Half-century trend in morbidity, mortality, lethality from acute myocardial infarction in persons aged 25–64 years and the influence on the risk of developing acute myocardial infarction of psychosocial factors in conditions in Russia / Siberia from the perspective of the WHO international programs Register of Acute Myocardial Infarction, MONICA

Purpose of the study: To establish over half a century (1977–2022) trends in morbidity, mortality, mortality from acute myocardial infarction (AMI) in people aged 25–64 years and the influence of psychosocial factors (PSF) on the risk of developing AMI in Russia/Siberia with positions of the international programs of the World Health Organization (WHO) Register of Acute Myocardial Infarction (RAMI), MONICA.

Material and methods. The study under the “RАMI” program began on 01/01/1977 in Oktyabrsky, and on 01/01/1981 – in the Leninsky and Kirovsky districts of Novosibirsk among people aged 25–64. In these same areas, since 1983, Institute of internal and preventive medicine, as a WHO center, has been implementing the MONICA program. Differences in AMI case-finding programs have not been identified. Both programs continue to operate to this day. All cases of acute MI for the entire study period were coded as ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI). For prehospital deaths, the variable “died outpatients from AMI (DOPAMI)” was introduced. Random representative samples of people aged 25–64 years (n = 4800) were examined in the Oktyabrsky district at standard epidemiological screenings (1984, 1988, 1994), where trait anxiety (A) was studied using the Spielberger test (the presence of levels of population stress); Social support was determined using the Berkman – Syme test. To determine the risk of developing AMI depending on HR for 20 years, all new cases of AMI were recorded in the studied sample of three screenings that did not have CVD at the time of examination. Statistical analysis was performed using the free software computing environment R (v.3.6.3).

Results. The incidence of AMI per 1000 residents of people aged 25–64 years in Russia/Siberia, according to international AMI programs, MONICA, is one of the highest in the world and is relatively stable throughout the entire half-century observation period, with the exception of some years of growth due to socio-economic instability in society, and is twice as high as Rosstat data. Mortality per 100,000 inhabitants from AMI resembles the dynamics of incidence, with the exception of 1977–1978 – a decrease. For the first time, in our study, a significant decrease in mortality and mortality of patients with AMI in 1978 compared to 1977 was obtained due to a decrease in inpatient mortality and mortality as a result of work under the WHO AMI program. For the first time, in our study, the cause of death in excess of the population in Russia was determined in the period 1988, 1993–1994, 1998 – these are acute cardiovascular diseases, not alcohol consumption. Prehospital mortality and mortality prevail throughout all years of observation and are 2–3 times higher than in-hospital mortality and are based on sudden death. Mortality, like morbidity, for RАMI is 2 times higher than according to official statistics. For the first time, our study showed that the increase in morbidity and mortality from AMI in Russia is associated with psychosocial factors.

Conclusions. It has been established that the morbidity, mortality and mortality rates of the population from AMI in Russia/Siberia are one of the highest in the world and are relatively stable throughout the entire half-century observation period, with the exception of some years of growth due to socioeconomic instability in society. Prehospital mortality and mortality prevail throughout all years of observation and are 2–3 times higher than hospital mortality. Indicators of morbidity, mortality and lethality of the population from AMI, when increasing, are the main markers of increasing social stress in the population.

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