Leading causes of death in older people and old age according to medical certificates of death in Moscow

BACKGROUND: The proportion of older people is increasing worldwide. Leading causes of death must be understood for the organization of medical and social care. AIM: This study aimed to identify and discuss the leading causes of death in older people and old age based on data from medical death certificates. MATERIAL AND METHODS: From the electronic database of the Main Department of the Civil Registry Office of the Moscow Region (the system of the Unified State Register of Civil Status Records), all cases in which diseases were indicated as the initial cause of death (all codes of external causes, injuries, and poisoning were excluded) were selected. From a total of 109,126 deceased individuals, 90,269 (82.7%) were ≥60 years old. Eighteen groups of initial causes of death were made (95.2% of deaths from diseases);40,442 (44.8%) medical death certificates were issued by the Bureau of Forensic Medicine. RESULTS: Five leading causes of death were COVID-19 (24.2%), pathologies associated with cognitive impairment and dementia (21.15%;aged 60–69 years, 6.02%;aged ≥100 years, 63.5%), chronic ischemic heart disease (18.6%), malignant neoplasms (10.7%;aged 60–69 years, 16.7%;aged ≥100 years, 1.46%), and acute cerebrovascular accident (6.2%). The contribution of causes such as acute forms of coronary artery disease, stroke, hypertension, diabetes mellitus, COVID-19, and others is low in older people. Only 30% of the medical death certificates have their part II completed. The probability of filling out part II of the medical death certificate is influenced by age, place of death, place of issuance of the medical death certificates (in the Bureau of Forensic Medicine less than in other medical organizations), and teaching staff. With age, the proportion of MCAs issued by the Bureau of Forensic Medicine is increasing. Medical death certificates often use codes that are not analogous to clinical diagnoses. CONCLUSION: The contribution of individual causes (and groups of causes) of death changes with age. For a better understanding of the leading causes of death, a multidisciplinary consensus is needed in determining the criteria and validity of the use of the International Statistical Classification of Diseases and Health-Related Problems, Tenth revision, codes. © 2023 Case reportS. All rights reserved.

[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.

Issues related to death reasons coding during the COVID-19 epidemic

Objective. Assessment of COVID-19 contribution to the mortality rate of the Russian Federation (RF) in January-June 2020. Material and methods. Rosstat data on natural population movement were used. For 2017-2019, monthly (January-June) were calculated the average number of deaths from all causes and compared with 2020. Values of «excessive» number of deaths from all causes were determined. Taking into account that the methodological recommendations of the Ministry of Health of Russia on coding causes of death under conditions of COVID-19 were published only at the end of May 2020, the analysis of COVID-19-related deaths was carried out in May and June 2020 in 24 subjects of the Russian Federation with a population of more than 2 million people, indicating COVID-19: a) as the main cause of death;b) as the cause of death;c) if the virus was identified but had no significant impact on the outcome. Results. In January-April 2020 in Russia the number of deaths from all causes has decreased compared to the average for the previous 3 years (2017-2019);in May and June 2020. The «excessive» number of deaths was 8.4 and 12.2% respectively. In January 2020. «excessive» number of deaths was recorded in 12 regions, in February - in 24, in March - in 10, in April - in 22, in May - in 43, in June - in 62. The largest number of «excessive» deaths was registered in May and June in Moscow, St. Petersburg, Leningrad and Moscow regions and the Republic of Dagestan (in May). There was no increase in mortality in 3 regions during any of the 6 months. Unstable dynamics was determined in the majority of RF regions, and no region revealed any monthly increase in the number of deaths as compared to the previous 3 years. In general for the Russian Federation the proportion of deaths with any mention of COVID-19 on the medical certificate of death (MSD) in both May and June 2020 was 7.3 and 4.3%, respectively, as the main cause of death, varying significantly in the regions. In May 55.3% of «excessive» deaths and in June 39.7% of cases were due to COVID-19 as the main cause of death (in Moscow 47.5 and 43.5%;in Moscow region 52.2 and 60.4%;in St. Petersburg 50 and 69.3% respectively). In some regions, deaths from COVID-19 were recorded as the main cause of death without an «excessive» number of deaths, while in others the opposite situation was observed. When comparing regions according to the data specified in the MSD, the variability of the fraction of causes of death was revealed: a) from COVID-19 as the main cause of death (with an identified and unidentified virus), b) as the cause contributing to death;c) not affecting the cause of death in the regions under consideration. Conclusions. The received results testify to the expressed variability of influence COVID-19 on «excessive mortality» in subjects of the Russian Federation, differences in approaches to definition of a cause of death. Similar data are registered in other countries of the world. Цель исследования. Оценка вклада COVID-19 в смертность населения Российской Федерации (РФ) за январь-июнь 2020 г. Материал и методы. Использованы данные Росстата о естественном движении населения. За 2017-2019 г. помесячно (январь-июнь) рассчитаны средние значения числа умерших от всех причин и проведено сравнение с 2020 г. Определены значения «избыточного» числа умерших от всех причин. Учитывая, что методические рекомендации Минздрава России по кодированию причин смерти в условиях COVID-19 опубликованы только в конце мая 2020 г., анализ случаев смертей, связанных с COVID-19, проведен за май и июнь 2020 г. в 24 субъектах РФ с численностью населения более 2 млн человек с указанием COVID-19: а) в качестве основной причины;б) причины, способствующей смерти;в) если вирус идентифицирован, но не оказал существенного влияния на исход. Результаты. В январе-апреле 2020 г. в России отмечено снижение числа смертей от всех причин по сравнению со средним значением за 3 предыдущих года (2017-2019);в мае и в июне 2020 г. «избыточное» число смертей составляло 8,4 и 12,2% соответственно. В январе 2020 г. «избыточное» число смертей зафиксировано в 12 регионах, в феврале - в 24, в марте - в 10, в апреле - в 22, в мае - в 43, в июне - в 62. Наибольшее число «избыточных» смертей зарегистрировано в мае и июне в Москве, Санкт-Петербурге, Ленинградской, Московской областях и Республике Дагестане (в мае). В 3 регионах не наблюдалось роста смертности ни за один из 6 мес. В большинстве субъектов РФ определялась неустойчивая динамика, ни в одном регионе не выявлено ежемесячного увеличения числа умерших по сравнению с предыдущими 3 годами. В целом по РФ доля случаев смертей с любым упоминанием COVID-19 в медицинском свидетельстве о смерти (МСС) и в мае, и в июне 2020 г. составила 7,3 и 4,3% соответственно в качестве основной причины смерти, значительно варьируя в регионах. В мае 55,3% случаев «избыточных» смертей, в июне - 39,7% случаев обусловлены COVID-19 как основной причиной смерти (в Москве 47,5 и 43,5%;в Московской области 52,2 и 60,4%;в Санкт-Петербурге 50 и 69,3% соответственно). В некоторых регионах случаи смерти от COVID-19 в качестве основной причины регистрировались без «избыточного» числа смертей, в других наблюдалась противоположная ситуация. При сравнении регионов по данным, указанным в МСС, выявлена вариабельность долей причин смерти: а) от COVID-19 в качестве основной причины смерти (с идентифицированным и неидентифицированным вирусом), б) в качестве причины, способствующей смерти;в) не оказавшей влияние на причину смерти в рассматриваемых регионах. Заключение. Полученные результаты свидетельствуют о выраженной вариабельности влияния COVID-19 на «избыточную смертность» в субъектах РФ, различии в подходах к определению причины смерти. Аналогичные данные регистрируются и в других странах мира.

COVID-19: Urgent questions for estimating morbidity, prevalence, case fatality rate and mortality rate

During epidemics, the usual statistical approaches will not allow determining the readiness of the public health system to take urgent measures to counteract the increase in morbidity, spread and mortality of the population. The quality of the medical, socio-economic and managerial decisions at all levels will depend on the accuracy of statistical data and the possibility of creating adequate prognostic models. However, there are still problems with the identification of COVID-19 cases and the diagnostic accuracy of the methods used. Complex analytical efforts require in order to determine the COVID-19 impact on the health status and case fatality rate/mortality rate.