MAIN CAUSES OF DEATH AND PREVENTABLE DEATH INDICATORS IN CITIES OF THE RUSSIAN FEDERATION
Authors:   Centre for Strategic Planning and Management of Biomedical Health Risks of the Federal Medical and Biological Agency, Moscow, Russia, Saltykova Marina , Banchenko Alexey ,   Centre for Strategic Planning and Management of Biomedical Health Risks of the Federal Medical and Biological Agency, Moscow, Russia, Shekhordanova Tatiana ,   Centre for Strategic Planning and Management of Biomedical Health Risks of the Federal Medical and Biological Agency, Moscow, Russia
Published: August 2024

Significance. Studies on preventable mortality have traditionally used the European list of causes of death, with 38 causes and classes of causes of death divided into three groups according to three levels of prevention. The greatest contribution is made by the first group, which is largely formed due to behavioral factors, such as alcohol abuse and smoking. However, the European list of causes of preventable mortality does not include all causes of death associated with alcohol and drug use. Therefore, the use of such a list may lead to an underestimation of preventable mortality with a corresponding overestimation of unpreventable mortality, since the latter will include mortality from causes related to alcohol and drug use outside the list of causes of preventable mortality. The purpose of the study was to assess the impact of expanding the list of causes related to alcohol and drug use to include all such causes in preventable mortality rates. Material and methods. The study included data provided by Rosstat on population size and mortality in 2011-2019 (stratified by sex and age) in 39 cities with populations ranging from 100 to 625 thousand people. In addition to the traditional 3 preventable mortality groups, additional groups were used to include all causes of death associated with alcohol and drug use. The authors have tested the hypotheses about the relationship between preventable mortality rates and the increase in preventable mortality rates due to the inclusion of all causes of death associated with alcohol and drug use, and the age structure and standards of living, as well as the size of the city, determined by population size. Results. The analyzed expansion of the first group of preventable mortality increases the contribution of male mortality from causes that can be prevented through primary prevention measures to overall mortality by an average of 4% (maximum 12%). In females, this contribution averages at about 3% (maximum 7%). A comparative analysis shows that in cities with a smaller proportion of young people, mortality rates from all causes (total mortality), as well as mortality from causes included in the expanded first group of preventable mortality, are significantly higher. In addition, in cities with a population of up to 200 thousand people, compared to larger ones, mortality rates from causes included in the expanded first group are also significantly higher, while there is no difference between mortality rates from causes included in the traditional first group. A relationship with standards of living was not identified. Conclusion. Expanding the list of preventable causes of death though including all causes of death associated with alcohol and drug use will make it possible to more adequately assess the reserves for reducing mortality, primarily in cities with a small population and a small proportion of young people, in which they are underestimated when using the traditional list of preventable causes of death. At the same time, in such cities, mortality from unpreventable causes is unreasonably overestimated, because it includes a significant proportion of deaths caused by alcohol and drug abuse.