Male and female mortality rates due to acute types of coronary artery disease in five-year age groups in the Russian Federation: what do the numbers mean?

Aim. To assess mortality rates due to acute types of coronary artery disease (CAD) in five-year age groups (20-85+ years) and the contribution to all-cause mortality in 2019-2020.

Material and methods. From the Center for Demographic Research of the Russian Economic School, data on all-cause and acute CAD mortality rates were selected (codes: I21.0-9; I22.0-9; I20, I24.1-9) in five-year age groups (from 20-24 years to the group 85+ inclusive) of men and women per 1 million population in 2019 and 2020. The contribution (in %) of acute types of CAD to all-cause mortality, the contribution of each disease to mortality, and the ratio of male/female mortality rates were determined.

Results. The contribution of all acute types of CAD to all-cause mortality among men of different 5-year age groups ranges from 1,2 to 7,9% (50-54 years), among women from 0,9 to 5,5% (65-69 years) and has the character parabolic dependence on age. In each subsequent 5-year age groups, mortality rates due to acute CAD is higher compared to the previous one. However, in age groups up to 60 years, the share of "other forms of acute CAD" prevails (from 51% to 100%), and after 60 years — myocardial infarction (MI) (from 56% to 78%). For all acute types of CAD in 2019-2020, mortality rate among men is higher than among women: a maximum of 25 times from recurrent MI in age group of 40-44 years in 2020; 7 times — from acute MI in age group of 40-44 years in 2019; and 4,5 times from "other forms of acute CAD" in age group of 50-54 years in 2019. In 2020, compared to 2019, there was an increase in mortality from all acute CAD, with the exception of age group of 25-29 years among women and 20-34 years among men.

Conclusion. The identified structural age-sex features of mortality from acute CAD may be due to approaches to diagnosis and identification of various CAD forms as the cause of death and require the creation in the Russian Federation of a methodological protocol or algorithm for determining the cause of death of various acute types of CAD.

Mortality from acute types of coronary artery disease in men and women in Russia in 2015 and 2019

Aim. To comparison standardized mortality rates (SMRs) among men and women from acute types of coronary artery disease (CAD) and their regional variability in Russia in 2015 and 2019.

Material and methods. The Federal State Statistics Service (Rosstat) data on the population and the number of deaths from CAD based on the brief nomenclature of death causes using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) in 2015 and 2019 in 82 Russian subjects are presented. For each sex, SMR was calculated for acute (primary) and recurrent myocardial infarction (MI) (I21-I22), for other types of acute CAD (I20, I24.1-9), as well as average regional SMRs, coefficient of variation (CV).

Results. The average regional SMR for each of the acute CAD types among men was significantly higher than among women both in 2015 (p<0,0001) and in 2019 (p<0,0001). For the period of 2015-2019 in men, SMR from all acute CAD types decreased by 22,5%, from acute MI — by 7,4%, from recurrent MI — by 22,2% and from other acute CAD types — by 25,8%, while in women, these figures were 11,8, 8,8, 19,0 and 29,7%, respectively. The men-to-women SMR ratio in 2015 and 2019 were 2,79/2,72 for all acute CAD types, 2,58/2,55 for all MI cases, and 3,36/4,18 for other acute CAD types. The minimum CV values (41,9% among men in 2019 and 44,7% among women in 2015) were recorded for acute MI, while the maximum CV values (129,3% among men and 158,6% among women in 2019) for other acute CAD types.

Conclusion. Over the period of 2015-2019, the average regional SMR from acute CAD types in men and women decreased in Russia, with a more noticeable decrease for men. Greater regional variability in mortality, especially for other acute CAD types, poses the problem of finding organizational, methodological and strategic solutions to clarify the criteria for coding and refine the logistics schemes for providing healthcare for doubtful or uncertain diagnostic signs of acute CAD.