Differences in Causes of Death among the Elderly in Four Regions of the Russian Federation: Retrospective Study

Objective

. To identify and discuss the causes of death among the elderly in the four regions of the Russian Federation, using medical death certificate (MDC) data.

Materials And Methods

A total of 114,402 deaths of people aged 75 years or older from diseases (ICD-10 codes I–XVIII and XXII) were selected from electronic databases of regional medical information and analysis centers in four regions of the Russian Federation for the year 2023. Of these, 45,988 died in Moscow (40.2%), 43,249 in the Moscow region (37.8%), 13,309 in Novosibirsk region (11.6%), and 11,856 in Kemerovo region (10.4%).

Results

. The structure of the underlying causes of death (OCD) from diseases by ICD-10 classes in 4 regions has significant differences (p < 0.0001). The share of diseases of the circulatory system (DCS) was 71.6% in Moscow, 47.7% in the Moscow region; 70.8% in the Novosibirsk region and 50.9% in the Kemerovo region. The share of deaths from malignant neoplasms (MN) was 18.7% in Moscow; 9.9% in the Moscow region; 14.9% in the Novosibirsk region and 14.1% in the Kemerovo region; diseases of the nervous system — 0.2%; 22.2%; 2.9% and 15.5%, respectively. The fourth rank place in the Moscow region (4.8%) and Kemerovo region (6.2%) was occupied by diseases of the endocrine system (0.2% in Moscow and 1.1% in the Novosibirsk region). The share of acute forms of ischemic heart disease (ICD-10 code groups I21–I24), stroke (I60–I64) and ruptured aneurysm or aortic dissection in the structure of the PPS was 9.7% in Moscow; 12.3% in the Moscow region; 8.8% in the Novosibirsk region and 12.9% in the Kemerovo region. The share of codes probably associated with chronic cognitive impairment and/or dementia (from 3 classes of diseases) accounted for 33.2% in Moscow, 30.8% in the Moscow region, 14.0% in the Novosibirsk region and 26.7% in the Kemerovo region. The CSD codes in any place of the ICD-10 were indicated in 83.0% of cases in Moscow and 85.2% in the Moscow region; in the Novosibirsk region — 85.6%, and in the Kemerovo region — 87.3%, with 98.0% of the MCCs indicating more than one 4-digit ICD-10 code.

Conclusions

. Despite significant differences in the structure of causes of the death, chronic pathology predominates in all four regions, with a high proportion of deaths associated with cognitive impairment. The causeof-death statistics for those aged 75 and older are not sufficiently objective, with underdiagnosis of some diseases and overdiagnosis of others, as well as a high frequency of using codes for unspecified causes of death or those not recommended for use in mortality statistics.