Причины смерти и методы их анализа Н.С. Гаврилова

Causes of death and their classification Established by the World Health Organization as International Classification of Diseases (ICD) Has several revisions. The most recent revision is the 10 th revision. Adopted by most countries in the mid 1990s

Classification of causes of death in Russia Classification of causes of death used in the Soviet statistical forms was different from WHO classification. Form #5 (later called form C51) had 185 causes of death. Main differences between WHO and Soviet classification are found in the groups of CVD and injuries

New classification of causes of death in Russia After dissolution of the Soviet Union most FSU countries continued to use the old classification of causes of death In 1999 Russia adopted a new classification of causes of death corresponding to the 10 th ICD revision Still incompatible with the WHO classification

Major causes of death within the group of injuries. Men Иванова и др., Demoscope Weekly, N , 2004

Major causes of death within the group of injuries. Women Иванова и др., Demoscope Weekly, N , 2004

Degradation of mortality statistics in Russia

Pace of Growth of Age-Adjusted Mortality in for Classes of Causes of Death

Proportion of deaths from ill- defined conditions is a measure of quality of mortality statistics Proportion higher than 5% indicates poor quality In developed countries most deaths from ill-defined conditions are diagnosed at older ages

Is this increase in mortality from ill-defined conditions related to more cases of deaths from senility?

Age Profile of Mortality from Ill-Defined Conditions in Russia MalesFemales

Top Five Causes of Death for Young Adult Males (20-24) Injuries NeoplasmsSymptoms, Signs and Ill- Defined Conditions Diseases of Circulatory System Infectious Diseases Symptoms, Signs and Ill- Defined Conditions Neoplasms Diseases of Nervous System and Sens.Organs Diseases of Respiratory System

Top Five Causes of Death for Young Adult Females (20-24) Injuries Neoplasms Diseases of Circulatory System Complications of Pregnancy and Childbearing Symptoms, Signs and Ill- Defined Conditions Diseases of Nervous System and Sens.Organs Infectious Diseases

What Causes of Death Are Hidden Behind the Ill-Defined Conditions?

We Used Individual Death Certificates With More Detailed Description of Circumstances of Death Collected by Kirov Department of Health Kirov is a Typical Russian Region with Lower than Average Mortality from Ill-Defined Conditions

Age-Adjusted Mortality from Injuries in 1996 for Russian Males Aged 0-64 years Data from the WebAtlas Project (

Deaths from Ill-Defined Conditions in Kirov Region of Russia in 2003 Sudden infant death (R95) 3.3% Decomposition in water (river, well, pond) (R99) 13.0% Decomposition at home (R99) 53.5% Decomposition in garden, summer house (R99) 1.7% Decomposition in forest or field (R99) 6.0% Decomposition in nonresidential building, on the street (R99) 12.3% Decomposition in water pipe (R99) 0.7% Decomposition on the cemetery (R99) 0.3% Decomposition in bath, lavatory or barn (R99) 1.0% Decomposition in other place (R99) 5.5% unknown (R99) 2.3% senility (R54) 0.3%

Mortality in Moscow city

Ill-defined conditions and external deaths of undetermined intent are two sides of the same coin It appears that both causes of death may be used for concealing criminal cases of violent death

Top Five Causes of External Mortality in Russia and Moscow in 2001 RussiaMoscow SuicideAccidental Falls Undetermined Injury HomicideAll Other Accidental Causes Accidental Poisoning by Alcohol Homicide All Other Accidental CausesSuicide

Autopsies in Russia Autopsies are used to verify cause of death Autopsy is mandatory for violent death, death of woman during pregnancy, labor or postpartum period, death of infant below 1 year, death from cancer not supported morphologically, death from any infectious disease

Situation with medical examiner services Only 34-48% of jobs are filled by physicians 38-54% of jobs are filled by histologists 35% of workers reached retirement age

Средний ожидаемый возраст смерти по причинам, женщины России Васин С., доклад в Киеве 2006

Вероятность для новорожденного умереть на протяжении жизни от семи групп причин смерти (на 100 родившихся), мужчины России БСК и новообр. – правая ось Васин С., доклад в Киеве 2006

Сравнение структуры смертности мужчин России и Западных стран год Васин С., доклад в Киеве 2006

Сравнение структуры смертности мужчин России и Западных стран год Васин С., доклад в Киеве 2006

Decomposition of the U.S.-Russia gap in life expectancy by cause USA – 1999; Russia – Source: Shkolnikov et a. Mortality reversal in Russia.

Decomposition of the U.S.-Russia gap in life expectancy by cause USA – 1999; Russia – Source: Shkolnikov et a. Mortality reversal in Russia.

Contribution of different causes of death to changes in LE, men

Contribution of different causes of death to changes in LE, women

Age and cause components of LE increase due to anti-alcohol campaign: Men

Age and cause components of LE increase due to anti-alcohol campaign: Women

Contribution of causes of death to 40 e 20 (CA) - 40 e 20 (Slav) Males (total difference = 2.90 years)

Contribution of causes of death to 40 e 20 (CA) - 40 e 20 (Slav) Females (total difference =.28 years)