MORTALITY ASSOCIATED WITH PREVENTABLE CAUSES OF DEATHS FROM CARDIO-VASCULAR DISEASES IN THE PRE-COVID PERIOD AND DURING THE PANDEMIC IN RUSSIA

Abstract

Significance. The healthcare system can manage preventable causes of death if timely and effective interventions are in place including interventions aimed at improving living conditions and lifestyle of the population. Which diseases of the circulatory system are preventable? These are chronic rheumatic heart diseases and arterial hypertension at least in ages 5-64, and cerebrovascular diseases. The updated list of treatable diseases includes ischemic heart disease originally considered as a non-manageable cause. In the pre-COVID period the mortality structure underwent quality changes in terms of diseases and age distribution since the impact of preventive measures can manifest itself both in the decreased share of preventable causes and increased life expectancy of patients with cardio-vascular diseases. Did the gain in the age structure of preventable mortality from cardio-vascular diseases (CVD) sustain during the pandemic? The purpose of the study is to analyze contribution of preventable causes to cardio-vascular diseases mortality in the pre-COVID period and during the pandemic in Russia. Material and methods. The study used ROSSTAT data (Russian Federal State Statistics Service) to analyze data on cardio-vascular diseases mortality in the Russian Federation in 1999-2021. Male and female mortality was calculated for ages 5-64 years – the age interval of preventability. Since access to health care and risk factors of cardio-vascular diseases differ among urban and rural settings, rural and urban mortality was analyzed separately. Potential years of life lost (PYLL) were calculated as the sum products of the absolute number of deaths and potential years lost in each age group divided by 10 000 population of the corresponding age. Results. In most cases, the contribution of preventable causes to cardio-vascular diseases mortality in ages 5-64 has been steadily decreasing since 2003. The share of chronic rheumatic heart diseases equaling to less than one percent in males in the beginning of the century has decreased more than 3-fold during the pandemic. Similar trends are registered in female mortality, yet at higher rates. It should be emphasized here that mortality from chronic rheumatic heart diseases has been reducing since the end of the last century including throughout the period of social and economic collapse. The contribution of arterial hypertension to cardio-vascular diseases mortality is also low. The highest contribution to cardio-vascular diseases mortality is made by ischemic heart disease. Unlike other diseases under study, its contribution is higher among male urban population. Heart failure is associated with the lowest contribution to cardio-vascular diseases mortality. During the pandemic, its share has decreased in male mortality while hardly changed in females. The contribution of cerebrovascular diseases to cardio-vascular diseases mortality has significantly decreased sustaining this decline throughout the pandemic. In general, the contribution of preventable causes to cardio-vascular diseases mortality in ages 5-64 has been steadily reducing in males from 79.9% in 2003 to 72.7% in 2019 and to 71.6% in 2021 and in females from 80.5%% to 69.5% and 69.8%, respectively. The contribution of preventable causes in male mortality is higher among urban population compared to rural one (73.1% versus 71.3% in 2019, 71.9% versus 70.7% in 2021), while mortality in urban and rural females is almost the same. Conclusion. Analysis of preventable causes of cardio-vascular diseases mortality concludes as follows: First, it is those causes that have contributed the most to the decrease in mortality; Second, at the preventability age interval, the impact of preventive measures manifests itself in changes in mortality from ischemic heart disease and cerebrovascular diseases. Third, to ensure reduction in male mortality from cerebrovascular diseases it is necessary to intensify measures aimed at preventing alcohol use. Forth, it makes sense to analyze effectiveness of measures aimed at preventing avoidable mortality from diseases of the circulatory system using PYLL-70.