clinmedКлиническая медицинаClinical Medicine (Russian Journal)0023-21492412-1339ООО «Медицинское информационное агентство»10.30629/0023-2149-2023-101-9-10-489-495clinmed-636Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL INVESTIGATIONSДинамика и вариабельность региональных показателей смертности от заболеваний печени и желчных путей в период с 2019 по 2021 г.Dynamics and variability of regional mortality rates from liver and biliary tract diseases in the period from 2019 to 2021https://orcid.org/0000-0001-9320-1503СамородскаяИ. В.SamorodskayaI. V.

Самородская Ирина Владимировна — д-р мед. наук, профессор, главный научный сотрудник отдела фундаментальных и прикладных аспектов ожирения

101990, Москва

Samorodskaya Irina V.

101990, Moscow

samor2000@yandex.ruhttps://orcid.org/0000-0002-6796-5953АфанасенковаТ. Е.AfanasenkovaT. E.

Афанасенкова Татьяна Евгеньевна — канд. мед. наук, доцент кафедры общей врачебной практики с курсом поликлинической терапии

214019, Смоленск

Afanasenkova Tatiana E.

214019, Smolensk

ФГБУ «Национальный медицинский исследовательский центр терапии и профилактической медицины» Минздрава РоссииРоссияNational Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of RussiaRussian FederationФГБОУ ВО «Смоленский государственный медицинский университет» Минздрава РоссииРоссияSmolensk State Medical University of the Ministry of Health of RussiaRussian Federation2023141120231019-10489495Copyright © Самородская И.В., Афанасенкова Т.Е., 20232023Самородская И.В., Афанасенкова Т.Е.Samorodskaya I.V., Afanasenkova T.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.clinmedjournal.com/jour/article/view/636

Цель: оценка вариабельности и динамики смертности населения от заболеваний печени и желчных путей в регионах России за 2019–2021 гг. Материал и методы. Данные Росстата о числе умерших по форме С51 и о среднегодовой численности населения по одногодичным возрастным группам по полу и возрасту. Рассчитаны стандартизованные коэффициенты смертности (СКС) по 12 причинам смерти, относящимся к заболеваниям печени и желчевыводящим путям и учитываемым в Краткой номенклатуре причин смерти Росстата (КНПСР) по 82 регионам РФ. Результаты. Средние значение СКС от всех заболеваний печени и желчевыводящих путей в 2020 (42,4 ± 11,9 на 100 тыс. населения) и 2021 г. (42,8 ± 13,2) были выше, чем в 2019 г. (39,4 ± 11,4), в 38 регионах отмечалось ежегодное увеличение, в 7 — снижение и в 37 наблюдалась разнонаправленная динамика. Вклад заболеваний печени в смертность от всех причин составил 3,95 ± 0,91% в 2019 г., 3,65 ± 0,85% в 2020 г. и 3,26 ± 0,92% в 2021 г. Наибольшие значения СКС зарегистрированы от фиброза и цирроза печени, а наименьшие СКС — от острых гепатитов. По данным 2021 г., между регионами отмечена значительная вариабельность СКС: максимальный СКС от рака печени отличался от минимального более чем в 14 раз; от фиброза и цирроза печени — в 25 раз. Высказаны гипотезы, объясняющие причины выявленных различий. Выводы. Значительная вариабельность региональных СКС не позволяет говорить об устойчивой тенденции к снижению смертности от указанных причин.

Objective: to assess the variability and dynamics of mortality from liver and bile duct diseases in the regions of Russia for the period of 2019–2021. Materials and methods. Rosstat data on the number of deaths according to form C51 and on the average annual population by one-year age groups by gender and age were used. Standardized mortality rates (SMRs) were calculated for 12 causes of death related to liver and bile duct diseases and included in the Brief Nomenclature of Causes of Death of Rosstat (BNCD) for 82 regions of the Russian Federation. Results. The mean SMRs from all liver and bile duct diseases in 2020 (42.4 ± 11.9 per 100,000 population) and 2021 (42.8 ± 13.2) were higher than in 2019 (39.4 ± 11.4), with annual increases observed in 38 regions, decreases in 7, and mixed trends in 37. The contribution of liver diseases to all-cause mortality was 3.95 ± 0.91% in 2019, 3.65 ± 0.85% in 2020, and 3.26 ± 0.92% in 2021. The highest SMRs were registered for liver fibrosis and cirrhosis, while the lowest SMRs were for acute hepatitis. Considerable variability in SMRs was observed between regions in 2021: the maximum SMR for liver cancer was more than 14 times higher than the minimum, while for liver fibrosis and cirrhosis it was 25 times higher. Hypotheses explaining the reasons for these differences are discussed. Conclusions. Significant regional variability in SMRs does not allow for a stable trend towards reducing mortality from these causes to be identified.

смертностьракгепатитцирроз печенихолециститmortalitycancerhepatitiscirrhosischolecystitisReferencesAsrani S.K., Devarbhavi H., Eaton J., Kamath P.S. Burden of liver diseases in the world. J. Hepatol. 2019;70(1):151–171. DOI: 10.1016/j.jhep.2018.09.014Asrani S.K., Devarbhavi H., Eaton J., Kamath P.S. Burden of liver diseases in the world. J. Hepatol. 2019;70(1):151–171. DOI: 10.1016/j.jhep.2018.09.014Rumgay H., Arnold M., Ferlay J., Lesi O. et al. Global burden of primary liver cancer in 2020 and predictions to 2040. J. Hepatol. 2022;77(6):1598–1606. DOI: 10.1016/j.jhep.2022.08.021Rumgay H., Arnold M., Ferlay J., Lesi O. et al. Global burden of primary liver cancer in 2020 and predictions to 2040. J. Hepatol. 2022;77(6):1598–1606. DOI: 10.1016/j.jhep.2022.08.021Asrani S.K., Devarbhavi H., Eaton J., Kamath P.S. Burden of liver diseases in the world. J. Hepatol. 2019;70(1):151–71. DOI: 10.1016/j.jhep.2018.09.014Asrani S.K., Devarbhavi H., Eaton J., Kamath P.S. Burden of liver diseases in the world. J. Hepatol. 2019;70(1):151–71. DOI: 10.1016/j.jhep.2018.09.014Pimpin L., Cortez-Pinto H., Negro F., Corbould E. et al. Burden of liver disease in Europe: epidemiology and analysis of risk factors to identify prevention policies. J. Hepatol. 2018;69(3):718–35. DOI: 10.1016/j.jhep.2018.05.011Pimpin L., Cortez-Pinto H., Negro F., Corbould E. et al. Burden of liver disease in Europe: epidemiology and analysis of risk factors to identify prevention policies. J. Hepatol. 2018;69(3):718–35. DOI: 10.1016/j.jhep.2018.05.011Sheu M.J., Liang F.W., Lin C.Y., Lu T.H. Changes in liver-related mortality by etiology and sequelae: underlying versus multiple causes of death. Popul. Health Metr. 2021;19(1):22. DOI: 10.1186/s12963-021-00249-0Sheu M.J., Liang F.W., Lin C.Y., Lu T.H. Changes in liver-related mortality by etiology and sequelae: underlying versus multiple causes of death. Popul. Health Metr. 2021;19(1):22. DOI: 10.1186/s12963-021-00249-0Asrani S.K., Devarbhavi H., Eaton J., Kamath P.S. Burden of liver diseases in the world. J. Hepatol. 2019;70(1):151–71. DOI: 10.1016/j.jhep.2018.09.014Asrani S.K., Devarbhavi H., Eaton J., Kamath P.S. Burden of liver diseases in the world. J. Hepatol. 2019;70(1):151–71. DOI: 10.1016/j.jhep.2018.09.014Sepanlou S.G., Safi ri S., Bisignano C., Ikuta K.S. et al. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol. Hepatol. 2020;5(3):245–66. DOI: 10.1016/S2468-1253(19)30349-8Sepanlou S.G., Safi ri S., Bisignano C., Ikuta K.S. et al. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol. Hepatol. 2020;5(3):245–66. DOI: 10.1016/S2468-1253(19)30349-8Nasr P., Ndegwa N., von Seth E., Ludvigsson J.F., Incidence, prevalence and mortality of chronic liver diseases in Sweden between 2005 and 2019. Journal of Hepatology. 2022;1:S82–S82. DOI: 10.1016/S0168-8278(22)00558-XNasr P., Ndegwa N., von Seth E., Ludvigsson J.F., Incidence, prevalence and mortality of chronic liver diseases in Sweden between 2005 and 2019. Journal of Hepatology. 2022;1:S82–S82. DOI: 10.1016/S0168-8278(22)00558-XYe F., Zhai M., Long J., Gong Y. et al. The burden of liver cirrhosis in mortality: Results from the global burden of disease study. Frontiers in Public Health. 2022;10:909455. DOI: 10.3389/fpubh.2022.909455Ye F., Zhai M., Long J., Gong Y. et al. The burden of liver cirrhosis in mortality: Results from the global burden of disease study. Frontiers in Public Health. 2022;10:909455. DOI: 10.3389/fpubh.2022.909455Sarin S.K., Kumar M., Eslam M., George J. et al. Liver diseases in the Asia-Pacifi c region: a Lancet Gastroenterology & Hepatology Commission. Lancet Gastroenterol. Hepatol. 2020;5(2):167–228. DOI: 10.1016/S2468-1253(19)30342-5Sarin S.K., Kumar M., Eslam M., George J. et al. Liver diseases in the Asia-Pacifi c region: a Lancet Gastroenterology & Hepatology Commission. Lancet Gastroenterol. Hepatol. 2020;5(2):167–228. DOI: 10.1016/S2468-1253(19)30342-5Самородская И.В. Кодирование причин смерти как фактор, влияющий на показатели смертности населения от отдельных причин. Врач. 2021;32(5):21–27.Samorodskaya I.V. Cause-of-death coding as a factor infl uencing mortality rates from individual causes. Vrach. 2021;32(5):21–27. (In Russian). DOI: 10.29296/25877305-2021-05-04Gallaher J.R., Charles A. Acute Cholecystitis: A Review. JAMA. 2022;327(10):965–975. DOI: 10.1001/jama.2022.2350Gallaher J.R., Charles A. Acute Cholecystitis: A Review. JAMA. 2022;327(10):965–975. DOI: 10.1001/jama.2022.2350Li S., Guizzetti L., Ma C., Shaheen A.A., Dixon E., Ball C., Wani S., Forbes N. Epidemiology and Outcomes of Symptomatic Cholelithiasis and Cholecystitis in the USA: Trends and Urban-Rural Variations. J. Gastrointest. Surg. 2023 May;27(5):932-944. DOI: 10.1007/s11605-023-05604-0Li S., Guizzetti L., Ma C., Shaheen A.A., Dixon E., Ball C., Wani S., Forbes N. Epidemiology and Outcomes of Symptomatic Cholelithiasis and Cholecystitis in the USA: Trends and Urban-Rural Variations. J. Gastrointest. Surg. 2023 May;27(5):932-944. DOI: 10.1007/s11605-023-05604-0Yoshiji H., Nagoshi S., Akahane T., Asaoka Y., Ueno Y., Ogawa K., Kawaguchi T., Kurosaki M., Sakaida I., Shimizu M., Taniai M., Terai S., Nishikawa H., Hiasa Y., Hidaka H., Miwa H., Chayama K., Enomoto N., Shimosegawa T., Takehara T., Koike K. Evidence-based clinical practice guidelines for Liver Cirrhosis 2020. J. Gastroenterol. 2021;56(7):593–619. DOI: 10.1007/s00535-021-01788-xYoshiji H., Nagoshi S., Akahane T., Asaoka Y., Ueno Y., Ogawa K., Kawaguchi T., Kurosaki M., Sakaida I., Shimizu M., Taniai M., Terai S., Nishikawa H., Hiasa Y., Hidaka H., Miwa H., Chayama K., Enomoto N., Shimosegawa T., Takehara T., Koike K. Evidence-based clinical practice guidelines for Liver Cirrhosis 2020. J. Gastroenterol. 2021;56(7):593–619. DOI: 10.1007/s00535-021-01788-xSingal A.K., Bataller R., Ahn J., Kamath P.S., Shah V.H. ACG clinical guideline: alcoholic liver disease. Am. J. Gastroenterol. 2018;113(2):175–194. DOI: 10.1038/ajg.2017.469Singal A.K., Bataller R., Ahn J., Kamath P.S., Shah V.H. ACG clinical guideline: alcoholic liver disease. Am. J. Gastroenterol. 2018;113(2):175–194. DOI: 10.1038/ajg.2017.469Coppola N., Onorato L., Sagnelli C., Sagnelli E. et al. Association between anti-HBc positivity and hepatocellular carcinoma in HBsAg-negative subjects with chronic liver disease: A meta-analysis. Medicine (Baltimore). 2016;95(30):e4311. DOI: 10.1097/MD.0000000000004311Coppola N., Onorato L., Sagnelli C., Sagnelli E. et al. Association between anti-HBc positivity and hepatocellular carcinoma in HBsAg-negative subjects with chronic liver disease: A meta-analysis. Medicine (Baltimore). 2016;95(30):e4311. DOI: 10.1097/MD.0000000000004311Драпкина О.М., Самородская И.В., Какорина Е.П. Вариабельность региональных показателей смертности. Профилактическая медицина. 2019;22(6):28–33.Drapkina O.M., Samorodskaia I.V., Kakorina E.P. Variability in regional mortality rates. Profi lakticheskaya Meditsina. 2019;22(6):2833. (In Russian) DOI: 10.17116/profmed20192206228Quantifying cause-related mortality by weighting multiple causes of death. Bull. World Health Organ. 2016;94(12):870–879.Quantifying cause-related mortality by weighting multiple causes of death. Bull. World Health Organ. 2016;94(12):870–879.Golabi P., Paik J.M., Eberly K., de Avila L. et al. Causes of death in patients with Non-alcoholic Fatty Liver Disease (NAFLD), alcoholic liver disease and chronic viral Hepatitis B and C. Ann. Hepatol. 2022;27(1):100556. DOI: 10.1016/j.aohep.2021.100556Golabi P., Paik J.M., Eberly K., de Avila L. et al. Causes of death in patients with Non-alcoholic Fatty Liver Disease (NAFLD), alcoholic liver disease and chronic viral Hepatitis B and C. Ann. Hepatol. 2022;27(1):100556. DOI: 10.1016/j.aohep.2021.100556Paik J.M., Golabi P., Younossi Y., Mishra A., Younossi Z.M. Changes in the global burden of chronic liver diseases from 2012 to 2017: The growing impact of NAFLD. Hepatology. 2020;72(5):1605–1616. DOI: 10.1002/hep.31173Paik J.M., Golabi P., Younossi Y., Mishra A., Younossi Z.M. Changes in the global burden of chronic liver diseases from 2012 to 2017: The growing impact of NAFLD. Hepatology. 2020;72(5):1605–1616. DOI: 10.1002/hep.31173Marques P., Francisco V., Martínez-Arenas L., Carvalho-Gomes Â., Domingo E., Piqueras L., Berenguer M., Sanz M.J. Overview of cellular and soluble mediators in systemic infl ammation associated with non-alcoholic fatty liver disease. Int. J. Mol. Sci. 2023;24(3):2313. DOI: 10.3390/ijms24032313.Marques P., Francisco V., Martínez-Arenas L., Carvalho-Gomes Â., Domingo E., Piqueras L., Berenguer M., Sanz M.J. Overview of cellular and soluble mediators in systemic infl ammation associated with non-alcoholic fatty liver disease. Int. J. Mol. Sci. 2023;24(3):2313. DOI: 10.3390/ijms24032313.Hua Z., Liu R., Chen Y., Liu G., Li C., Song Y., Cao Z., Li W., Li W., Lu C., Liu Y. Contamination of afl atoxins induces severe hepatotoxicity through multiple mechanisms. Front Pharmacol. 2021;11:605823. DOI: 10.3389/fphar.2020.605823Hua Z., Liu R., Chen Y., Liu G., Li C., Song Y., Cao Z., Li W., Li W., Lu C., Liu Y. Contamination of afl atoxins induces severe hepatotoxicity through multiple mechanisms. Front Pharmacol. 2021;11:605823. DOI: 10.3389/fphar.2020.605823Wang J., Huang R., Liu J., Lai R., Liu Y., Zhu C., Qiu Y., He Z., Yin S., Chen Y., Yan X., Ding W., Zheng Q., Li J., Wu C. A novel non-invasive model for the prediction of advanced liver fi brosis in chronic hepatitis B patients with NAFLD. J. Viral Hepat. 2023; 30(4):287-296. DOI: 10.1111/jvh.13808Wang J., Huang R., Liu J., Lai R., Liu Y., Zhu C., Qiu Y., He Z., Yin S., Chen Y., Yan X., Ding W., Zheng Q., Li J., Wu C. A novel non-invasive model for the prediction of advanced liver fi brosis in chronic hepatitis B patients with NAFLD. J. Viral Hepat. 2023; 30(4):287-296. DOI: 10.1111/jvh.13808Tapper E.B., Parikh N.D. Mortality due to cirrhosis and liver cancer in the United States, 1999-2016: observational study. BMJ. 2018;362:k2817. DOI: 10.1136/bmj.k2817Tapper E.B., Parikh N.D. Mortality due to cirrhosis and liver cancer in the United States, 1999-2016: observational study. BMJ. 2018;362:k2817. DOI: 10.1136/bmj.k2817McCall В. Shock as death certifi cates cite obesity in < 10% of relevant cases. URL: https://www.medscape.com/viewarticle/936778McCall В. Shock as death certifi cates cite obesity in < 10% of relevant cases. URL: https://www.medscape.com/viewarticle/936778Allison M.E.D., Verne J., Bernal W., Clayton M., Cox S., Dhanda A., Dillon J.F., Ferguson J., Foster G., Gilmore I., Hebditch V., Jones R., Masson S., Oates B., Richardson P., Sinclair J., Wendon J., Wood D. Deaths from alcohol-related liver disease in the UK: an escalating tragedy. Lancet. 2023;401(10375):418–420. DOI: 10.1016/S0140-6736(22)02583-1Allison M.E.D., Verne J., Bernal W., Clayton M., Cox S., Dhanda A., Dillon J.F., Ferguson J., Foster G., Gilmore I., Hebditch V., Jones R., Masson S., Oates B., Richardson P., Sinclair J., Wendon J., Wood D. Deaths from alcohol-related liver disease in the UK: an escalating tragedy. Lancet. 2023;401(10375):418–420. DOI: 10.1016/S0140-6736(22)02583-1Kim D., Alshuwaykh O., Dennis B.B., Cholankeril G. et al. Trends in etiology-based mortality from chronic liver disease before and during COVID-19 pandemic in the United States. Clin. Gastroenterol. Hepatol. 2022;20(10):2307-2316.e3. DOI: 10.1016/j.cgh.2022.05.045.Kim D., Alshuwaykh O., Dennis B.B., Cholankeril G. et al. Trends in etiology-based mortality from chronic liver disease before and during COVID-19 pandemic in the United States. Clin. Gastroenterol. Hepatol. 2022;20(10):2307-2316.e3. DOI: 10.1016/j.cgh.2022.05.045.

The authors declare that there are no conflicts of interest present.