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

Abstract

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 6069 years, 6.02%; aged 100 years, 63.5%), chronic ischemic heart disease (18.6%), malignant neoplasms (10.7%; aged 6069 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.