounting of death causes for population over the working age. For 98 061 deaths of people over working age registered in Moscow dead database, the structure of underline and multiple causes of death were compared. To determine whether information on morbidity of elderly can improve the diagnosis of death causes the structure of death causes was compared with officially registered prevalence and detected prevalence. The last was calculated on the basis of the household survey of health of elderly population in Nizhny Novgorod Region (22 558 people). We find fundamental difference between the structure of causes for officially registered prevalence, detected prevalence and mortality. In the structure of death causes the nervous diseases are in the second place and the proportion of uncertain death causes is 6.7%. The difference in the structure of underline and multiple causes of death is not so great. For people over working age, the coding errors were detected in 9.8% underline death causes. Thus, morbidity statistics cannot provide informational support for diagnosing causes of death in full. To improve the quality of accounting of death causes, it is advisable to introduce the institution of coders and to give them the possibility of verifying death diagnoses in medical organizations where the diagnosis has been established.

[The mortality of diabetes mellitus from the perspective of multiple causes of death: encoding problems].

The statistics of causes of death is the informational basis for identifying public health problems. That is why the accurately accounting for mortality from diabetes mellitus, which is a global medical and social problem for society, is important. The study was carried out to analyze the correctness of coding death causes of diabetes mellitus and the frequency of alleged death. MATERIALS AND METHODS: The Moscow deceased population database of July 2018 - July 2019 was analyzed. Using the decision tables on codes linkages from ICD-10, incorrect codes for underline cause were established for 342 death cases from diabetes mellitus. Among 43044 cases of cardiovascular death the cases of presumed death from diabetes were detected. The analysis was carried out in the Microsoft Access 2007 software. THE RESULTS: In 18.4% of cases, the cause of death from diabetes was encoded incorrectly. If a modification of the underline death cause is assumed due to the mention of certain diseases in any line of the Death Certificate, cases of coding for death from diabetes with wrong fourth character are more often detected when mentioning kidney diseases. If modification of the underline cause is provided for cases when information in the Death Certificate indicates that diabetes has caused the development of some diseases then the largest number of cases with incorrect coding was detected when mentioning circulatory diseases. Only in one medical organization the frequency of incorrect coding is 3.4%, in the rest it varies from 15.4% to 52.2%. Among all death causes, diabetes was only 0.41%. If to add cases of presumptive death from diabetes mellitus, then the proportion of diabetes in the structure of death causes will almost triple and reach up to 1.2%. CONCLUSIONS: The quality of diagnosis and coding of death causes from diabetes has not improved in recent years. To increase it, it is advisable to organize and establish the institution of coders. It is advisable to indicate the presence of diabetes mellitus in the Death Certificate without fail and use the information from the diabetes register. It is proposed to encode the death cause from diabetes mellitus with multiple complications use line D in the Death Certificate to indicate damage to various organs and systems if it is necessary.

[Multimorbidity of elderly persons in urban and rural areas of the Nizhny Novgorod region.]

The article compares the prevalence of pathological changes in different organs and systems among city and rural residents of the next ages: elderly (60-74 years for men and 55-74 years for women), senile (75-84 years) and advanced (85 years and older) ages. The results of the continuous survey of all persons of the retirement age of one urban (7 809 people) and two rural areas (14 749) of the Nizhny Novgorod region were analyzed. The region is comparatively homogeneous in terms of the national composition of the population. In the city, the number of chronic pathologies of different organs and systems per one person of elderly age are: 2,83 for man and 2,76 for woman of elderly ages, 3,06 and 3,07 respectively for senile ages, 2,71 and 2,75 of advanced ages. In rural areas, the analyzed indicators for men and women are respectively 1,64 and 1,58 for elderly ages, 1,84 and 1,78 for senile ages, 1,86 and 1,84 for advanced ages. Demonstrating the difference in the phenotypic manifestations of the genes of predisposition to chronic diseases in old age between the city and village, the results make it possible to produce the following assumptions. First, better access to medical care does not guarantee the better health status of the elderly, while it contributes to an increase in the life expectancy of men. Second, in spite of better access to health care, urban lifestyle contributes to the accumulation of chronic diseases in population of a region. Third, if chronic pathology of three different classes of diseases presented, then the probability of a long life is fundamentally determined by the access to health care. Fourth, the probability of longevity is significantly reduced in result of illness by neoplasms, cardiovascular, respiratory, endocrine or genitourinary diseases in ages of working or beginning of retirement period.