Semyonova V.G., Ivanova A.E., Sabgaida T.P., Zubko A.V., Zaporozhchenko V.G., Evdokushkina G.N., Borovkov N.V., Gavrilova N.S. Injury and poisoning in the context of multiple causes of death exemplified by a megalopolis. Social'nye aspekty zdorov'a naselenia ...

Текст статьи на сайте журнала URL: http://vestnik.mednet.ru/content/view/1270/30/lang,ru/ (дата обращения 14.01.2022)

Abstract

The approach to register health loss based on the concept of multiple causes of death is becoming increasingly relevant on the eve of the transition to ICD-11: ICD-11, unlike ICD-10 that is currently in effect in most countries, and according to which registration is based on the underlying cause of death, considers a complex of causes that both directly led to death and aggravated the patient's situation. The purpose of this study is, first, to verify completeness of registration of multiple causes of death in case of injury and poisoning, and second, to identify associations between external causes and both psychosomatic pathologies and other injuries and poisoning in Moscow. The analysis is based on data of the EMIAS Moscow database for 2019 in line with the item 19-II of the Medical Death Certificate (other important conditions that contributed to death, but are not related to the disease or pathological condition that led to it). The authors have analyzed deaths from suicide (X65-X84) (191 people, 21 entries about concomitant conditions); from accidental falls (W00-W19) (1046 people, 314 entries); poisoning (X40-X49, Y10-Y19) (2017 people, 322 entries), other events of undetermined intent (Y20-Y34) (1899 people, 128 entries), accidental suffocation and strangulation (W75-W84) (119 people, 14 entries), exposure to smoke, fire and flames (X00-X09) (93 people, 18 entries), and exposure to forces of nature (X30-X39) (33 people, 5 entries). The study shows that, first, there is a clear lack of information to provide for a comprehensive assessment of the impact of these causes on realization of a particular incident, especially in case of injury with undetermined intent, when it is these data that can specify the true cause of death. Second, diagnosis of a specific external cause is highly complicated by the lack of data on the mental status of the deceased. Third, the analysis of concomitant conditions indicates alcohol as a factor significantly increasing the risk of death from external causes. Fourth, due to lack of indications of somatic pathologies in case of drug poisoning, an obviously false picture of the absolute somatic health of the deceased is formed. Fifth, a detailed analysis of concomitant conditions in incidents attributed to accidental (falls, poisoning), as well as poisoning with undetermined intent, makes it possible to suggest with a high degree of probability a significant latent suicidal component, as evidenced by the presence of severe pathologies (cancer, HIV/AIDS) in the deceased, which paradoxically is extremely rare to find among incidents attributed to suicides.