[The Impact of Medical and Non-Medical Factors on Population Mortality: Phenotype and Behavioral Factors].

The secondary analysis of results of studies evaluating impact of genetic, phenotype and behavioral factors on indices of population mortality was implemented. The database included accessible publications in print and e-format (MEDLINE, EMBASE, ISI, Web of Science) in Russian and English from 1990 to November 2015. The heredity apparently impacts life-span of a single individual. However, there is no reliable data testifying its input into level of mortality and life-span at the population level. The human gender is the most demonstrative inherent characteristic effecting population mortality: in all countries life-span of females is higher than in males. The search of scientific proves of availability of such phenomenon as "premature aging" that, according to preliminary data, is related to conditions and style of life. The role and significance of such "traditional" risk factors as surplus body mass index, sedentary way of life is reconsidered. The dominant convictions concerning negative effect of sedentary life and surplus body weight require additional reliable argumentation. The aggressive behavior, extreme hobbies, asocial life-style increase individual risk of premature death while population mortality depends on percentage of individuals with such characteristics. The implementation of inherent characteristics of human organism in many respects depends on conditions and style of life of a particular individual. The prevalence of risk factors in population has no linear relationship with level of mortality.

[The Impact of Medical And Non-Medical Factors on Population Mortality: Environment Factors].

The second analysis was implemented concerning results of study evaluating impact of environmental factors on indices of population mortality on the basis of hard copy and digital publications in Russian and English in 1990-2016. It is established that air pollution by tiny particles of different origin results in a reliable increasing of risk of premature death independently of level of economic development and geographical positioning of country. In European countries this occurrence conditions shortage of of life-span on 8-13 months. The industrial factors are a cause of about 30% of involuntary occupational traumas. The limitation of access to clear drinking water specific to developing countries conditions death of more than 3 million people annually. The impact of waves of cold and heat on mortality depends on particular region, their duration and intensity, level of economic development of country, social economic conditions and age of particular groups of population and is estimated in 1-16% of additional deaths. The global climate warming is associated with decreasing of level of mortality. the negative impact of environment is increased by residing in underdeveloped regions, lower social economic status, lower level of education, population density, shortcomings of architecture and public space, the factors of environment play a significant role in population mortality. As regards their impact an uncertainty exists: it is quite difficult to separate an impact of single factor. So, different approaches are applied in different studies.

[The Impact of Medical and Non-Medical Factors on Population Mortality: the Social Factors].

The study was carried out to analyze national and international publications evaluating impact of social factors on population mortality. The analysis was made on the basis of publications accessible in prints and electronic format (MEDLINE, EMBASE, ISI Web of Science) in Russian and English from 1990 to 2015. The results of generalized studies testify a valuable impact on standardized mortality coefficients of such factors as social support and social integration, higher level of education, higher social position, global peacefulness index, developed infrastructure. The negative impact is made by social stress, lower level of education, higher level of unemployment, social deprivation. It is established that social factors are ones the main factors effecting population mortality level. The effect of social factors is ambivalent and heterogeneous in time and by population groups. he quantitative evaluation of effect of every one of social factors is difficult.

[The relationship between regional levels of mortality of ischemic heart disease and social economic factors in the Russian Federation].

The study was carried out to evaluate input of particular indices considered by Rosstat into indices of mortality of ischemic heart disease in three age groups at regions of the Russian Federation in 2003-2013. The data base of the Institute of demographic studies of the Russian Economic School was used as the source of data concerning mortality of ischemic heart disease and myocardium infarction. The panel data analysis was applied to form panel of 800 observations (on every variable) i.e. on 80 subjects of the Russian Federation in 2003-2012. The base «United inter-sectoral informational statistical system" was used as source of factorial indices. It is established that the most significant impact on mortality of ischemic heart disease, including of myocardium infarction, is render such stress factors as alcohol abuse and urban residence at that this dependence only increases with age. The number of physicians and per capita level of gross value added demonstrate negative correlation with mortality of ischemic heart disease in all age groups both in males andfemales. The level of consumption of carbohydrates (grams per day) correlates positively with mortality of ischemic heart disease and negatively with mortality of myocardium infarction in all groups. The application of non-typical techniques of mathematical statistics is necessary for more accurate evaluation of factors effecting level of mortality of ischemic heart disease. From methodological point of view, the most proper is carrying out of prospective cohort studies.

[Connected high cardiovascular mortality in Russia with incorrect coding of causes of death?].

In this article we present data indicative of overestimation of mortality from cardiovascular diseases related to inadequate filling of certificates of causes of death and misuse of ICD-10 codes. Significant errors in coding causes of death result in significant differences in mortality with other countries what precludes correct comparison of mortality from cardiovascular diseases, the development of programs aimed at reducing mortality in the target groups.

[Dynamics of cardiovascular mortality among men and women in subjects of Russian Federation (2002 to 2011)].

OBJECTIVE: to study the dynamics of CVD mortality in men and women in the Russian Federation (RF) for the period from 2002 to 2011. METHODS: The study was performed on the basis of official statistics "Rosstat". Results. In 2011 the average death rate from CVD for the regions of the Russian Federation among men and women was significantly lower than in 2002 (p<0.0001). Average mortality from CVD among women was lower than among men (p<0.0001). Factors of time and gender were statistically significant (p<0.0001 ) for changes CVD mortality in the subjects of the Russian Federation. The mean absolute decrease in CVD mortality among men in Russia amounted to -39.7; among women - 24.9. In regions with 2002 CVD mortality in men above 1000 the mean absolute decrease was -41.1+/-15.1 while in regions with 2002 CVD mortality below 1000 mean absolute decrease was -22.1+/-11.8 (p=0.001). At the same time, in 39 subjects the downward trend in performance was unstable, between-year differences were substantial, especially among male population. CONCLUSION: During the period 2002-2011 decline of CVD mortality of men and women was recorded in all regions of Russia. At the same time, given the significant variation of figures and high probability of inadequate coding of causes of death additional research is needed in one-year age groups using the RF subjects uniform criteria of causes of death.

[Gradient of mortality of persons aged 40-59 in regions of the Russian Federation].

AIM: The purpose of the study was to evaluate the differences and factors that are interlinked with mortality rates of the population aged 40-59 years in the subjects of the Russian Federation. MATERIALS AND METHODS: To calculate mortality rates used by Rosstat data on population and number of deaths in the age groups 40-59 years among men and women in the regions of Russia, as well as indicators that characterize the socio-economic condition of the region. RESULTS: In the Russian Federation there is a significant mortality gradient between the regions, and among male and female population aged 40-59. Except in certain republics of the North Caucasus, mortality among male and female population in the other regions of the Russian Federation is significantly higher than in Moscow. There was a statistically significant correlation of medium strength (r = 0.6; p < 0.0001) between the mortality rates (both men and women) and indicators such as the sale of vodka, liqueurs and brandy (liters per person) per capita of working age and older people. Correlation between mortality and indicators reflecting the level of life in the regions was weaker or not detected at all. CONCLUSION: For an accurate assessment of the factors influencing mortality gradient in regions longitudinal cohort studies are needed to be carry out.

[The evaluation of costs: standards of medical care and clinical statistic groups].

The article presents the comparative analysis of techniques of evaluation of costs of hospital treatment using medical economic standards of medical care and clinical statistical groups. The technique of evaluation of costs on the basis of clinical statistical groups was developed almost fifty years ago and is largely applied in a number of countries. Nowadays, in Russia the payment for completed case of treatment on the basis of medical economic standards is the main mode of payment for medical care in hospital. It is very conditionally a Russian analogue of world-wide prevalent system of diagnostic related groups. The tariffs for these cases of treatment as opposed to clinical statistical groups are counted on basis of standards of provision of medical care approved by Minzdrav of Russia. The information derived from generalization of cases of treatment of real patients is not applied.

[Survival and working ability in men after coronary bypass surgery (analysis of registry data)].

This retrospective study was focused on the survival and working ability in 2169 men (mean age 54.5 +/- 5.8 yr) included in the registry after they underwent coronary bypass surgery in 2000-2009. Three, five and ten-year survival rates were 91, 87 and 74% respectively. Independent factors influencing long-term survival were correction of valve defects (OR 3, 1, 95%, CI 1.9-4.8; p < 0.001) and left ventricular ejection fraction (OR 2, 9, 95% CI 2.1-3.8; p < 0.001). 34.2 and 60.2% of the patients were disabled before and after surgery respectively. This rise is attributed to the poorly developed system of postoperative rehabilitation. Occupational status was not an independent factor affecting long-term survival.

[Surgical therapeutic decision-making in elderly patients with heart valvular defects combined with lesions of coronary and brachiocephalic arteries].

Due to considerable incidence of combined cardiac and vascular pathology in elderly and aged patients with heart valve defects, of special importance is the problem regarding surgical therapeutic decision-making. The present article is aimed at considering the problems concerning possibility and feasibility of stagewise or simultaneous surgical correction in patients diagnosed as having cardiac valve defect and haemodynamically significant lesions of coronary and/or brachiocephalic arteries based on generalizing the results of international studies.

[Expert assessment of operations' complexity and its interrelationship with lethal outcomes and duration of treatment].

The aim of the work was to carry out expert assessment of complexity of operations and to study interrelationship of the average score of complexity of the interventions with lethal outcome and duration of treatment in the Intensive Care Unit (exemplified by comparison with the outcomes of operations on cardiac valves performed in 2009 in the setting of artificial circulation in adult patients). Complexity was assessed by a total of 13 cardiovascular surgeons specialized in operations aimed at correcting valve defects (4 of them were from the A. N. Bakulev Scientific Centre for Cardiovascular Surgery), with none of the participants being aware of the therapeutic outcomes of each type of the operation performed. An average expert-defined score was assigned for each of the 33 names of the operations. The Kendall coefficient of concordance for all operations amounted to 0.29 (p<0.001); consensus in the complexity-score (from 69 to 85%) was achieved for 48.5% of the operations thus considered. The values of the mean scores of complexity of operations, defined by the specialists form the SCCS (2.02±0.54) were significantly lower (Wilcoxon's test; p<0.001) as compared with the average score assigned by specialists from other facilities (2.28±0.43). The duration of the stay at the ICU of the patients subdivided into groups depending on the expert score was found to differ significantly (p=0.007). The area under the ROC curve using the EuroSCORE (0.59) is suggestive of its lower accuracy in assessing the lethal outcome as compared to the expert score (0.68). The obtained findings strongly suggest advisability of using expert score of operations' complexity for solving complicated non-formalized tasks on allied problems of cardiovascular surgery and organization of public health care (accrediting of medical facilities, formation of the government order, and planning of the budget of medical facilities).