[The chronic cardiac insufficiency as a cause of death: the problems of statistical service and evaluation]

Area of Science:

• Public Health
• Medical Statistics
• Cardiology

Background:

• Accurate cause-of-death (COD) coding is crucial for public health surveillance.
• The application of the I50.9 code for cardiac failure in Russian Federation mortality statistics requires detailed analysis.
• Understanding coding practices is essential for interpreting mortality trends.

Purpose of the Study:

• To analyze the application of the I50.9 code as the primary cause of death (PBC) across Russian Federation regions from 2013-2019.
• To assess trends in standardized mortality rates (SDR) attributed to cardiac failure.
• To investigate regional variations and changes in the coding of cardiac failure as a cause of death.

Main Methods:

• Utilized Rosstat data (Annual forms C41 and C51) based on the "Brief Nomenclature of Causes of Death of Rosstat" (KNPSR).
• Calculated standardized mortality rates (SPS) using specialized software (state registration number 216661114).
• Analyzed coefficient of variation (Cv) and max/min ratio to assess regional variability and coding practices.

Main Results:

• Regional average SDR from cardiac failure (I50.9) decreased significantly (up to 4 times) between 2013-2019 (p <0.0001).
• The coefficient of variation (Cv) for regional SDR from cardiac failure increased substantially (by 162% to 230%).
• The percentage of regions not indicating cardiac failure as PBC rose from 8% to 19%, with notable regional exceptions and variability.

Conclusions:

• Observed changes in cardiac failure mortality indices are likely influenced by both actual mortality trends and evolving coding methodologies.
• Distinguishing between "chronic cardiac failure syndrome" and "cardiac failure as a death mechanism" is necessary for accurate assessment.
• Implementing uniform coding rules for chronic cardiac failure syndrome is recommended to improve the reliability of mortality statistics.