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.

Comparative Structure of Male Mortality From Cardiac Causes in Five-Year Age Groups.

Aim      To study the nosological structure of male mortality in 5-year age groups (15-85+) and the contribution of cardiac causes to all-cause mortality in 2020; to discuss the correctness of statistical recording of causes of cardiac death.Material and methods  Data source: Center for Demographic Research of the Russian School of Economy http://demogr.nes.ru / index.php / ru / demogr_indicat / agreement. The selected indexes were all-cause death, causes of the class of circulatory diseases (CD) according to the International Classification of Diseases, Tenth Revision (ICD-10) (class IX, codes I00-I99), and cardiac causes of death (codes I00-I40, I70, I67.4, Q20-28) in 5-year age groups.Results Proportions of CD and cardiac causes in the male all-cause mortality were almost identical in the age groups younger than 30 years. Then the proportion of cardiac deaths remained almost unchanged (30-34 %) in contrast to the rapid growth of the CD proportion (to 51 % with a maximum at 75-79 years). Until the age of 45 years, more than 50% of cardiac deaths were caused by heart defects and cardiomyopathies and more than 25% by acute forms of ischemic heart disease (IHD); in older groups, their proportions decreased but the mortality increased. In the age groups younger than 50 years, the mortality from "Other forms of acute IHD" (ICD codes I20, I24.1-9 counted as one line) was higher than the mortality from myocardial infarction (MI); after 50 years, the MI mortality became higher. The combined proportion of two groups in the mortality from cardiac causes was maximal at the age of 20-24 years (31 %), then it decreased to a minimum of 9 % at the age of 85+. The mortality from and the proportions of chronic forms of IHD (more than 50% of which have no clear criteria for diagnosis and death), arterial hypertension, "Myocardial degeneration" (ICD code I51.5), and "Pulmonary heart and pulmonary circulation disorders" (ICD codes I26-I28) rapidly grow with increasing age. Existing approaches to recording the causes of death do not allow assessment of the contribution and mortality rates from a number of cardiac diseases.Conclusion      Mortality reduction programs should provide more accurate recording of the causes of death and take into account age-related features of the nosological structure of cardiac mortality.

Dynamics of Regional Mortality Rates From Cardiac Causes in Russia 2019-2020.

Aim      To analyze the dynamics of standardized mortality ratios (SMR) (2019-2020) for the cardiological causes indicated as the primary (original) cause of death, in regions of the Russian Federation, based on the RF State Statistics Service Brief Nomenclature of Causes of Death (RFSSS BNCD). Reports have indicated substantial changes in the indexes and structure of mortality since the beginning of the COVID-19 pandemic in many countries.Material and methods  RFSSS data on numbers of deaths were analyzed according to BNCD and mid-year population in single year of age groups in 2019 and 2020. SMRs were determined for 23 cardiological causes of death listed in the BNSD in a separate line; the average regional SMR value and the standard deviation were provided; and SMRs were compared both among 4 groups (with a previously described method) and by 23 RFSSS BNCD causes using the Wilcoxon test.Results In 2020 vs. 2019, the mean regional SMR for cardiological causes increased by 12.07±9.86 % (from 301.02±77.67 to 336.15±84.5 %; р<0.0001). Decreases in SMR were found in 9 of 82 regions; however, only in two of them (the Republic of Ingushetia and the Sakhalin Region), SMR was decreased for all 4 groups of causes. In both 2019 and 2020 (60.9±13.8 and 62.5±12.8 %, respectively), the highest proportion of deaths was related with the 1st group of causes (chronic ischemic heart disease, IHD), with an increase in SMR of 18.66±33.28 % (р<0.0001). Increases in SMR were found in 75 regions while in the other regions, decreases in SMRs were observed. For the 2nd group of causes (myocardial infarction, other acute forms of IHD, sudden cardiac death), the mean regional SMR increased in 2020 by 3.2±18.1 % (р=0.3). Increased SMRs were noted in 54 regions. The proportion of the 2nd group in cardiological mortality was 17.3±9.7 % in 2019 and 16.1±9.6 % in 2020. The mean regional SNR for the 3rd group of causes (heart defects, myocardial diseases, etc.) increased in 2020 by 11.6±23.1 % (р=0.006). The mean regional proportion of causes for this group did not significantly changed compared to 2019 (17.5±8.2 and 17.1±7.3 %, respectively); however, the contribution of this group was greater than the contribution of the 2nd group. Increases in SMR were observed in 65 regions, while the contribution of causes related with arterial hypertension did not significantly change. Significant mid-regional differences in SMR values, dynamics of SMRs for different causes, and increases in the coefficient of variation were noted for almost all causes of death. Significant differences between 2019 and 2020 were found for 3 of 23 causes: other forms of chronic IHD (decreased SMRs in 15 regions and increased SMRs in the others), atherosclerotic heart disease (decreased SMRs in 38 regions), and alcoholic cardiomyopathy (decreased SMRs in 28 regions).Conclusion      During the COVID-19 pandemic, the SMR for cardiological causes was increased. Considerable regional differences in values and dynamics of SMR for individual causes call for attention to the unification of the criteria for clinical diagnosis.

[Analysis of the dynamics of mortality from respiratory diseases in the Russian Federation for 2019-2020].

AIM: To study the dynamics and contribution of mortality from Diseases of the respiratory system (DRS) in 2019 and 2020 to mortality from all causes with and without deaths from COVID-19 in 82 regions of the Russian Federation. MATERIALS AND METHODS: The data provided by Rosstat for 2019 and 2020 on the average annual population and the number of deaths due to causes of DRS (class J00J99) were used the standardised death rate (SDR) were calculated, the regional average value, standard deviation and coefficient of variation. RESULTS: The average increase in the SDR from DRS in 2020 was 22.1913.22 per 100 thousand population (66.4489.6% higher than in 2019). The average regional SDR from DRS + COVID-19 in 2020 was higher than the SDR from DRS in 2019 by 87.6530.1 per 100 thousand population. The average regional share of SDR in the structure of mortality excluding COVID-19 increased from 3.661.44 to 5.062.49%; taking into account COVID-19, it increased to 10.963.13%. In 16 regions, the SDR from DRS + COVID-19 exceeded the increase in mortality from all causes. No correlation was found between SDR (2020) from all causes and SDR from COVID-19 (r=0.09; p=0.39); an inverse correlation was found between SDR from DRS and SDR from COVID-19 in 2020 (r=-0.42; p0.0001). CONCLUSION: Against the background of high interregional variability of SDR from DRS in most regions, an increase in the mortality rate from DRS and the contribution of DRS to total mortality in 2020 was registered.

[Cardiovascular disease and cognitive impairment]. / Serdechno-sosudistye zabolevaniya i kognitivnye narusheniya.

As life expectancy increases, cardiovascular disease (CVD) is increasingly associated with cognitive impairment and dementia. Cognitive impairment can be a complication of CVD, develop at the same time or earlier than CVD. Often, the preclinical period of neurodegenerative diseases accompanied by cognitive impairment lasts for decades and their relationship with CVD is not fully understood. Studies have to take into account a large number of factors that are often interconnected with each other, so the role and mechanisms of action of each of them in the long term is very difficult to prove. The combination of CVD and cognitive impairment requires special approaches to patient management.

[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 asymptomatic microhematuria in the physician's practice].

The review article presents data on: a) definition of microhematuria and diagnosis; b) prevalence estimation and causes of the asymptomatic microscopic hematuria; c) diagnostic approaches for the first time identified of microhematuria; d) follow-up monitoring of patients with asymptomatic hematuria; e) feasibility of medical screening for microhematuria. The analysis includes recommendations of Russian and foreign urological associations, the results of cohort and observational studies, previous study reviews. The identification of 3 or more red blood cells during microscopic examination should be considered microhematuria. There is no uniform examination algorithm for all patients. The basic principle is an individual diagnostic tactic, taking into account the anamnesis, age, concomitant diseases and risk factors. The purpose of a comprehensive examination is to exclude life-threatening conditions (malignant neoplasms and/or glomerular kidney damage). In some cases, after research, the cause of microhematuria remains unclear and monitoring is required. Routine screening of the population in order to detect microhematuria is currently not justified.

Mortality from arterial hypertension in the regions of the Russian Federation in the period from 2013 to 2019.

Aim      To analyze the dynamics of mortality from arterial hypertension (AH) between 2013 and 2019.Material and methods  Arterial hypertension (AH) is one of the most common diseases. At the same time, there are no unified international criteria for establishing the primary cause of death from AH. Data were studied for the period between the end of the program for modernization of health care and the start of the Federal Project "Program for combatting cardiovascular diseases". Data for 2013-2019 by AH-related codes were provided by the Federal Service of State Statistics on request via the C15 form, "Mortality by gender and one-year age groups". A standardized mortality ratio, its mean value, standard deviation, and a coefficient of variation were determined for each "cause". The standardized mortality ratio was calculated using the European standard.Results In Russia during the studied period, the standardized mortality ratio for the death from AH yearly decreased (1.7 times for 6 years; the standardized mortality ratio decreased 1.15 times). However, only in 7 regions, the standardized mortality ratio yearly decreased while in the other regions of the Russian Federation, the standardized mortality ratio changed wavily. In 17 regions of the Russian Federation, the standardized mortality ratio increased in 2019 compared to 2013, including the 31.7 time increase in the Republic of North Ossetia-Alania. In the Penza Region and the Republic of Kalmykia in 2018, there were no cases of death related with AH. The highest value of the standardized mortality ratio was observed in the Chukotka Autonomous District in 2019 (85.13 per 100,000 population) and the lowest value was observed in the Penza Region (0.14 per 100,000 population). The ratio of maximal to minimal values of the standardized mortality ratio was 622. The coefficient of variation for regional standardized mortality ratios increased by 42.3 % (from 86.8 to 123.5 %).Conclusion      Although the standardized mortality ratio for death from AH, in general, decreased in the Russian Federation, Russian regions showed variable dynamics and a high variability of the standardized mortality ratio. The study results together with results of international studies showed that differences in standardized mortality ratios for death from AH are largely due to different approaches to determining the primary cause of death. An international consensus on the terminology and criteria for determining the primary cause of death is required.

[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 comparative analysis of coefficients of variation of standard regional indices of mortality and causes having and having not accurate criteria of diagnostics].

The standardized mortality coefficients for different causes have significant variability between regions and depend on many factors. The purpose of study was to investigate interregional variation coefficients of standardized mortality of oncologic diseases as compared with other causes having no explicit diagnosis criteria. The 49 death causes were selected out of 295 causes of the Short nomenclature of the Rosstat. These causes were distributed by 2 groups: neoplasms and causes without explicit diagnostic criteria. The standard mortality indicator was calculated on the basis of the European standard. The significance of differentiations between the groups was estimated using one-factor dispersion analysis by pair comparison and Bonferroni amendment. The level of interregional variation coefficient of the standard mortality indicator from cancer was lower than from other causes with no explicit diagnostic criteria. Even the reasons of death from oncologic diseases which has no explicit criteria have the significantly less marked variation coefficient as compared to other two groups. There were reliable differences of the variation coefficients between the subgroup of oncologic diseases with precise location of tumor and the subgroup of oncologic diseases of other and non-explicit locations. The death causes due to "other diseases" and the death causes due to diseases with no-explicit diagnostic criteria had similarly high level of variation coefficient. The difference of the regional standard mortality indicator of concrete reasons is affected by uncoordinated criteria of diseases diagnostic and the main reason of death determination. The letter of the Minzdrav of Russia concerning the rules of application of notion "senility" as cause of death played certain role also. The different level of morbidity in regions had the influence as well. The harmonization of verification of all the cases of diagnosis, its "depth" and applied criteria is needed for proper analysis of data of death from separate causes is needed.

[comparative analysis of variability of mortality rates from various causes in the subjects of Russian Federation]. / Sravnitel'nyi analiz variabel'nosti pokazatelei smertnosti ot razlichnykh prichin v sub"ektakh Rossiiskoi Federatsii.

Mortality rates have significant differences between regions of the Russian Federation. Standardized mortality rates (SMR) are influenced by many factors, including diagnosis criteria and causes of death. AIM OF STUDY: Analysis of coefficient of variation of SMR from malignant neoplasms compared with other causes of death in the subjects of Russian Federation. MATERIALS AND METHODS: The study formed 3 comparison groups: malignant neoplasms, other causes and causes of death, presented in ICD-10 to indicate conditions that do not have clear diagnostic criteria and rules for its use, as well as unspecified and not recommended for use in mortality statistics. To calculate SMR out of 79 reasons selected from the «Brief nomenclature of causes of death of Russian Statistic Bureau (RosStat)¼, the European standard was used. The accuracy of differences between the groups was evaluated using one-way analysis of variance with pairwise comparison and Bonferroni correction. RESULTS: In the group of malignant neoplasms, there were significant differences in the coefficients of SMR variability between the subgroup of neoplasms with an exact indication of localization and the subgroup of malignant neoplasms of other and inaccurately defined localizations. However, even the causes of death from malignant neoplasms that do not have sufficiently clear application criteria have a significantly less pronounced coefficient of SMR variability compared to the other two groups. The causes of death, starting in the RosStat nomenclature with the words «other diseases¼, and the causes associated with the diseases presented in ICD-10 to indicate conditions that do not have clear diagnostic criteria and rules of its use, as well as unspecified and not recommended for use, had practically the same high level of SMR variability coefficient. A certain contribution to the differences in regional SMR indicators from specific causes can be affected by the inconsistency of the criteria for diagnosing diseases and choosing the initial cause of death. CONCLUSIONS: To obtain the correct indicators of mortality from individual causes / groups of causes, we need unified generally accepted definitions and rules for the application of conditions presented in ICD-10, which do not have clear diagnostic criteria, as well as unspecified; and as well as rejection of statistics not recommended for use because of the initial causes of mortality.

[Guidelines for the Diagnosis and Management of Chronic Coronary Syndromes in Primary Health Care - the Issue of Acceptability for the Russian Federation].

In 2019, the European Society for Cardiology (ESC) published guidelines with a new term, "chronic coronary syndromes" (CCS). These guidelines presented 6 clinical scenarios, which are most common in outpatient practice. The diagnostic approach described in these guidelines shifts from the standardization to the rationality of individualized solutions on using various diagnostic methods. The diagnostic approach suggested in the ESC guidelines requires extensive medical discussion and consensus because this will definitely entail a) further increase in indexes that reflect the morbidity of ischemic heart disease (IHD) due to unconfirmed diagnoses and b) administration of unreasoned therapy. This article presents statements of the guidelines, which cannot be automatically transmitted to the existing medical practice and should be discussed and adjusted by experts of the Russian Society of Cardiology.

[Opportunities and Problems of Analysis of Mortality from Myocardial Infarction According to Medical Certificates of Death (on the Example of the Tula Region)].

AIM: to analyze the quality of completion medical certificates of death (MCD) of residents of the Tula region, in which in 2017 acute and subsequent myocardial infarction (MI) was listed as the underlying cause of death (UCD) or as multiple causes of death (MC). MATERIALS AND METHODS: From the electronic database (DB) of MCD of residents of Tula region for 2017 we selected all MSD in which MI was written down irrespective of a section of MCD. A total of 689 MSD (43.8% men and 56.2% women) were analyzed. RESULTS: Mean age of the deceased was 72.6±11.3 years (men 67.25±0.62; women 76.7±9.8; p<0.001). Multimorbid pathology was registered in 31.5% of the deceased. In 77.9% of cases myocardial infarction was selected as the UCD and in 22.1% - as a complication of other diseases. Among registered MI complications were hemotamponade (24.5%), cardiogenic shock (3.6%), ventricular fibrillation (0.3%), heart failure (50.2%). Complications of MI were not listed in 3.9% of MCD. Analysis of MCD showed that their completion did not comply with established ICD-10 rules and recommendations of Ministry of Health of RF; all lines were filled out only in 1% of completed MCD. Also, problems of determining the initial cause of death when myocardial infarction occurred in the presence of multimorbid pathology were revealed. CONCLUSION: Mortality analysis using solely UCD leads to decreasing mortality rates from MI, and unsatisfactory quality of filling the MCD decreases the ability to identify MC, that prevents the correction of priorities in the organization of medical care. The revealed problems of coding causes of death require urgent solutions from the professional community of cardiologists, pathologists, and the Ministry of Health.

[Trends in stroke mortality rates in Russia and the USA over a 15-year period]. / Dinamika pokazatelei smertnosti naseleniia ot ostrogo narusheniia mozgovogo krovoobrashcheniia v Rossii i SShA za 15-letnii period.

AIM: to comparatively analyze standardized mortality ratios (SMR) from stroke in the populations aged over 30 years in the Russian Federation and in the USA over a 15-year period. MATERIAL AND METHODS: The analysis included nontraumatic subarachnoid hemorrhage (NTSH) (a group of ICD-10 codes I60), nontraumatic intracerebral hemorrhage (NTIH) (I61), cerebral infarction (CI) (I63), and stroke, not specified as hemorrhage or infarction (SNSHI) (I64). The new European standard (European Standard Population.2013) was used for standardization. The data of the Federal State Statistics Service of the Russian Federation, those of the World Health Organization Mortality Database (WHO MD) and Human Mortality Database (HMD) for the USA were applied. RESULTS: During the considered period, 30-49-year-old Russian men showed a reduction in SMRs from NTSH (I61) by 9.0% (from 18.9 to 17.2 per 100,000 population), from SNSHI (I64) by 10 times (from 12.5 to 1.3); SMRs from CI (I63) increased by 4.3% (from 6.9 to 7.2). In men aged 50 years and older, SMRs from NTIH and SNSHI decreased by 32.3% (from 143.2 to 97.0) and by 10 times (from 580.8 to 60.6), respectively; those from CI increased by 13.8% (from 229.8 to 261.4). In the USA, 30-49-year-old men displayed 26.1% and 2-fold decreases in SMRs from NTIH (from 2.5 per 100,000 population in 1999 to 1.7 in 2013) and CI (from 1.8 to 0.9), respectively; those from SNSHI remained unchanged (1.3). In men aged 50 years and older, SMRs from NTIH, CI, and SNSHI reduced by 39.7% (from 29.0 to 17.5), by 2 times (from 1.8 to 0.9), and by 2 times (143.0 to 72.5), respectively. 30-49-year-old Russian women exhibited a 22.2% reduction in SMRs from NTIH (from 9.0 to 7.0), a 4.3% increase in those from CI (from 2.7 to 2.8), and an 11-fold decrease in those from SNSHI (from 5.5 to 0.5). Women aged 50 years and older showed changes in SMRs from the codes in the same sequence from 105.6 to 60.5, from 172.8 to 189.6, and from 466.5 to 43.7, respectively. In the USA, 30-49-year-old women displayed reductions in SMRs from NTIH by 10.0% (from 1.5 to 0.9), from CI by 33.3% (from 0.3 to 0.2), and from SNSHI by 10% (from 1.0 to 0.9). Women aged 50 years and older exhibited changes in SMRs from the codes in the same sequence from 24.0 to 14.8), n those from CI (from 20.6 to 6.7) and from SNSHI (from 6.5 to 10.3). CONCLUSION: In Russia, the reduction in mortality rates from the above causes (which is most significant from that in NTSH may be associated with both medical and socioeconomic factors, including with the improved prevention and organization of medical care. The differences in SMRs between the two countries may be related to the principles in the organization and control of coding of the causes of death.

The prevalence of multimorbidity: discussion about the terminology, registration and its effect on patient's health care utilization.

The purpose of the present review is to bring into focus the issues regarding terminological and registration aspects of multimorbidity we come across in the modern literature. Key questions regarding the definitions for the most widely used terms «comorbidity¼, «polymorbidity¼ and «multimorbidity¼ are discussed. We also considered the aspects of their origin and distinctive features between the concepts. The interaction between illnesses can exacerbate one another, modify the clinical picture and course of illnesses, the nature and severity of complications, lead to a progressive worsening of the prognosis and quality of life in patients. It has been proposed that the terms of "comorbidity¼ (in case of presence of the pathogenesis interrelation) or "polimorbidity¼ (in case of absence of the pathogenesis interrelation) are the most appropriate diagnostic and treatment patterns for practice and epidemiological study. «Multimorbidity¼ seems to be a more appropriate term for clinical practice usage, because it involves not only diagnosis but also interaction between diagnosises, symptoms/syndromes, the mobility or self-care problems et al. The algorithm of the managing patients with multimorbidity is presented. >.

[Comparative analysis of mortality from acute forms of ischemic heart disease during a 15-year period in the Russian Federation and the United States and the factors influencing its formation]. / Sravnitel'nyi analiz smertnosti naseleniia ot ostrykh form ishemicheskoi bolezni serdtsa za piatnadtsatiletnii period v RF i SShA i faktorov, vliiaiushchikh na ee formirovanie.

AIM: To comparatively analyze the registered mortality rates from coronary heart disease (CHD) as a whole, as well as myocardial infarction (MI) and other acute forms of CHD during a 15-year period in the Russian Federation (RF, 2000-2014) and the United States of America (USA, 1999-2013). MATERIAL AND METHODS: Primary data were obtained from the database of the RF State Statistics Service, the World Health Organization Mortality Database, Human Mortality Database, then converted into standardized mortality rates and are presented in three age groups (30+, 30-49, and 50+ years old) in men and women separately. RESULTS: The analysis revealed a substantial excess of the registered mortality rates from CHD in the RF versus in the USA, as well as a lower incidence of MI and a higher incidence of other acute CHD forms registered as the cause of death. It also showed considerable differences in the structure of registered types of MI as the cause of mortality. CONCLUSION: The differences found in the mortality rates from CHD, MI, and other acute forms of CHD in the RF and the USA can be explained by objective (the higher prevalence of cardiovascular risk factors, the higher and earlier incidence of CHD in the RF, as well as differences in the organization of medical care and, as a result, actually higher mortality rates from CHD in Russia) and subjective (differences in approaches to statistically developing a population-based mortality rate, as well as defects in filling out the medical documents and coding the causes of death) factors.

[Assessment of the Possibility of Comparing Mortality Rates from Diseases of the Circulatory System in the United States and Russia].

OBJECTIVE: to compare and discuss causes of differences between standardized mortality rates (SMR) from diseases of the circulatory system (DCS) among men and women older than 50 years in Russia and USA. MATERIAL AND METHODS: Data on mortality rate in the USA were taken from WHO mortality database (WHO MD), those on the USA population by 5-years age bands from Human Mortality Database (HMD). Information on mortality rates in Russia was obtained from Rosstat. In analysis we used age-adjusted death rates and SMR for DCS or ages more or equal 50 years. For standardization of mortality rates we used data of the European Standard Population 2013. RESULTS: By 23 3-digit codes mortality rates among men in USA were higher than in Russia (in the structure of mortality among women there were 28 such codes). Portion of such deaths in Russia in total number of DCS deaths was 6.5% both for men and women, while figures for USA were 36.8 and 40%, respectively. About 99% of differences in SMR from DCS between countries were determined by 8 and 6 groups of causes in men and women, respectively. Analysis of 4-digit ICD codes showed that almost 40% of DSC class deaths both in Russia and USA had the forth digit of ICD-10 code 8 or 9 and were accompanied by wording "other" or "unspecified" or formulation of diseases which were not used in clinical practice and were absent in both guidelines issued by Russian or American professional societies. Despite existence of ICD rules the conducted analysis allows to state that those rules could be interpreted differently in various countries. This resulted in obtaining noncomparable data. CONCLUSION: Comparison of mortality rates in USA and Russia based on existing ICD coding rules cannot be correctly performed. Therefore, this comparison does not allow to assess contribution of financing and organization of medical service in differences in mortality rates between two countries.