Cardiac causes of death in Moscow and Moscow Region

Rationale: Cardiovascular disorders play a leading role in populational mortality, but they are not synonymous to cardiac pathology. The city of Moscow and the Moscow Region are one of the biggest urban agglomeration worldwide.Aim: Analysis of cardiac-related mortality in Moscow and the Moscow Region.Materials and methods: We calculated standardized mortality coefficients (SMC) for 23 death causes given as separate lines in the Short List of Death Causes by the Russian Agency of Statistics (Rosstat) in 2019.Results: In 2019, SMC for cardiac causes was 171.2 per 100 000 of the population in Moscow (27.6% of all causes) and 248.7 per 100 000 of the population in the Moscow Region (26.9% of all causes). More than 60% of deaths both in Moscow and in the Moscow Region were caused by chronic variants of ischemic heart diseases, whose criteria are not well-defined or are absent. In Moscow, SMC for myocardial infarction is significantly lower, whereas that for unspecified cardiomyopathy (the code by International Classification of Diseases and Health-related Conditions, version 10 (ICD10) I42.9) is higher. SMC from the groups of death causes related to chronic illness possibly unrelated to atherosclerosis, are comparable: 29.64 in Moscow and 24.59 in the Moscow Region. SMC from arterial hypertension (ICD10 I10-13) are 8.7 and 5.6 per 100000 of the population, respectively.Conclusion: Despite higher total cardiac mortality in the Moscow Region, SMCs for individual death causes in Moscow are significantly higher. SMC variability is mostly related to different algorithms for determination of primary death cause. ICD10 and the Rosstat the Short List of Death Causes seem to be suboptimal sources to understand the contribution of cardiac causes into the mortality structure. Any correct comparison would become possible after a consensus of expert positions by specialists in Moscow and Moscow Region on the criteria of diagnosis, choice of primary death cause and corresponding disease code