D.O. Roschin¹, T.P. Sabgayda², G.N.Evdokushkina^2
1Federal hospital of Russian Academy of Sciences, Troitsk, Moscow region
²Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, Moscow

Summary. Russia enters the “big ten” of nations with greatest number of diabetes mellitus, while mortality from it ranges rather low in official statistics. That indicates an evident under-registration of diabetes mellitus as a cause of death. The aim of this study is to analyze the frequency of diabetes indications while death causes diagnostics.

Two approaches were applied. First, three “science-oriented” towns of Moscow region (Chernogolovka, Pushkino, and Troitsk) were screened through this study, and a comparison of death certificates (Form No.106/ó-08) with medical records of dead patients of the only in-patient facilities of those towns was performed. Second, death certificates (Form No.106/ó-98) from the regions of Tver, Tula, and Kaluga were also enrolled in this study, and the subclauses a), b), c) of the clause N18 of those death certificates (Form No.106/ó-98) were investigated into. The morbidity and mortality from diabetes mellitus in 1994-2010 were investigated into for those three regions. Microsoft Office Access 2003 and Microsoft Office Excel 2003 software were used for data processing.

In case of in-hospital mortality, about one quarter of the dead patients had had diabetes mellitus in medical records, while it had never been officially proclaimed among causes of death, save one case with diabetes mellitus stated as underlying cause of death. Mostly, while death causes diagnostics clinical approach in applied. Lack of determination in persons who establish cause of death to give an evaluation of population health results in perception of diabetes mellitus as a background disease and not as a primary cause of disorders of organs and systems functioning leading to lethal outcomes from causes of different classes.

The mathematical frequency of inclusion of diabetes mellitus in causes of death in issued medical certificates of death surveyed into in this study was one order of magnitude less than it had been in overall morbidity with diabetes mellitus of the adult population.

In the regions of Tver and Kaluga where morbidity and mortality in diabetes mellitus were similar to the all-Russia indicators, diabetes mellitus was very rarely mentioned in death certificates, namely: in 1.3% and 1.9% of issued certificates, respectively, while in the region of Tula where morbidity was higher, it was mentioned in 2.5% certificates.

Distribution of number of records indication presence of diabetes mellitus in death certificates doesn’t coincide with the frequency of diabetes complications. Apart from endocrine diseases the most often such records were found in cases of deaths from diseases of the skin and subcutaneous tissue and from diseases of the musculoskeletal system and connective tissue. In case of diseases of the skin and subcutaneous tissue, respiratory and digestive diseases input of diabetes-associated deaths in females is by 1.2-1.9 times higher than in males; in case of infections, Ill-defined and unknown causes of mortality and traumas and poisonings – by more than 8 times.

The problem of diabetes mellitus still has no adequate social perception as concerns health status of the population, and a vicious circle is formed when underestimation of social and medical implications of diabetes mellitus evokes not a rare inclination of a corresponding official to skip it in medical certificates of death being issued. This leads to a lack of attention of public health authorities to the problems of prevention of diabetes mellitus and enhancement of medical care quality for patients with diabetes mellitus. The whole situation makes for underestimation of diabetes mellitus for the state of health of the population, experts of public health also being mystified as concerns this problem. The first obligatory step for breaking the vicious circle is compulsory registration of diabetes mellitus while death causes diagnostics.

Keywords. Problem of diabetes mellitus in public health; coding of causes of death; perception of diabetes problem; mortality in diabetes mellitus; in-hospital lethality of patients with diabetes mellitus; evaluation of completeness of revelation of mortality from diabetes mellitus; diabetes mellitus-related mortality; filling-in of medical death certificates.

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