Causes of Death in Patients Asking for Polyclinic Care for Coronary Heart Disease.

AIM: Retrospective analysis of the underlying causes for death of patients who did and did not seek outpatient medical care (OPMC) for ischemic heart disease (IHD), and discussion of a possibility for using administrative anonymized but individualized databases for analysis. MATERIAL AND METHODS: The electronic database of the Central Administration of the Civil Registry Office of the Moscow Region (Unified State Register of the Civil Registry Office of the Moscow Region), including medical death certificates (MDC) for 2021, was used to select all cases of fatal outcomes with the disease codes of the International Classification of Diseases, Tenth Revision (ICD-10) (codes of external causes, injuries, poisonings excluded) that were indicated as the primary cause of death (PCD). Personalized data of the deceased were combined with data from electronic medical records of patients who sought OPMC at institutions of the Moscow Region within up to 2 years before death. In addition to IHD, the following PCD codes were taken into account: malignant tumors, COVID-19, diabetes mellitus, cerebrovascular diseases, hypertension, chronic obstructive pulmonary disease, alcohol-associated diseases, and, as examples of unspecified PCD, old age and unspecified encephalopathy.Results In total, among those who died from diseases, the proportion of those who died from IHD was 18.9%; for another 8.4%, IHD was indicated as a comorbid disease in Part II of the MDC. Among those who sought OPMC for IHD, the IHD proportion indicated as PCD was 27.5%, and among those who did not seek OPMC 17.4% (p <0.0001). Those who died from IHD and who had sought OPMC were older (mean age, 75.59 ± 10.94 years) than those who died from IHD and had not sought OMPM (mean age, 73.96 ± 10.94 years; p < 0.0001). The frequency of myocardial infarction as PCD among those who had and had not sought OPMC was the same (12%), chronic forms of IHD were 83.9% and 79.7%, the frequencies of "unspecified" acute forms of IHD (codes I24.8-9) were 4.1% and 8.3%, respectively. The proportion of deaths from COVID-19 was the highest (21.7% and 24.3%, respectively), from malignant neoplasms 11.6% and 12.7%, respectively, and from unspecified encephalopathy 10.6% and 10.7%, respectively. CONCLUSION: Only 25% of patients who had sought OPMC for IHD died from IHD, otherwise the causes of death were the same as for patients who had not sought OPMC for IHD. Analysis of administrative databases allows identifying disparities in the PCD structure and to direct the efforts of specialists to reconciling the criteria for death from various forms of IHD.

[Diseases of the nervous system as the underlying cause of death]. / Bolezni nervnoi sistemy kak pervonachal'naya prichina smerti.

OBJECTIVE: To identify the leading causes of death in the adult population from the class of diseases of the nervous system (DNS, class G) according to medical death certificates (MDC) and to discuss the problems of their assessment. MATERIAL AND METHODS: The source of information was the electronic database of the Main Department of the Civil Registry Office of the Moscow Region. All cases of class G deaths were selected (total 10.739), an analysis was carried out according to underlying cause of death (UCD) codes and the immediate cause of death. RESULTS: In 2022, mortality from diseases included in the DNS amounted to 130.7 per 100 000 of the population over 18 years old (100.3 among men, 191.0 among women). The average age of men is 74.3±14.1, women - 83.5±9.9 years (p<0.0001) due to the younger age of death of men from «G31.2 Degeneration of the nervous system caused by alcohol¼ and a higher contribution of this cause to male mortality; 82.5% of deaths were for codes G90-G99 («Other disorders of the nervous system¼); 15.5% were neurodegenerative diseases (G10-G32). Sixty-six percent of all UCD in both women and men accounted for «unspecified encephalopathy¼ (G93.4), in 2nd place (10.5%) was «cerebral cyst¼ (G93.0). In 45 cases, code G93.6 (cerebral edema) was mistakenly used as UCD. Differences in the structure of causes of death at home, in hospital and elsewhere are statistically significant (p<0.00001). In 58.3%, cerebral edema and herniation were indicated as the immediate cause of death (G93.6 and G93.5). CONCLUSIONS: Nosologically unfounded, insufficiently well-defined UCD were established in most cases of death from DNS, In 0.5% of the total number of deaths from DNS, an erroneous presentation as UCD of transient disorders of cerebral circulation or cerebral edema was noted. The results indicate the need for an analysis of the causes of death based on a comparison of medical records and MDC.

[Causes of death in the Moscow region according to medical death certificates]. / Prichiny smerti v Moskovskoi oblasti po dannym meditsinskikh svidetel'stv o smerti.

OBJECTIVE: Determination of the leading causes of death based on data from primary medical death certificates (MDCs) depending on the place of death. MATERIAL AND METHODS: From the electronic database of the Main Department of the Civil Registry Office of the Moscow Region (the USR registry office system) for 2021, all cases were selected in which diseases were indicated as the primary cause of death (PCD); all codes of external causes, injuries and poisonings were excluded. A total of 109.126 cases, 50.6% died in the hospital, 34% died at home, and 16.4% died elsewhere. Bureau of Forensic Medical Examination (BFME) issued 45.2% of MSS. Taking into account the frequency of use of ICD codes, the clinical similarity of individual codes, 20 groups were formed, which accounted for 90.1% of deaths from diseases. RESULTS: The frequency of registration of individual groups of causes of death largely depends on the place of death. 5 leading groups of causes of death were established: 1) in general from COVID-19 23.55%, chronic ischemic heart disease (CIHD-1) without postinfarction cardiosclerosis, aneurysm and ischemic cardiomyopathy (CMP) 14.5%, from encephalopathy indefinite (EI) 11.4%, malignant neoplasms (MN) 11.3%, stroke 6.2%; 2) in a hospital from COVID-19 45%, stroke 10%, MN 8.3%; CIHD-1 7.1%, CIHD with a history of MI/ischemic CMP 2.7%; 3) at home from CIHD-1 21.8%, EI 21.5%, MN 15.5%, from diseases associated with alcohol 3.3% and brain cyst 3.3%; 4) elsewhere from CIHD-1 22.7%, EI 21.6%, MN 12%, from other forms of acute coronary artery disease 5.4%, alcohol-associated diseases 4.8%. Acute MI ranked 6th among deaths in general - 2.7%. PCD is also associated with the place of issue of the MDCs - 90% of the MDC with the indication of EI and «other degenerative diseases of the nervous system¼ as the cause of death were issued by the BFME. Not a single MDC issued by the BFME contained such PCDs as "old age" or "brain cyst". CONCLUSION: The nosological structure of the causes of death and the issuance of individual ICD codes in the MDC as a PCD varies significantly depending on the place of death and the issuance of the MDC. The reasons need to be further clarified. The use of codes that are not permitted for use has been registered.

[The chronic cardiac insufficiency as a cause of death: the problems of statistical service and evaluation].

The purpose of the study is to analyze the application of I50.9 code as initial cause of death (PBC) in various subjects of the Russian Federation in 2013-2019. The Rosstat data (Annual forms C41 and C51) based on the "Brief Nomenclature of Causes of Death of Rosstat" (KNPSR) in 2013-2019. The standardized mortality rates (SPS) were determined using corresponding software (state registration number 216661114), coefficient of variation (Cv) and the max/min ratio. In 2013-2019, the regional average value of the SCR from cardiac failure (code I50.9) decreased up to 4 times (from 6.3 ± 10.3 to 1.5 ± 3.5; p <0.0001), but Сv of regional SCR increased by almost 1.5 times (162% and 230%). The percentage of regions where cardiac failure was not indicated as PPP, increased from 8% in 2013 to 19% in 2019. However, only in the Yaroslavl Oblast and the Republic of Buryatia no case of indicating I50.9 code as PPP was registered. In five regions, less than 10 cases were registered in 7 years, in 3 regions an unstable tendency to increase in SDR from HF was established. In 36 regions, more significant variability of RMS from year to year was recorded. From our point of view, the indices are affected in parallel by teo processes: changes in mortality rates associated with chronic heart failure and changes in mortality rates due to approaches to filling out the MSS and coding PPP. To determine the contribution of cardiac failure into population mortality, it is necessary to separate concepts "chronic cardiac failure syndrome" and "cardiac failure as death mechanism" and to introduce uniform rules of indicating chronic cardiac failure syndrome in the MSS.

[The mortality of individuals older than able-bodied age because of consequences of external causes effect].

The analysis of mortality because of external causes in persons older than able-bodied age in the Russian Federation permitted to determine their high level and significant contribution into formation of age profile of mortality of persons of older age groups. The comparison of mortality rates from injuries, poisoning, and some other consequences of external causes effect in persons older than 65 years in the Russian Federation and the European countries was carried out. The high mortality due to external causes of persons older than able-bodied age in the Russian Federation emphasizes vulnerability of this age group of population and is characterized by increased victimization.

[The analysis of results of implementation of per capita payment with elements of fund-holding in the Russian Federation].

The article presents the results of implementation of per capita payment with elements of fund-holding in the Russian regions. The objective of study was to develop proposals improving implementation of per capita payment for medical care with elements of fund-holding to decrease risks of its implementation in the regions of the Russian Federation. The definition of the concept of fund-holding is given. The obstacles for implementation of per capita payment with elements of fund-holding in the regions of the Russian Federation are considered. The suggestions are proposed for choosing areas for improving normative legal base regulating payment of medical care at the expense of compulsory medical insurance funds in the Russian Federation.

[Ways to solve the problem of heart failure statistics in clinical practice].

For organization of health care, it is important to know the requirement for its individual types, including the number of hospitalizations and the use of expensive technologies. Heart failure (HF) syndrome in patients with cardiovascular diseases often determines their severity and prognosis. However, being a complication of underlying disease, HF is not included into statistical reports and medical bills in the compulsory health insurance system. This article focuses on issues in evaluating HF prevalence and mortality in different countries and provides the authors' consensus on approaches to HF coding in the informational systems, which record morbidity and mortality.

[The characteristics of mortality of population older that able-bodied age in the Russian Federation in 2012-2018].

The positive trend of decreasing mortality of elderly population in all countries of the European Region in 2000-2015 was observed. In the Russian Federation the mortality of elderly population decreased up to 3,798.3 per 100 000 population in the 2018, i.e. on 14% lower as compared with 2012 (4424.6), and on 45% lower as compared with corresponding indices in 1998 (6877.0 per 100 000 population). The purpose of the study is to identify characteristics of mortality and to compare with foreign data of mortality of population older than able-bodied age in the Russian Federation. The standardized indices of mortality in 2012-2018 were analyzed. The gender characteristics of mortality levels were established. The main causes and the structure of main causes of death were presented. The comparison of mortality rates. The contribution of particular age groups into total mortality of population of the Russian Federation over the years was described.

[The characteristics of morbidity of population older than able-bodied age in the Russian Federation in 2012-2018].

The indices of population health exhibit tendency to deteriorate with age. The high level of morbidity, prevalence of chronic diseases, polymorbidity, atypical course of disease, continuous rehabilitation period, frequent complications and exacerbations are specific for individuals over able-bodied age. The purpose of study is to analyze dynamic, structure and characteristics of morbidity of population over able-bodied age in the Russian Federation. The study established specific features in dynamics and structure of morbidity of elderly population during 2012-2018. They are associated with high prevalence of cardiovascular diseases, diseases of musculoskeletal system and connective tissue. Furthermore, there is variety in morbidity rates of neoplasms, endocrine, nutritional and metabolic diseases, mental and behavioral disorders, diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism, diseases of the eye and adnexa, diseases of ear and mastoid process and also symptoms, signs and abnormal clinical and laboratory findings, not classified in other rubrics. The analysis of indices of primary and common morbidity of pneumonia in elderly population of different regions of the Russian Federation was carried out.

[The organizational aspects of early diagnostic of metabolic syndrome on the basis of implementation of new genetic, cellular and bio-informational technologies].

The characteristic feature of molecular medicine as medicine based on molecular structure of human genome data, is its individual character. It is focused on correcting pathological process in specific individual considering unique characteristics of its genome. The other most important feature is its expressed preventive direction. The complete genome information can be obtained well before the onset of disease. The appropriate preventive measures can completely eliminate or significantly prevent development of severe disease. The establishment of gene network of every multi-factorial disease, identification of central genes and genes-modifiers in it, analysis of association of their alleles with disease, development on this basis of set of preventive measures for specific patient constitute conceptual and methodological basis of predictive medicine. As a result of the examination, information can be obtained concerning particular risk of disease development. The physician, considering the results of molecular genetic analysis, elaborates tactics of pathogenetically justified preventive therapy, i.e. corrects congenital metabolic defect.

[FEATURES OF THE STRUCTURE OF MORTALITY IN RUSSIAN FEDERATION].

One demographic indicator is the structure of mortality by cause. Analysis of the causes of death allows you to define the fight against the disease, efforts should be focused to reduce mortality and on the effectiveness of measures against those or other diseases. The basis of information about the causes of death is a medical certificate of death, filling it depends on the correct diagnosis, the choice of the original cause of death, coding, as well as on policy documents aimed at reducing mortality from a particular cause. In the Russian Federation, in contrast to the countries of the European region, there is a fairly high proportion of inaccurately marked conditions, which account for 6.9% of all causes (in 2010 - 5%), the main reason for this is «old age¼, which ranks 4th among the leading causes of death (5% of all causes, in 2010 - 2.8%), as well as damage with uncertain intentions, which are on the 7th rank place of the leading causes of death (2.3% of all causes, in 2010 - 2%).

[Results of implementation of a 'Complex of measures to improve medical care for patients with stroke in the Russian Federation']. / Rezul'taty realizatsii 'Kompleksa meropriiatii po sovershenstvovaniiu meditsinskoi pomoshchi patsientam s ostrymi narusheniiami mozgovogo krovoobrashcheniia v Rossiiskoi Federatsii'.

Vascular diseases of the brain and heart are the main cause of death and disability of the population of the Russian Federation. The social and economic burden of acute cerebral circulation disorders necessitated the development of a national program for the care of patients with acute vascular diseases. As a result of the implementation of a set of measures to improve medical care for patients with stroke over the past decade, the regions of the Russian Federation managed to create an 'insult network', equip the departments with high-tech diagnostic and therapeutic equipment, and train medical personnel. Due to the implementation of modern methods of treatment of stroke, the rates of disability and mortality from stroke have decreased.

[The evaluation of economic damage due to premature mortality of population of the Republic of Sakha (Yakutia)].

The evaluation of economic damage was implemented in relation to premature mortality of population of the Republic of Sakha (Yakutia), the region with particular social economic and natural climatic conditions specific to territories of the North. The calculation of economic damage is based on methodology proposed by number of ministries of the Russian Federation and Rosstat in 2012. The presented evaluations and analysis of materials give an idea about total amount of economic damage because of mortality of population of the Republic of Sakha (Yakutia) which is necessary to consider during development of regional programs of decreasing of population mortality.

REGIONAL TRENDS IN THE WORKING-AGE POPULATION MORTALITY RATE IN THE REPUBLIC OF SAKHA (YAKUTIA) IN 1990-2012.

Regions of the Russian Federation differ in climatic-geographic, medical-demographic and social-economic situations. One of the regions with distinct peculiarities is the Republic of Sakha (Yakutia). Ranking first by the territory (3,103.2 thousand sq x km), Yakutia is on the 81th place by the population density among regions of the Russian Federation (0.3 people per 1 km2).Yakutia is one of the most isolated and inaccessible regions of the world: 90% of the territory lacks all-the-year-round transportation. Regions of the republic, as well, differ significantly in the climatic conditions and the levels of social-economic development, which influences the population health indicators, including mortality. This survey aimed to study the trends of mortality in the working-age population in different groups of regions. To do this, basing on the statistical data, we compared the levels, trends and structure of mortality in 1990-2012. It was established that the different groups of regions show a significant variation in the working-age population mortality, depending on the social-economic conditions. Since 2000, the Arctic group of regions has demonstrated higher mortality in working-age men and women, especially of cardiovascular and digestive system diseases, and external causes. Lying beyond the Arctic Circle, these regions have severe conditions and a relatively low level of social-economic development. As for the rural regions, despite the relatively favourabe situation, they also show a high level of mortality of external causes. The industrial regions are characterized by higher social-economic development, better transport infrastructure, a satisfactory material base of medical institutions. They also have sufficient resources of health institutions, including the staff and modern equipment for treatment and diagnostics, as well as, which is critical, the full range of medical specialists. Thus, these regions demonstrate lower population mortality; however, there is still mortality of infectious diseases, neoplasms, and respiratory diseases.

[THE STATE OF TRAFFIC TRAUMATISM ACCORDING DATA OF OFFICIAL MEDICAL STATISTICS].

The article presents situation with traffic accident traumatism and medical care support of victims of traffic accidents at pre-hospital and hospital stages. The recommendations are proposed concerning insertion of additions into reporting forms of federal (sectoral) monitoring to guarantee fullness of information.

[Procedure for coding the causes of death in some circulatory system diseases].

The paper deals with the unification of requirements for coding the causes of death in circulatory system diseases, by taking into account the recently updated ICD-10 and the Consensus of the Expert Council Task Force on Pathological Anatomy, Ministry of Health of the Russian Federation (27 February 2014).

[The development of mass physical culture and sports in the constituent entities of the Russian Federation as a factor of formation of the healthy life style].

Provision of proper conditions for the creation of healthy life style is a priority of the state policy in this country with special attention given to the development of the mass physical culture and sports. The present paper contains information on the proportion of the population of the Russian Federation regularly engaged in physical culture and sports, provision of necessary sport facilities, and budgetary expenditures for the purpose in different constituent entities of the country. Public satisfaction with the conditions available for mass physical education and sports is discussed. Taking into account the low average life expectancy of the country's population and the increasing morbidity and traumaticity rates among the younger generation, it appears impossible to address the global challenge of improving the health of the nation without promotion of mass physical culture and sports and renewal of interest in these activities among the general population.

[Official statistics on urological morbidity in the Russian Federation].

Official medical statistics have been analysed corcerning overall urological morbidity in the Russian Federation (RF) and in some particular regions of the RF. The analysis covered morbidity and mortality from urogenital diseases including glomerular, tubulointersticial and other diseases of the kidneys and ureter, prostatic diseases, male infertility, cancer of the urinary bladder and prostatic gland. It was found that information on urological and oncourological morbidity in the literature is available but its amount is not satisfactory. It is necessary to introduce innovations in organization of medical statistical service, in registration of urological diseases, in particular. Active screening for urological cancer in the RF does not meet requirements and potentialities of modern health care. Special screening programs must be designed to reduce mortality and improve follow-up of urological patients.

[A universal clinico-statistical classification of urolithiasis].

The article reviews the defects of a statistical classification of urolithiasis in ICD-10. The main defect is the discrepancy of clinical diagnoses in case histories with statistical codes of ICD-10. A new coded classification of urolithiasis reflecting basic clinical characteristics of urolithiasis (a type and size of the stones, function of the kidneys, x-ray positivity and infection of the stones, chemical structure of the stones) is proposed. This coded classification can raise significance of statistical information about urolithiasis and optimize standards of the diagnosis and treatment of this disease.

[On some aspects of the practice of the pathologoanatomic services].

It is demonstrated that the adequacy of the data of the structure of population mortality depends not so much upon the indicators of the practice of the pathologoanatomic services as upon the commitment both of the authorities and general community.