A.E. Ivanova1, T.P. Sabgayda1, V.G. Semenova1, V.G. Zaporozhchenko, E.V. Zemlyanova1, S.Yu. Nikitina2
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:
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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.
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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.
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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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