Spatial Patterns in Premature Cardiovascular Mortality in Russia (2000-2018)

The object of the study is premature cardiovascular mortality in the Russian Federation. The subject of the study is the regional characteristics of mortality from CVD. The purpose of the study is to describe the inequality of premature mortality from CVD in Russia and to identify its regional characteristics. The features of mortality in certain European countries representing various geopolitical regions of Europe (France, Poland, Great Britain) were studied too. The time frame of the study is limited to 2000-2018, that is, the period of use of the tenth revision of the International Classification of Diseases (ICD-10), with the exception of the first "transitional" year (1999). The study examined only premature cardiovascular mortality at the ages of 30-69 years (in accordance with the indicator of premature mortality from noncommunicable causes used by WHO). Since 2009, inequality in mortality from acute forms of coronary heart disease has been growing. While in most regions mortality from this cause is steadily decreasing, in some regions the opposite trend is observed. These regions include the Republic of Karelia, Vologda Oblast, Kostroma Oblast, Ryazan Oblast, Saratov Oblast, Ingush Republic, Krasnoyarsk Krai, Novosibirsk Oblast, Republic of Khakassia, Chukotka Autonomous Okrug. Possible factors affecting the mortality rate from coronary heart disease are the prevalence of dangerous alcohol use and the availability of modern medical care. In 2011, mortality from coronary heart disease (except myocardial infarction) is statistically related to the mortality rate from alcoholic causes, that is, in regions with high mortality from one cause, mortality from another is also high. In 2018, this relationship is no longer observed, and mortality from coronary heart disease changes independently of alcohol mortality. The mortality rate from acute coronary heart disease is not statistically related to the number of surgical interventions in the region, but the available medical statistics do not allow a more detailed analysis. In 2016-2018, heart diseases played the largest role in the division of regions by type of cardiovascular mortality. Cerebrovascular diseases, which had a noticeable effect on regional inequality in 2000-2002, practically do not differentiate regions in 2016-2018. It can be assumed that this is due to the establishment of relative control over hypertension, which affects cerebrovascular diseases more than heart disease. This issue requires separate studies, including epidemiological. Increased mortality from chronic coronary heart disease is most common in the north of the European part of the country. The regions of Eastern Siberia and the Far East are characterized by relatively high mortality from non-ischemic heart diseases. Regions with high mortality from acute coronary heart disease do not form a single geographical cluster. The results of the study can be used in planning a network of healthcare institutions, primarily vascular centres, as well as for formulating priority directions for reducing cardiovascular mortality both in Russia as a whole and in individual regions.