Long-term trends and determinants of myocardial infarction morbidity, mortality, and lethality in Russian population

The objective of the study was to elucidate 33-year trends and determinants in myocardial infarction (MI) morbidity, mortality, and lethality in Russia in 1977 to 2009. Data of WHO studies (Acute Myocardial Infarction Register and MONICA) were analyzed in three districts of Novosibirsk. MI morbidity in 25 to 64-year-old population in Russia was found to be one of the highest in the world. MI morbidity rates remained steady for the entire period of study except for 1988, 1994, 1998 (increase), 2002 to 2004, and 2006 (decrease). Changes in mortality and lethality were similar to changes in morbidity except for 1977 to 1978 and 2002 to 2005. Prehospital mortality and lethality rates significantly exceeded the rates of inhospital deaths. MI mortality rates exceeded death rates caused by alcohol abuse by 2 to 3 times. Mortality and lethality decrease during period of unchanged morbidity suggested improvement in cardiac care; increase in mortality and lethality at a time of decreased morbidity indicated disorganization of medical services. Prevalence of psychosocial risk factors significantly increased over time, whereas levels of behavioral and somatic risk factors remained unchanged. MI morbidity, mortality, and lethality rates were markers of increasing social stress in population. MI deaths were the main component of increase in mortality in Russia.