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ISSN 2304-3415, Russian Open Medical Journal
2020. Volume 9. Issue 1 (March). Article CID e0108 DOI: 10.15275/rusomj.2020.0108_
Public report
Dynamics of urological morbidity of the Central Federal District population (Russian Federation) in
2013-2017
Aimar A. Orudzhev 1, Aleksey V. Breusov 1,2
1 Peoples' Friendship University of Russia, Moscow, Russia 2 Kursk State Medical University, Kursk, Russia
Received 25 September 2019, Revised 4 February 2020, Accepted 18 February 2020
© 2019, Orudzhev A.A., Breusov A.V. © 2019, Russian Open Medical Journal
Abstract: Based on official statistics of the Russian Federal State Statistics Service and the Ministry of Healthcare, the article analyzes the state and dynamics of urological morbidity, along with urologic cancer incidence and mortality in adult population of the Central Federal District vs. entire Russian Federation (RF). It was established that genitourinary diseases are consistently at the top in the structure of RF population morbidity and mortality, often being among leading causes of disabilities as well. The analysis results, using the case-studies of specific nosological forms, constitute an important methodological and informative base for strategic planning of developing both medical and preventive care in the patients, as well as create essential basis for further improvement of specialized outpatient and inpatient types of a health care.
Keywords: urological morbidity, urologic cancer incidence, morbidity trends, mortality from urologic diseases, improving urological care.
Cite as Orudzhev AA, Breusov AV. Dynamics of urological morbidity of the Central Federal District population (Russian Federation) in 2013-2017. Russian Open Medical Journal 2020; 9: e0108.
Correspondence to Aleksey Breusov. Address: Miklukho-Maklaya, 10, build. 2, Moscow, 117198, Russia. Tel.: +79035116080. Email: [email protected].
Introduction
Genitourinary system (GS) diseases are among priority issues of contemporary medicine. As noted by many authors and confirmed by official statistics, there was a significant morbidity increase in this class of diseases over the past decade [1-4]. By the end of the twentieth century, the proportion of GS diseases in the structure of the total morbidity incidence was 4-5%. Currently, according to the statistics, this number in Russian Federation (RF) increased up to 7%, or still more in some RF regions and foreign countries [2, 4-6].
In 2017, the GS diseases' share in the general morbidity structure of RF population surpassed the above-mentioned cut-off value and reached 7.17% (161,776.0 and 11,594.3 cases per 100 thousand people, respectively), while the annual growth rate was 0.08%. The highest growth rates were observed for the following nosologies: diseases of prostate and bladder, urolithiasis, and male infertility [1, 3, 6]. Similar to those nosological forms, there was even more pronounced increase in urologic oncology - especially stage I or II tumors with localization of malignant neoplasms (MN) in the kidneys and prostate, which led to augmented disability and mortality rates, predominantly, in the working age population [710].
Analysis of urological morbidity dynamics is an important methodological and informational basis for strategic planning of specialized medical care development. It creates required prerequisites for designing a set of measures for developing residential outpatient and inpatient care. Hence, the objective of our research stated below.
Study objective involved analyzing uronephrological morbidity (including urologic cancer incidence) in adult population of the Central Federal District (CFD) over 2013-2017 in comparison with similar data for entire Russian Federation (RF) in order to evaluate morbidity levels and dynamics.
Material and Methods
Data source
Data sources for the study included official statistics, reporting forms of municipalities - such as form No. 12 "Information on the number of diseases registered in patients living in the service area of a medical institution (MI)", form No. 30 "MI annual medical report", scientific (magazines and information portals) and methodological literature.
Study design
The research design consisted of three consecutive stages: Stage 1 - analysis of literature sources, official statistics on the topic under study, development of the research program and the formulation of its objective; Stage 2 - copying data from their official sources and their statistical processing; Stage 3 - data analysis, synthesis and discussion of the results. The dynamics of morbidity indicators over 2013-2017 was analyzed for entire RF vs. entire CFD vs. particular CFD subjects, using absolute growth and growth rate indices, along with building a forecast trend graph.
ISSN 2304-3415, Russian Open Medical Journal
2020. Volume 9. Issue 1 (March). Article CID e0108 DOI: 10.15275/rusomj.2020.0108_
Figure 1. Comparative dynamics of the overall GS diseases morbidity of the Central Federal District population vs. entire Russian Federation population over 2013-2017 (per 100,000 residents).
10166,8
9919,3
9510,4
|| ll l ll Kostroma Region Ryazan Region Yaroslavl Region Kaluga Region Ш 2013 value П Показатель 2017 года
Figure 2. Central Federal District regions with highest growth rates of GS diseases morbidity over 2013-2017 (per 100,000 residents).
Figure 3. Central Federal District regions with the highest rate of decline in the overall incidence of GS diseases (per 100,000 residents).
Figure 4. Dynamics of urologic oncology incidence in the population of the Central Federal District and entire Russian Federation over 2013-2017 (per 100,000 residents).
Statistical analysis
Analyzing our results involved calculating relative indicators and assessing statistical significance of the differences in population means (Student's t-test). Computed t-criterion values were compared with tabular values, while the differences in the indicators were considered statistically significant at significance level of p<0.05. The confidence intervals for the means were calculated at a confidence level of at least 0.95 [11]. Statistical data processing was performed using the PASW (Predictive Analytics Software) Statistics 22 software.
Results
Incidence of GS diseases in the population
The total registered incidence of GS diseases in RF in 2017 was 17,025,367(absolute number), or 11,594.3 (per 100,000 of the population), which was lower than in 2013 (absolute number of 16,821,274 people, or 11,634.6 per 100 thousand residents). The growth rate of this indicator (per 100,000 population) amounted to -0.4% over the specified period of time. The incidence rate of GS diseases in CFD population had lower values: 10,159.1 in 2013 and 9612.8 in 2017 (per 100 thousand people). However, the growth rate of this indicator in CFD significantly exceeded its values for the entire RF and amounted to -5.4% over the analyzed period of time (Appendix 1, Figure 1).
Considering particular CFD subjects, four of those had the highest growth rate of GS diseases per 100,000 residents: Kostroma Region (+18.6%), Ryazan Region (+15.9%), Yaroslavl Region (+8.3%) and Kaluga Region (+7.3%) (p<0.05) (Appendix 1, Figure 2).
Over the analyzed period of time, the highest rate of decline in this indicator (per 100 thousand people) was recorded in the following CFD subjects: Smolensk Region (-20.0%), Lipetsk Region (-17.1%), Ivanovo Region (-16.9%), Bryansk Region (-13.4%), Vladimir Region (-11.6%) (differences were significant, p<0.05) (Appendix 1, Figure 3).
Urologic cancer incidence
Urologic oncology, as well as overall morbidity related to malignant neoplasms of various localizations, demonstrated a distinct upward trend in all CFD regions, as well as in the entire RF. For the period from 2013-2017, the growth rate of this pathology was 13.93% in the CFD vs. 17.49% in the RF (per 100,000 residents), the annual growth rate was 2.8% vs. 3.5%, respectively (Appendix 2, Figure 4).
Mortality from GS MN in RF for the period of time from 20132017 increased by 6.7%, vs. 5.7% in CFD. Detailed data on residential mortality from MN in general, and MN of GS, for both entire RF and CFD are given in Table 1.
The proportion of deaths from GS MN in the structure of mortality from all malignant neoplasms annually was over 17%. In the entire RF, the proportion of the patients, who died during their first year after the MN diagnosis and registration in the previous year, declined from 25.3% in 2013 to 22.5% in 2017. Residential mortality rates from major nosological categories of GS MN are compiled in Table 2. The following diagnoses sensu ICD-10 are assigned to MN of other GS organs: C65 (MN of the renal pelvis); C66 (MN of ureter) and C68 (MN of other and unspecified urinary organs).
ISSN 2304-3415, Russian Open Medical Journal
2020. Volume 9. Issue 1 (March). Article CID e0108 DOI: 10.15275/rusomj.2020.0108_
Table 1. Residential mortality in the Russian Federation and Central Federal District from malignant neoplasms over 2013-2017
Years
Indicators 2013 20M 2015 2016 ¿6i7
RF CFD RF CFD RF CFD RF CFD RF CFD
Total died from MN, absolute numbers 288,636 85,320 286,900 84,311 296,476 83,973 295,729 84,487 290,662 81,256
Total died from MN, absolute numbers 288,636 14,997 49,,527 14,679 50,281 14,699 51,371 14,894 50,813 14,408
GS MN, per 100,000 people 32.7 33.3 34.3 33.7 34.5 33.3 34.0 34.5 34.9 35.2
Died from GS MN,% 16.3 17.6 17.3 17.4 17.0 17.5 17.4 17.6 17.5 17.7
Growth rate, % - - 4.9 1.2 0.6 -1.2 -1.4 3.6 2.7 2.1
Table 2. Comparative characteristics of genitourinary system malignant neoplasm-caused mortality rates
Subject
Prostate
Kidney
Urinary bladder
Other GS organs
RF CFD
Abs. no.
11111 3 364
Rel. no. per
100,000 residents 16.72 18.95
Abs. no.
8 459 2 409
Malignant neoplasm localtion in 2013
Rel. no. per Abs. no. Rel. no. per
100,000 residents 100,000 residents
5.89 6.22
6 561 1 993
4.57 5.14
Abs. no.
445 171
Rel. no. per
100,000 residents 6.42 0.44
RF CFD
Abs. no.
12 565 3 607
Rel. no. per
100,000 residents 18.46 20.01
Abs. no.
8 386 2 271
Malignant neoplasm location in 2017
Rel. no. per Abs. no. Rel. no. per
100,000 residents 100,000 residents
5.71 5.78
6 094 1 744
4.15 4.44
Abs. no.
558 131
Rel. no. per
100,000 residents 6.40 0.33
RF CFD
Abs. no. 1454 243
Rel. no. 10.4* 5.6
Growth rate, absolute and relative, per 100,000 residents
Abs. no. Rel. no. Abs. no. Rel. no.
- 73
- 138
- 3.1
- 7.1
- 467
- 249
- 9.2* -13.4*
Abs. no. Ü3 - 40
Rel. no. -4.8 -25.0
* differences are significant at p<0.05; Abs. no. - absolute numbers; Rel. no. - relative numbers.
Data in Table 2 imply that, over the analyzed period, solely mortality from prostate cancer had a steady upward trend: +10.4% (RF) vs. +5.6% (CFD). As for MN of other locations (kidney, urinary bladder, and other GS organs), there was a tendency to decrease in these indicators.
Discussion
Our study confirmed high significance of conducting a systematic analysis of the dynamics related to urological morbidity and urologic cancer incidence of the population, along with monitoring the mortality caused by GS MN. Such analysis could serve a methodological basis for implementing strategic planning methods aimed at specialized medical care.
When analyzing statistical resources on residential morbidity incidence in the RF vs. CFD subjects, we obtained the following data. The absolute number of registered adult patients diagnosed with GS vs. relative index (per 100,000 residents) in the Russian Federation in 2013 was 16,821,274.0 vs. 11,634.6. In 2017, this indicator decreased by 0.4% and amounted to 17,025,367 vs. 11,594.3, respectively.
A comparative analysis of the relative incidence of GS diseases in CFD regions vs. entire RF (per 100 thousand residents) showed declining trends for both CFD and RF. However, in a number of CFD subjects, during 2013-2017, there has been a steady upward trend, confirmed by the studies of domestic and foreign scientists [2-4]. Moreover, the dynamics of declining morbidity rate in this nosological category was developing unevenly over five years. In RF, between 2013-2015, its decline was obvious due to improvements in diagnosing and detecting GS diseases in the primary health care sector; while since 2016, there has been a slight drawback, which, apparently, can be explained by a higher
detection rate of this pathology. As for CFD, a different picture was observed: from 2013-2016, there was a significant GS morbidity decline, which can be explained by successful implementation of comprehensive preventive programs, additional medical examinations, and implementation of a three-level system of provisioning medical care to the population [7, 9].
The increased attention to the problems of oncological morbidity is due to a steady tendency towards an increase in its incidence rate worldwide. The latter is projected to continually increase in virtually all countries in the years to come, which could be explained by a number of objective and subjective reasons, including population aging, along with environmental, economic and other factors [3, 4, 9, 10, 12]. During the analyzed period, the indicators of active detection of the patients with GS MN at the early stages significantly improved for both entire Russian Federation and CFD. This progress was caused by multiple factors, such as changing demographic situation (a steady increase in the elderly people share in the general structure of the country population); ongoing organizational changes in the healthcare sector of the RF (increased coverage of medical examinations of the residents belonging to the various age groups); expansion of oncological institutions' network; and emergence of new and improvement of existing diagnostic methods.
As for specialized medical institutions, there were 96 oncological dispensaries in the RF in 2017, 92 of those had hospitals, and 2 had specialized oncological hospitals. The greatest number of the patients with tumors of various localizations is detected at the early stages (I-II), which may also indicate an increase in the vigilance of the doctors of various specialties, especially in the primary care units. The analysis of the incidence structure in malignant neoplastic diseases by nosological categories showed that the leading localizations in the general
ISSN 2304-3415, Russian Open Medical Journal
2020. Volume 9. Issue 1 (March). Article CID e0108 DOI: 10.15275/rusomj.2020.0108_
structure of residential GS oncological morbidity were prostate, uterine corpus, kidney, urinary bladder, and ovary [6, 9, 10].
The analysis of mortality from GS MN revealed that this indicator had a steady upward trend both in the RF and all regions of the CFD, as well as in other countries [1, 4, 8-10, 12]. An average annual mortality growth rate was stably high and ranged from 0.42% (CFD) to 0.54% (entire RF), which corresponded to the data for most European countries. In the structure of mortality for this nosological class, the first three places are taken by prostate cancer (4.3% in the RF vs. 4.4% in CFD), kidney MN (2.9% in the RF vs. 2.8% in CFD), and MN of ovaries (2.6% in RF vs. 2.8% in CFD).
An analysis of the mortality trends in RF population from GS cancer, with calculation of its forecast levels, showed that in 2020, the mortality rate in entire RF would increase up to 35.5±1.2 cases per 100 thousand residents vs. 36.1±1.3 in CFD.
Conclusion
Thus, the data obtained from our study, convincingly confirmed that residential GS morbidity, prevalence of GS MN and mortality rate from those are high and tend to increase. The noted trends are associated with increase in coverage of various residential age groups by clinical examination, implementation of a three-level system of provisioning residential medical care, improvement in the detection of GS MN, especially at early stages, via new effective diagnostic methods and expansion of the oncological institutions' network. It should be also noted that domestic urological care still has a number of shortcomings, such as lack of continuity in the work among the clinic and the hospital, insufficient staffing by primary health care specialists, insufficient effectiveness of disease prevention system, poor quality and low efficiency of medical diagnostic and rehabilitation measures and health education of the population.
Ethical Issues
The article does not contain studies involving humans or animals performed by any of the authors.
Conflict of Interest
No conflict of interest is stated.
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Authors:
Aimar A. Orudzhev - MD, PhD student, Department of Public Health, Healthcare and Hygiene, Institute of Medicine, Peoples' Friendship University of Russia, Moscow, Russia. https://orcid.org/0000-0002-0518-5521.
Aleksey V. Breusov - MD, DSc, Professor, Department of Public Health, Healthcare and Hygiene, Institute of Medicine, Peoples' Friendship University of Russia, Moscow, Russia; Head of the Department of Public Health and Healthcare, Faculty of Postgraduate Education with a Training Center for Lean Technologies, Kursk State Medical University, Kursk, Russia. http://orcid.org/0000-0003-2335-3338.
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ISSN 2304-3415, Russian Open Medical Journal
2020. Volume 9. Issue 1 (March). Article CID e0108 DOI: 10.15275/rusomj.2020.0108_
Appendix 1. Population morbidity based on genitourinary system diseases in the RF and Central Federal District territories
Federal subjects of Russia 2013 2014 2015 2016 2017 Growth rate*
Absolute Relative (per 100 thousand residents) Absolute Relative (per 100 thousand residents) Absolute Relative (per 100 thousand residents) Absolute Relative (per 100 thousand residents) Absolute Relative (per 100 thousand residents) Per 100 thousand residents. 2017 to 2013. %
RUSSIA 16,821,274 11,634.6 17,047,406 11,655.1 17,050,217 11,656.9 17,019,933 11,614.2 17,025,367 11,594.3 -0.4
CENTRAL FEDERAL DISTRICT 3,929,448 10,159.1 3876703 9,952.6 3,773,378 9,687.4 3,694,486 9,447.8 3,774,020 9,612.8 -5.4
Belgorod Region 185,274 12,023.1 176,400 11,395.8 177,314 11,454.9 183,868 11,861.4 169,446 10,922.3 -9.2
Bryansk Region 141,968 11,324.2 137,251 11,132.0 128,193 10,397.3 120,995 9,871.2 119,227 9,806.8 -13.4
Vladimir Region 202,847 14,267.5 188,281 13,394.9 183,590 13,061.2 183,411 13,127.3 174,498 12,608.5 -11.6
Voronezh Region 242,458 10,404.2 249,427 10,699.8 255,644 10,966.4 272,750 11,688.6 248,426 10,641.1 +2.3
Ivanovo Region 136,606 13,023.0 121,760 11,742.6 107,352 10,353.1 27,726 2,692.3 110,285 10,823.8 -16.9
Kaluga Region 89,142 8,864.7 91,767 9,081.5 97,335 9,632.5 104,809 10,379.5 96,375 9,510.4 +7.3
Kostroma Region 56,464 8,569.4 60,464 9,239.8 58,609 8,956.3 51,785 7,949.2 65,651 10,166.8 +18.6
Kursk Region 90,141 8,053.6 84,945 7,602.2 81,991 7,337.8 84,566 7,550.4 83,174 7,432.5 -7.7
Lipetsk Region 153,003 13,164.5 142,200 12,281.2 127,106 10,977.6 125,858 10,886.5 125,965 10,923.0 -17.1
Moscow Region 557,365 7,908.0 580,358 8,025.9 578,427 7,999.2 569,937 7,787.5 570,166 7,639.5 -3.4
Orel Region 111,269 14,342.0 107,871 14,096.5 102,111 13,343.8 106,307 13,992.9 107,970 14,376.2 +0.2
Ryazan Region 97,963 8,558.3 101,172 8,910.4 114,054 10,044.9 107,151 9,481.5 111,503 9,919.3 +15.9
Smolensk Region 111,290 11,412.2 92,685 9,606.7 92,267 9,563.4 85,865 8,957.1 86,888 9,133.9 -20.0
Tambov Region 109,798 10,206.7 112,309 10,571.0 103,818 9,771.8 103,012 9,807.9 99,770 9,621.6 -5.7
Tver Region 124,508 9,333.0 124,213 9,445.3 122,040 9,280.1 123,348 9,453.8 125,771 9,747.2 +4.4
Tula Region 175,390 11,445.2 173,311 11,450.5 171,693 11,343.6 163,075 10,825.1 166,018 11,100.2 -3.1
Yaroslavl Region 101,427 7,975.9 95,623 7,519.7 99,330 7,811.2 102,556 8,063.1 109,550 8,638.2 +8.3
Moscow 1,242,535 10,372.2 1,236,666 10,138.6 1,172,504 9,612.6 1,177,467 9,549.5 1,203,337 9,670.4 -6.8
* Growth rate is over 5 yr time span is given in relative extensive indicators (%) per 100 thousand residents.
Appendix 2. Population morbidity based on urological cancer incidence in the RF and Central Federal District territories_
2013 2014 2015 2016 2017 Growth rate*
Federal subjects of Russia Absolute Relative (per 100 thousand residents) Absolute Relative (per 100 thousand residents) Absolute Relative (per 100 thousand residents) Absolute Relative (per 100 thousand residents) Absolute Relative (per 100 thousand residents) Per 100 thousand residents. 2017 to 2013. %
RUSSIA 110,874 13.09 120,092 14.04 124,979 14.57 127,056 14.72 132,709 15.38 17.49
CENTRAL FEDERAL DISTRICT 31,938 14.14 33,495 14.86 35,217 15.56 34,704 15.18 36,794 16.11 13.93
Belgorod Region 1,243 13.52 1,340 14.53 1,410 15.18 1,432 14.72 1,456 15.58 15.24
Bryansk Region 1,112 15.52 1,127 15.77 1,054 14.62 1,072 14.61 1,178 16.04 3.35
Vladimir Region 1,042 12.56 1,275 15.42 1,367 16.66 1,351 16.32 1,330 16.48 31.21
Voronezh Region 1,854 13.72 2,124 15.68 2,153 15.88 2,099 15.39 2,202 16.14 17.64
Ivanovo Region 1,015 16.31 964 15.76 1,105 18.24 1,181 19.78 1,214 20.17 23.67
Kaluga Region 1,112 14.12 1,227 15.89 1,259 16.59 1,306 16.93 1,303 17.28 22.38
Kostroma Region 967 16.66 988 17.15 1,050 18.09 1,048 18.24 977 16.71 0.30
Kursk Region 575 14.49 637 15.86 560 14.34 571 14.38 589 14.60 0.76
Lipetsk Region 968 14.07 1,071 16.14 1,131 16.95 1,226 18.11 1,134 16.52 17.41
Moscow Region 1,086 15.62 1,038 14.92 1,122 16.44 1,109 16.15 1,073 15.71 0.58
Orel Region 5,404 13.00 5,863 14.15 6,180 14.64 5,838 13.59 6,232 14.37 10.54
Ryazan Region 769 16.35 790 17.33 839 18.49 829 18.26 815 18.10 10.70
Smolensk Region 1,095 16.25 1,149 17.12 1,273 19.26 1,147 17.17 1,175 17.78 9.42
Tambov Region 748 12.82 848 14.74 810 14.02 805 14.16 856 15.10 17.79
Tver Region 878 13.63 1,035 16.38 1,020 16.00 970 15.56 972 15.75 15.56
Tula Region 1,421 15.64 1,543 17.33 1,580 17.81 1,507 16.83 1,637 18.75 19.89
Yaroslavl Region 1,185 15.67 1,256 17.12 1,271 17.12 1,263 16.89 1,360 18.21 16.21
City of Moscow 9,456 13.88 9,227 13.39 10,023 14.47 9,983 14.23 11,298 16.03 15.49
* Growth rate is over 5 yr time span is given in relative extensive indicators (%) per 100 thousand residents.
