MORTALITY FROM EXTERNAL CAUSES AMONG THE RUSSIAN POPULATION AND SPECIFICS OF ITS REGISTRATION
Authors:   Federal Research Institute for Health Organization and Informatics of the Ministry of Public Health of Russian Federation, Moscow, Semyonova V.G. ,   Research Institute of Medical Management and Health Organization of the Moscow Healthcare Department, Moscow, Russia,   The Institute of Socio-Political Research of the Russian Academy of Sciences, Moscow, Ivanova A.E. ,   Research Institute of Medical Management and Health Organization of the Moscow Healthcare Department, Moscow, Russia,   The Institute of Socio-Political Research of the Russian Academy of Sciences, Moscow, Sabgayda T.P. ,   Federal Research Institute for Health Organization and Informatics of the Ministry of Public Health of Russian Federation, Moscow,   Research Institute of Medical Management and Health Organization of the Moscow Healthcare Department, Moscow, Russia,   The Institute of Socio-Political Research of the Russian Academy of Sciences, Moscow, Zubko A.V. ,   Federal Research Institute for Health Organization and Informatics of the Ministry of Public Health of Russian Federation, Moscow,   Research Institute of Medical Management and Health Organization of the Moscow Healthcare Department, Moscow, Russia,   The Institute of Socio-Political Research of the Russian Academy of Sciences, Moscow, Zaporozhchenko V.G. ,   Federal Research Institute for Health Organization and Informatics of the Ministry of Public Health of Russian Federation, Moscow, Gavrilova N.S. ,   The Institute of Socio-Political Research of the Russian Academy of Sciences, Moscow, Evdokushkina G.N. ,   Federal Research Institute for Health Organization and Informatics of the Ministry of Public Health of Russian Federation, Moscow,   Research Institute of Medical Management and Health Organization of the Moscow Healthcare Department, Moscow, Russia,   The Institute of Socio-Political Research of the Russian Academy of Sciences, Moscow, Chizhikova I.O. ,   Bureau of Forensic Medical Examination of the Moscow City Health Department
Published: May 2021

The study is substantiated: first, by extremely high mortality rates from external causes in Russia compared to the Western Europe and, second, by problems related to its registration. The purpose of this study is to track evolution of mortality from external causes in Russia against the background of processes in the Western Europe, as well as explore the problem of its registration in the context of the leading risk factors. Material and methods. To analyze situation in Russia, the authors used the Rosstat data calculated in the FAISS-Potential system. To assess situation in the Western Europe (the European Union until May 2004), the authors used information available from the European Mortality Database. Unfortunately, the European Database data are limited to 2015. The authors also used age-specific and standardized (European standard population) indicators by causes of death in line with the ICD-10. Results and discussion The study shows that, first, decline in mortality from injury and poisoning in the 2000s in Russia was determined by all major age groups and external causes, while the rate of positive trends in Russia usually outpaced the Western European ones. Second, injury of undetermined intent turned out to be the exception; against the background of abnormally high mortality rates injury with undetermined intent demonstrated a minimum rate of decline in indicators. Third, mortality from external causes in Russia is associated with deaths from symptoms, signs and ill-defined conditions, at least in working-ages. Fourth, these circumstances have resulted in distortion of the mortality from external causes by the following aspects: in terms of ill-defined conditions its scale is distorted; in terms of injury with undetermined intent – distorted is its structure. Both of these factors jeopardize the real scale of deaths from external causes as well as rates of the observed trends in mortality from injury and poisoning both in general and by individual causes, including homicides and suicides. Fifth, the abnormally high and ever-increasing share of alcohol poisoning with undetermined intent calls for an update of the diagnoses: all alcohol poisoning should be considered as accidents, each diagnosis of "alcohol poisoning with undetermined intent" should be subject to a thorough analysis in the professional community. Sixth, the abnormally low number of deaths due to drug abuse suggests a systematic underestimation: to assess the real scale of drug-related deaths, a fundamental revision of approaches to their diagnosis is required. Seventh, currently Russia needs to develop a system of complete registration of deaths associated with the leading risk factors - alcohol and drugs, based on both deaths from external causes and deaths from somatic pathologies. Eighth, it takes a comprehensive update of the existing regulatory framework to eliminate these problems that have acquired a chronic nature in Russia, unfortunately. This update should be a complex one, aimed at taking into account the results of forensic medical examinations by statistical authorities on the one hand, and law enforcement agencies on the other hand, and be based on ICD – 10.