Variability and changes in regional mortality rates from acute cerebrovascular accidents

Abstract

Objective. To assess the changes and variability of regional mortality rates from stroke in the period of 2013 to 2021 and to discuss the probable causes of changes and differences. Material and methods. The authors have used the Russian Federal State Statistics Service (ROSTAT) data obtained upon the request of the National Medical Research Center for Therapy and Preventive Medicine, Ministry of Health of Russia. The standardized mortality rates (SMRs) were calculated using the European Standard and on the ROSTAT Brief Death Nomenclature, that takes into account the following ICD-10 codes: subarachnoid hemorrhage (I60); intracerebral and other non-traumatic intracranial hemorrhages (I61-62); brain infarction (I63); stroke unspecified as hemorrhage or infarction (I64). Results. There was a decrease in the average regional stroke rates from 2013 to 2019 (95.9±30.9 and 68.1±22.2 per 100,000 population, respectively) with stagnation in 2020-2021 (70.8±22.8 and 68.9±21.5 per 100,000, respectively). Only in Moscow, there was an annual consequent reduction in stroke rates; this was noted in 15 regions before 2019; in 7 regions in 2021 the SMRs was higher than in 2013. The most significant changes in SMRs (in 2013 – 17.6±16.3 per 100,000 population, in 2021 – 1.3±2.2 per 100,000 population) were registered for the code I64, with the highest coefficient of variation of regional SMRs (from 92.7 to 161.6% in different years); the share of I64 among the causes of death from all stroke decreased significantly from 2013 to 2021 – 17.1±11.7 and 2.1±3.4%, respectively. Conclusion. Significant variability of regional SMRs from individual types of stroke and their shares in the structure of mortality from all forms of stroke was revealed, which may be associated with both differences in morbidity, organization of medical care, and peculiarities of coding of causes of death. The growth of SMRs in 2020-2021 is possibly associated with the COVID-19 pandemic.