A.E. Ivanova¹, T.P. Sabgayda¹, V.G. Semenova¹, V.G. Zaporozhchenko, E.V. Zemlyanova¹, S.Yu. Nikitina^2
1 - Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, Moscow
² – Federal State Statistics Service, Moscow

Summary. Population mortality in Russia during the last half a century appears to be an extensively studied problem. At the same time accuracy of death cause coding becomes an increasingly important issue for mortality analysis and interpretation of its regularities. Working age population has been the key group determining life expectancy level in Russia for several decades, its regional variance, trends and projection. Therefore, coding accuracy of death causes is this age group is the most pressing issue.

Aim of the study was to analyze death causes structure in working population in Russia, to determine its age-specific, gender and nosological regularities; and to determine distortion scale of death causes and its impact on nosological profile of mortality in population of working ages.

Methods and data. The authors used official mortality statistics for 1965-2010. Component analysis method was used to evaluate impact of age groups and separate death causes on mortality shifts at different stages of its development. Analysis of factors distorting death causes was conducted on the basis of depersonified 2010 death database tabulated by full nomenclature of diagnosis. Method of fourfold tables with chi-square criterium was also used. Probability of variation reliable with error level ð<0,05 was calculated as well.

Discussion. By the end of the first decade of the XXI century Russia returned to its 45-year old life expectancy levels only; total losses of life expectancy during 1965-2010 added up to 2.5 years and 0.5 years in males and females correspondingly because of population of working ages. Both in ages where crude mortality rate didn’t change (15-29 years old) and especially in ages where it did increase (over 30 years) the structure of death causes has undergone substantial changes. The conducted analysis of mortality has raised the following questions:

1. Related to reliability of decreased mortality from external causes that started prior to improvement of socio-economic situation in the country and implementation of whatever measures in this area (1994-2005). Underestimation of mortality from external causes related to concealment of violent causes (chapter “Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified”, and from alcohol poisonings in “Diseases of circulatory system” in young ages has been proved. Distortion of external causes structure due to underestimation of mortality from murders and suicides in section “Events of undetermined intent” has been validated as well.
2. Related to reliability of increased mortality from cardio-vascular diseases in middle and especially in young (15-29 years) ages. It has been proved that cardio-vascular epidemic in Russia especially in young ages was mainly trigged by alcoholic factor. At the same time its scale is not as great as it is demonstrated by official statistics.
3. Related to insufficient reliability of diagnostics of somatic death causes which is suggested, in particular, by high prevalence of unspecified diagnosis among basic death causes (about 4% in diseases of the digestive system and about 64% in diseases of the respiratory system) due to insufficient volumes of instrumental examination even using routine methods including unsatisfactory diagnostic base of medical institutions and/or its inadequate use; medical documents are not obligatory claimed to diagnose death cause; limitations of diagnostics of death causes due to tabulation of death causes by primary cause only.

Scope of application. Reliable data on death causes are necessary for developing adequate policy measures to reduce population losses due to untimely and avoidable mortality.

Keywords. Life expectancy; mortality; main death causes; working population; quality of mortality data; coding of death causes; ill-defined conditions; murders; suicides; mortality caused by alcohol; diagnostics.

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