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.

Impact of a new coronavirus infection on causes of death in Moscow and St. Petersburg.

The distribution of causes and mortality rates in Moscow and St. Petersburg (SPb) are different. Objective. To analyze changes in the distribution of causes of death in Moscow and St. Petersburg related to the COVID-19 pandemic. Material and methods. The data were used on the annual average population and the annual number of deaths in one-year age groups according to Rosstat for 2019-2021. Standardized mortality rates based on the European standard were calculated. An ABC analysis of the deaths and causes of death in the two cities was performed. Results. Despite the new coronavirus infection, mortality rates in St. Petersburg exceeded those in Moscow by 20% for three years. ABC analysis of the cause of death distribution showed a sharp decrease in the number of causes responsible for 80% of deaths. The 50 leading causes of death in St. Petersburg were more consistent. In the list of causes, mortality due to malignant neoplasms of various localizations in Moscow has shifted down by 3-11 positions, and in St. Petersburg, it increased by 10 positions. The proportion of malignant neoplasms exceeds half of the deaths due to gastrointestinal and respiratory diseases. Mortality from cardiovascular diseases in Moscow was 30% lower in 2021. Mortality from diseases associated with the gastrointestinal tract tended to decrease in both cities. Mortality from respiratory diseases was 15-20% lower in Moscow. The changing distribution of causes of death during a pandemic was expected for several reasons. In Moscow, compared to St. Petersburg in 2020, the <<coronavirus infection>> diagnosis was apparently used more <<cautiously>> as a cause of death. Conclusion. The coronavirus pandemic had a significant impact on mortality rates and distribution. The trends of mortality changes during the analyzed period were often inconsistent;however, mortality from leading causes in St. Petersburg remained higher than in Moscow.Copyright © 2023, Media Sphera Publishing Group. 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.

Impact of a new coronavirus infection on causes of death in Moscow and St. Petersburg

The distribution of causes and mortality rates in Moscow and St. Petersburg (SPb) are different. Objective. To analyze changes in the distribution of causes of death in Moscow and St. Petersburg related to the COVID-19 pandemic. Material and methods. The data were used on the annual average population and the annual number of deaths in one-year age groups according to Rosstat for 2019—2021. Standardized mortality rates based on the European standard were calculated. An ABC analysis of the deaths and causes of death in the two cities was performed. Results. Despite the new coronavirus infection, mortality rates in St. Petersburg exceeded those in Moscow by 20% for three years. ABC analysis of the cause of death distribution showed a sharp decrease in the number of causes responsible for 80% of deaths. The 50 leading causes of death in St. Petersburg were more consistent. In the list of causes, mortality due to malignant neoplasms of various localizations in Moscow has shifted down by 3—11 positions, and in St. Petersburg, it increased by 10 positions. The proportion of malignant neoplasms exceeds half of the deaths due to gastrointestinal and respiratory diseases. Mortality from cardiovascular diseases in Moscow was 30% lower in 2021. Mortality from diseases associated with the gastrointestinal tract tended to decrease in both cities. Mortality from respiratory diseases was 15—20% lower in Moscow. The changing distribution of causes of death during a pandemic was expected for several reasons. In Moscow, compared to St. Petersburg in 2020, the «coronavirus infection» diagnosis was apparently used more «cautiously» as a cause of death. Conclusion. The coronavirus pandemic had a significant impact on mortality rates and distribution. The trends of mortality changes during the analyzed period were often inconsistent;however, mortality from leading causes in St. Petersburg remained higher than in Moscow.

Impact of a new coronavirus infection on causes of death in Moscow and St. Petersburg

The distribution of causes and mortality rates in Moscow and St. Petersburg (SPb) are different. Objective. To analyze changes in the distribution of causes of death in Moscow and St. Petersburg related to the COVID-19 pandemic. Material and methods. The data were used on the annual average population and the annual number of deaths in one-year age groups according to Rosstat for 2019—2021. Standardized mortality rates based on the European standard were calculated. An ABC analysis of the deaths and causes of death in the two cities was performed. Results. Despite the new coronavirus infection, mortality rates in St. Petersburg exceeded those in Moscow by 20% for three years. ABC analysis of the cause of death distribution showed a sharp decrease in the number of causes responsible for 80% of deaths. The 50 leading causes of death in St. Petersburg were more consistent. In the list of causes, mortality due to malignant neoplasms of various localizations in Moscow has shifted down by 3—11 positions, and in St. Petersburg, it increased by 10 positions. The proportion of malignant neoplasms exceeds half of the deaths due to gastrointestinal and respiratory diseases. Mortality from cardiovascular diseases in Moscow was 30% lower in 2021. Mortality from diseases associated with the gastrointestinal tract tended to decrease in both cities. Mortality from respiratory diseases was 15—20% lower in Moscow. The changing distribution of causes of death during a pandemic was expected for several reasons. In Moscow, compared to St. Petersburg in 2020, the «coronavirus infection» diagnosis was apparently used more «cautiously» as a cause of death. Conclusion. The coronavirus pandemic had a significant impact on mortality rates and distribution. The trends of mortality changes during the analyzed period were often inconsistent;however, mortality from leading causes in St. Petersburg remained higher than in Moscow. © 2023, Media Sphera Publishing Group. All rights reserved.

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.

Dynamics of regional mortality rates for men and women from diseases and external causes in Russia for the period 2016-2019 compared to 2020

The COVID-19 pandemic has led to excess mortality in the Russian Federation. This article is a continuation of the previous study. Objective. To analyze the dynamics of mortality of men and women from all and, in particular, from three groups of causes in the regions of the Russian Federation for the period 2016-2019. compared to 2020. Material and methods. The study was conducted on the basis of Rosstat data on the number of deaths in accordance with the brief nomenclature of the causes of death of Rosstat (BNCDR) and the average annual population in one-year age groups for 2016-2020. Using the program developed in the Federal State Budgetary Institution "National Medical Research Center for Therapy and Preventive Medicine" of the Ministry of Health of Russia, the standardized mortality rates (SMRs) from all causes and three groups of causes were determined according to the previously described method, and the SMRs were compared. Results. A decrease in SMR from all causes from 2016 to 2019 was observed in less than half of the regions (women in 34, men in 37 regions;in the rest, undulating dynamics was noted). In 2020, the regional average SDR from all causes compared to the 2016-2019 average increased (p<0.0001) in all regions (SMR of men by 17.3±6.3%, women — by 14.5±6.1%;in 4 regions, the increase was more than 25%). From 2016 to 2019, male deaths from diseases decreased from year to year in 30 regions;women — at 28;from causes associated with alcohol and drugs — in 19 and 21 regions, respectively;from external causes in 40 and 30 regions. The rest showed undulating dynamics. In 2020 compared to the average value of 2016-2019. the average regional value of SMR from diseases increased statistically significantly (p<0.0001) and decreased (p<0.0001) from external causes (SDR of men by 15.69±6.22% and 8.82±11.43%, respectively, and women by 16.6±6.57% and 11.3±13.69%). An increase in mortality of men and women from causes associated with alcohol and drugs was noted in 35 and 34 regions, from external causes — in 9 and 12 regions. The proportion of two groups of causes (external and associated with alcohol and drugs) in men was 14.8±3.4% (average across regions in 2016-2019) and 12.5±3.8% (2020), in women 7.8±3.3% and 6.1±2.3%, respectively. It is for these groups of reasons that the maximum differences in mortality between men and women are recorded (4 times on average). Conclusions. Until 2020, more than half of the regions of the Russian Federation showed unstable trends in standardized mortality rates. Interregional differences in standardized mortality rates from diseases are smaller than those from causes of the other two groups considered. The study established the need to study interregional differences in the mortality of men and women in order to establish the reasons for both the decrease and increase in indicators. © 2022, Media Sphera Publishing Group. All rights reserved.

[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.

The outpatient medical care in patients with chronic diseases under dispensary supervision in the conditions of the COVID19 pandemic. Temporary guidelines. Version 2

The aim of these guidelines is to provide primary care physicians with scientifically based algorithms for the implementation of dispensary monitoring in patients with chronic noncommunicable diseases in the conditions of the new coronavirus infection (COVID19) pandemic, including the use of telemedicine technologies. The organization and conduct of highquality medical followup are the most important tasks aimed at both reducing the risks of developing complications of chronic noncommunicable diseases and reducing overall mortality, especially in the current conditions of the COVID19 pandemic. The guidelines contain clinical aspects of dispensary followup, general principles of tactics for managing patients with various chronic noncommunicable diseases in COVID19 conditions, in addition, brief checklists with options for interviewing patients with various chronic noncommunicable diseases are presented, topical aspects of the interaction of drugs used in the treatment of chronic noncommunicable diseases with antiviral drugs are considered. The guidelines are intended for general practitioners, district therapists, general practitioners (family doctors), as well as doctors of other specialties providing primary health care. © 2022 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved.

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.

Interim guidelines: "Outpatient care for patients with chronic diseases subject to outpatient care in the context of the COVID-19 pandemic"

Consensus of experts of the Russian Society for Prevention of Noncommunicable Diseases, S.P. Botkin National Society for Advanced Medical Training, Profile Commission on Therapy and General Medical Practice of the Ministry of Health of Russia and Profile Commission on Medical Prevention of the Ministry of Health of Russia. Консенсус экспертов Российского общества профилактики неинфекционных заболеваний, Национального общества усовершенствования врачей имени С.П. Боткина, Профильной комиссии по терапии и общей врачебной практике Минздрава России и Профильной комиссии по медицинской профилактике Минздрава России.

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.