Trends in mortality rates from chronic forms of coronary heart disease in the regions of the Russian Federation in 2017–2021

Abstract

Objective. To assess the trend and variability of standardized mortality ratios (SMRs) from chronic forms of coronary heart disease (CHD) in the regions of the Russian Federation (RF) in 2017–2021. Material and methods. The investigation used the 2017–21 Russian Federal State Statistics Service (RFSS) data on the average annual population and the number of deaths in the one-year age groups in 82 RF regions on the basis of the RFSS “Brief Death Cause Nomenclature” (BDCN). The SMRs were calculated on the basis of the European standard per 100,000 population for each region; then the average regional SMRs related to the chronic forms of CHD were determined using 4 BDCN accounting lines. Results. For the period from 2017 to 2019, a decrease was noted in the average regional SMRs from all forms of CHD (from 183.9±68.5 to 176.8±65.3 cases per 100,000 population), but in 2020 and 2021, an increase was recorded in SMRs from CHD (204.3±75.4 and 207.4±76.9 cases per 100,000 population, respectively) as the proportion of these causes decreased in the structure of all-cause mortality in the COVID-19 pandemic period (18.4±7.1% in 2017 and 15.8±5.4% in 2021). there was a decrease in the average regional SMRs from all forms of chronic heart diseases (CHD) (from 183.9±68.5 to 176.8±65.3 cases per 100,000 population), but in 2020 and 2021, an increase in the SMRs from CCHD (204.3±75.4 and 207.4±76.9 cases per 100,000 population, respectively) hand in hand with a reduction in the proportion of these causes in the COVID-19 pandemic period (18.4±7.1% in 2017 and 15.8±5.4% in 2021). Results. For the period from 2017 to 2019, over a 5-year period, an annual consistent decrease was recorded in the SMR from CHD in none Russia’s regions; their annual rise was seen in 4 regions; whereas an unstable trend was noted with a decrease and a rise in SMRs in the others. There was a considerable interregional variability of SMRs from all forms of CHD (in 2017, the maximal SMR differed from the minimal one by 60 times) and from individual forms of CHD (in 2020, the regional minimum and maximum SMRs from I25.1 differed by 500 times). The paper presents hypotheses about the causes of the revealed differences and proposals to modify the accounting of deaths from CHD. Conclusion. There were substantial regional differences with an unstable 5-year trend in SMRs from CHD in the entire and individual accounting forms included in this group in accordance with the ICD. The fact that there are no unified criteria for and approaches to identifying the individual forms of CHD as the main cause of death, including that in the presence of multimorbid pathology complicates understanding the causes of death.