Regional variability of male and female mortality from three types of coronary artery disease: comparison of two periods 2017-2019 and 2020-2022

Abstract

Aim. To assess regional variability of standardized mortality rates (SMRs) for men and women from three types of coronary artery disease (CAD) for 2 periods (2017-2019 and 2020-2022).Material and methods. Rosstat data on the average annual population and the number of deaths in one-year age groups for 82 constituent Russian entities were used. SMRs was calculated using software (state registration number 216661114) and the European Standard Population by the direct standardization per 100 thousand population. The average regional SMRs were calculated for 2017-2019 and 2020­2022 as follows: (I21-I22) myocardial infarction (MI); (I20, I24.1-9) other acute coronary artery disease types; (I25.0-9) chronic coronary syndromes; all 3 groups of CAD.Results. We found that the regional average CAD SMR among men (343,0±98,3 and 364,2±105,7 per 100 thousand population) is >2 times than among women (163,3±55,7 and 179, 5±61,2 per 100 thousand population), but men and women did not differ in the average regional proportion of CAD in the structure of all-cause mortality. In 5 regions, a simultaneous decrease in SMR from three CAD types and their total indicator was registered in both men and women; in 8, an increase in SMR was registered for each of the three forms and their sum, and in the remaining regions, multidirectional dynamics were noted. The coefficient of variation of regional MI SMR changes for men was 830%, for women — 322%; for other acute CAD — 7145% and 2523%, respectively. In general, the increase in CAD SMR occurred mainly due to an increase in SMR from chronic CAD against the background of a decrease in MI SMR. The proportion of chronic CAD in the structure of all CAD types is higher in women (80,1±11,9 and 82,9±10,3%) than in men (75,5±14 and 77,6±13%). The proportion of MI among men is 14,8±6,1 and 13,5±6,6%, among women — 7,1±10,9 and 6,2±8,7%.Conclusion. The pronounced variability of regional SMRs and their changes over time, differences in mortality structure between men and women indicate a number of unresolved statistical issues related to determining the initial cause of death from CAD and its individual types, including with multimorbid pathology.