Analysis of the fatal outcomes due to chronic obstructive pulmonary disease in St. Petersburg
Authors:   I.P. Pavlov First Saint-Petersburg State Medical University, St. Petersburg, Russian Federation, Titova O.N. , Kuzubova N.A. ,   Pavlov First Saint-Petersburg State Medical University, St. Petersburg, Russian Federation, Kozyrev A.G. ,   Pavlov First Saint-Petersburg State Medical University, St. Petersburg, Russian Federation, Dvorakovskaya I.V. ,   Pavlov First Saint-Petersburg State Medical University, St. Petersburg, Russian Federation, Chermenskii A.G. ,   Pavlov First Saint-Petersburg State Medical University, St. Petersburg, Russian Federation
Published: October 2024

Background: mortality from chronic obstructive pulmonary disease (COPD) is increasing worldwide. The prognosis of a COPD patient's life largely depends on the presence of concomitant conditions, primarily diseases of the cardiovascular system. Aim: to analyze the fatal outcomes of COPD in 2022–2024 in St. Petersburg. Materials and Methods: statistical data on mortality from COPD in St. Petersburg for 2022–2024 were studied. Besides, 159 medical records and protocols of pathoanatomical autopsies of patients hospitalized with COPD who died in 2023 were analyzed. Results: in 2022 in St. Petersburg, COPD caused the fatal outcome of 165 people (0.27% of the total urban mortality structure), in 2023 — 252 (0.44%), in January and February 2024 — 78 (0.63%). During the same period, chronic coronary artery disease (CCAD) became more commonly mentioned as a concomitant disease in deceased patients with COPD: in 2022, 44.8% of patients, in 2023 — in 62.3%, in January and February 2024 — in 74.4%. Based on the analysis of medical records of 159 deceased patients, an expert group determined that in 53 cases, COPD either was not the cause of death, which occurred due to cardiovascular or oncological diseases, or was not confirmed upon expert evaluation. In 56 patients, the role of the respiratory disease was deemed primary, while in 50 cases, the severity of COPD and concurrent pathologies were comparable, preventing the experts from reaching a definitive conclusion regarding the cause of death. Overdiagnosis of COPD as the cause of death could be facilitated by the fact that the rate of payment for hospitalization under compulsory health insurance (CHI) for patients with COPD was higher than for patients with CCAD. Conclusions: in a significant part of the reviewed cases, COPD was not the main cause of death or its diagnosis was not justified. One of the conditions for improving the correctness of the disease diagnosis and the causes of fatal outcomes may be the pricing policy improvement of the CHI, which would make the estimation of the main diagnosis independent of economic factors. KEYWORDS: COPD, mortality from COPD, concomitant diseases in patients with COPD, mortality from chronic coronary heart disease, overdiagnosis of COPD, compulsory medical insurance. FOR CITATION: Titova O.N., Kuzubova N.A., Kozyrev A.G., Dvorakovskaya I.V., Chermenskii A.G. Analysis of the fatal outcomes due to chronic obstructive pulmonary disease in St. Petersburg. Russian Medical Inquiry. 2024;8(8):447–452 (in Russ.). DOI: 10.32364/2587- 6821-2024-8-8-1.