Mortality from alcoholic cardiomyopathy: evidence and statistical problems

Abstract

Alcoholic cardiomyopathy (ACM) is considered an independent disease, the diagnosis of which is based largely on prior alcohol abuse and the exclusion of other cardiomyopathy causes.Aim. To discuss the accounting and accuracy of the analysis of ACM mortality, including assessing the variability and changes of regional standardized mortality rates (SMR) for 2013-2021, as well as to conduct an analysis of Medical Certificate of Cause of Death (MCCD) and discuss the criteria for ACM as the underlying cause of death (UCD).Material and methods. Rosstat data on the average annual population and ACM death rate (I42.6) in 2013-2021 by region were analyzed. SMRs were calculated using software. To analyze MCCDs, anonymized data from the Department of Civil Registration of the Moscow Oblast (3538 MCCDs in total) were used.Results. In 2013, the regional average SMR from ACM was 14,0±13,9 per 100 thousand population, in 2021 — 13,2±13,6. The only region with annual SMR decrease was the Tyumen Oblast. Zero values were registered in the republics of Ingushetia and Chechnya. In other regions, “wave-like” changes were noted — a decrease or increase in SMR. The coefficient of variation of the SMR was minimal in 2016 (73%) and maximum in 2021 (103%). The contribution to mortality varied from 0 to 6%. Heart failure group codes (I50) were indicated as the immediate cause of death in 93,3% of MCCDs. Part II of the MCCDs was completed in 39,1%. The most common cause of death is group F10 (mental and behavioural disorders due to use of alcohol) and group K70 (alcoholic liver disease). In the literature and guidelines there are no clear criteria for ACM as UCD. The indication of alcohol-related codes in Part II of the MCCD is contrary to the ICD rules.Conclusion. Significant regional variability in SMR from ACM may be due to problems in UCD determination. And despite the small contribution of ACM to allcause mortality, a consensus statement is required on the criteria for diagnosing and completing the MCCD.