ЭПИДЕМИОЛОГИЧЕСКИЙ АНАЛИЗ БОЛЕЗНЕЙ СИСТЕМЫ КРОВООБРАЩЕНИЯ В КРАСНОЯРСКОМ КРАЕ

Significance: This article is about assessing changes in selected indicators of public health against the background of the pandemic of a new coronavirus infection COVID-19 in adult population of the Siberian Federal District - a territory of the Russian Federation with a special climatic, geographical and ecological "portrait", characterized by a high prevalence of risk factors for chronic non-communicable diseases. The study of this issue creates prerequisites for a detailed analysis of the leading causes of death and peculiar features of their statistical coding in the Siberian Federal District for a given time interval, which helps to identify true mortality from diseases of the circulatory system (in particular, coronary artery disease and myocardial infarction. The purpose of the study was to assess dynamics in the indicators of total mortality and mortality from diseases of the circulatory system in adult population of the Siberian Federal District during the pandemic caused by a new coronavirus infection COVID-19. Material and methods. The study used data of the Federal State Statistics Service «Virtual statistical data mart» official website. The study analyzed non-standardized total mortality rates in adult population of the Siberian Federal District (per 100,000 population), and mortality from diseases of the circulatory system, coronary artery disease and myocardial infarction for the period from 2016 to 2021 and compared these indicators with the all-Russia data. The COVID-19 impact was assessed starting from January 2020, while the period preceding this date was conventionally designated as pre-COVID period. Ranks and econometric analysis of time series were used. Results. In the pre-COVID period, the total mortality rate in adult population was decreasing over time in the Russian Federation and most regions of the Siberian Federal District, with the exception of the Altai Republic. With the onset of the new coronavirus infection, total mortality increased in most regions of the Siberian Federal District, except for the Republic of Tyva. In the Siberian Federal District in the pre-COVID period, mortality from diseases of the circulatory system increased due to a rise in mortality from diseases of the circulatory system in the Altai Republic and Krasnoyarsk region, Irkutsk, Tomsk and Kemerovo regions; mortality from coronary artery disease increased due to a rise in mortality from diseases of the circulatory system in the Krasnoyarsk region, Altai Republic, Kemerovo, Novosibirsk and Tomsk regions; while increased mortality from myocardial infarction is associated with the increased mortality from diseases of the circulatory system in the Republic of Khakassia, Kemerovo, Novosibirsk and Irkutsk regions. With the beginning of the COVID-19 pandemic in 2020, there was an increase in mortality from diseases of the circulatory system and coronary artery disease in the Russian Federation and regions of the Siberian Federal District, including a rise in mortality from myocardial infarction, with the exception of the Altai Republic, and the Irkutsk region. In the Siberian Federal District in 2021, there was no increase in mortality from diseases of the circulatory system and coronary artery disease in the republics of Tyva and Khakassia, the Novosibirsk region and Krasnoyarsk Territory (only from coronary artery disease); mortality from myocardial infarction - in all regions of the Siberian Federal District, except the Tomsk region. Conclusion. The tendency towards lower total mortality in adult population in the pre-COVID period in the Russian Federation and the Siberian Federal District has changes towards increasing starting from official registration of COVID-19 cases. A similar trend is typical of diseases of the circulatory system (including coronary artery disease and myocardial infarction) in the Russian Federation and some regions of the Siberian Federal District. The COVID-19 pandemic is obviously associated with changes in public health indicators in the Russian Federation

Introduction. In the Russian Federation, diseases of the circulatory system are leading in the structure of the common incidence and mortality in the adult population, and since 2008, they have also been the leading causes of death among the employable age population. Reducing mortality among the employable age population and mortality from diseases of the circulatory system are the most important target indices of the national project “Healthcare”. Materials and methods. Life expectancy was calculated using an indirect (demographic) method, the contribution of mortality from diseases of the circulatory system by age groups to the differences in life expectancy of men in Kuzbass and subjects of the Russian Federation, and elimination reserves of life expectancy were calculated based on the component method. The age-related mortality rates of the Russian Fertility and Mortality Database were used. To identify the incidence of atherosclerosis of the main arteries, 610 patients aged 47.003±4.875 years were examined. Results. Mortality in Kuzbass men from diseases of the circulatory system is higher in all age groups compared to the Russian Federation, except for 20–29 years. In 2022, the difference in life expectancy with the Russian Federation is 3.30 years, of which 0.79 years is the contribution of diseases of the circulatory system (0.23 years – ischemic heart disease, 0.32 years – cerebrovascular diseases). The elimination reserve associated with the exclusion of mortality from diseases of the circulatory system is 5.78 years. In a random sample, we found a high occurrence of asymptomatic atherosclerosis in men of employable age (61.35%). Arterial hypertension as one of the leading risk factors for the development of atherosclerosis was revealed in almost half of the examined individuals (43.2%). Limitations of the study are related to the duration of the preventive medical examination. Conclusion. Regional features of the life expectancy of Kuzbass men and the impact of mortality from circulatory system diseases, a significant proportion of which is associated with atherosclerosis, have been identified. The elimination of mortality from diseases of the circulatory system promotes an increase in the life expectancy of Kuzbass men by 5.78 years.

Significance. Diseases of the circulatory system remain one of the leading causes of death and morbidity of the adult population. Over the years, the efforts of the State aimed at controlling diseases of the circulatory system have made the contribution of this disease class to the total mortality in Russia gradually reduce. Nevertheless, diseases of the circulatory system remain the leading ones among diseases, characterized by a steady growth and rapidly increasing prevalence among the population. The purpose of the study is to analyze dynamics in incidence and prevalence of the diseases of the circulatory system among the Russian adult population in 2007-2019. Material and methods. The study used data of the statistical collections of the Ministry of Health of the Russian Federation and the Federal Research Institute for Health Organization and Informatics of the Ministry of Health of Russia: "Morbidity of the adult population of the Russian Federation" for 2007-2019. The study, which is a continuous statistical observation, used the method of direct ranking, calculation of indicators of time series. Results. Diseases of the circulatory system in 2019 ranked fourth in the incidence structure of the adult population (8%), while its prevalence ranked second to none (21%). Over 13 years, the incidence of diseases of the circulatory system in adults increased by 42% (2007-2019) while its prevalence increased by 24%. The highest levels of incidence of diseases of the circulatory system in 2019 are registered in the Krasnodar Territory (9,024.3 per 100 000 population, + 324%), the Kurgan Region (7,404.2, + 103%) and the Karachayevo-Circassian Republic (7 286.2, + 268%), and prevalence - in the Altai Territory (52 557.6, + 2%), the Chuvash Republic (51 814.6, + 38%) and the Voronezh Region (45 339.4, + 59%). The maximum rates of increase in morbidity with diseases of the circulatory system from 2007 to 2019 are registered in the South Federal district (incidence - by 119%, prevalence - by 56%), among the constituent entities of the Russian Federation: incidence - in the Krasnodar Territory (by 324%), prevalence – the Karachayevo-Circassian Republic (by 136%). According to the state statistical reporting, on average, every 7th acute myocardial infarction is complicated by recurrent heart attack in Russia. Conclusions. Throughout the study period of 13 years, the leading nosological forms include: Hypertensive diseases (35%; 45%, respectively), Ischemic heart diseases (22%; 21,6%) and Cerebrovascular diseases (23%; 20%). Over half of the diseases of the circulatory system are registered in the older working ages (55-60 and over). Scope of application. The study results can be useful to regional authorities in public health in planning and implementing regional programs aimed at controlling diseases of the circulatory system.

The problem of incidence rate among workers of the main professions of the coal mining industry is traditionally considered from the perspective of occupational pathologies. At the same time, the issues of the spread of production-related somatic diseases among this category of the employable population are undeservedly left without due attention. The objective of the study was assessing the frequency of somatic pathology occurrence in workers of coal pits in the South of Kuzbass. 489 workers of the main professions of coal pits in the South of the Kemerovo region were examined (men aged 22 to 55 years, who were randomized into 2 groups according to the level of exposure to a complex of unfavorable factors of the production environment). The first group with a higher level of exposure to harmful and hazardous production factors of class 3.3 and 3.4 included 196 people: machinists of mining and technological equipment, machinists of drilling rigs, explosives; the second group with the level of danger and harmfulness of class 3.1 and 3.2 consisted of 293 workers, namely, drivers of technological motor vehicles. The study of the frequency of somatic pathology was carried out depending on the length of work experience and the age of the subjects. Each group was divided into subgroups: by the age and work experience. In group 1, somatic pathologies were detected in 52.0% of the cases, in group 2 - in 44.4% (χ2=2.772, p=0.096). In the structure of somatic diseases in the group with a higher class of danger and harmfulness, diseases of the circulatory system (38.24%), diseases of the musculoskeletal system and connective tissue (12.75%) and diseases of the nervous system (8.82%) prevailed; in the group with a lower hazard class there were also diseases of the circulatory system (33.85%), diseases of the musculoskeletal system and connective tissue (14.62%), diseases of the nervous system (12.31%). The frequency of somatic diseases is recorded in a direct linear relationship with the work experience and age of coal pit workers. Limitations. This study is limited to a sample of workers in the main professions of coal pits undergoing periodic medical examinations at the Research Institute for Complex Problems of Hygiene and Occupational Diseases. Conclusion. In the structure of somatic diseases of workers of the main professions of coal pits in the South of Kuzbass, three nosological forms occupy a leading position: diseases of the circulatory system, diseases of the musculoskeletal system and connective tissue, and the nervous system. Among the surveyed workers employed in coal pits with a higher level of exposure to harmful and hazardous production factors, a 100% incidence of somatic diseases was revealed among the respondents aged more than 41 years and with work experience over 21 years. These data should be taken into account when carrying out periodic medical examinations, preventive medical examinations, for the development and implementation of therapeutic and prophylactic measures and post-shift rehabilitation programs. Ethics. The study was conducted in compliance with the standards of the Bioethical Committee of the Research Institute for Complex Problems of Hygiene and Occupational Diseases, established in accordance with the Helsinki Declaration of the World Association "Ethical Principles for Conducting Human Scientific Medical Research" as amended in 2013 and the "Rules of Clinical Practice in the Russian Federation", approved by the Order of the Ministry of Health of the Russian Federation No. 266 of 19.06.2003. All subjects signed an informed consent to participate in the study.

Significance. The study analyzes dynamics in incidence of the most common socially significant pathology - diseases of the circulatory system in the Far Eastern Federal District and the Russian Federation as a whole with due regard to the territorial and economic prospects for the Far East development. The purpose of the study was to analyze incidence of diseases of the circulatory system and their individual types on the example of the Far Eastern Federal District and the Russian Federation as a whole, as well as to compare short-term and long-term projections and actual data. Material and methods. The study has undertaken a comparative analysis of the dynamics in predictive and actual indicators of the overall incidence and incidence of diseases of the circularity system and individual nosological forms over five-year and ten-year periods until 2021. The period of the coronavirus infection (COVID-19) pandemic has been separately analyzed. Results. In general, a more intensive increase in morbidity in the Russian Federation and the Far Eastern Federal District has been identified in comparison with the projected increase. For 5 years prior to 2019, the increase in the overall incidence of diseases of the circulatory system in the Russian Federation turned out to be almost 4 times higher than projected, while incidence was more than 2 times higher than projected. During the COVID-19 pandemic (from 2017 to 2021), the growth dynamics slowed down significantly, 2-fold exceeding the projected overall incidence and more than 1.5-fold the projected incidence. Such trends may be a consequence of the effective ongoing preventive measures aimed at early detection of diseases. Against this background, there is a decrease in the growth rate of the incidence of diseases of the circulatory system in the Russian Federation and the Far Eastern Federal District in the context of the pandemic of a new coronavirus infection. In the Far Eastern Federal District in 2017-2021, compared with the pre-pandemic period, there was a decrease in the overall incidence increase by 65.5% with the increase inversion in incidence. During the period including the pandemic, the Russian Federation and the Far Eastern Federal District registered a negative growth rate of the overall incidence and incidence of ischemic and cerebrovascular diseases. The noted decrease in the actual incidence rates of diseases of the circulatory system, which is not comparable with the projected trends, requires an analysis of causes of the change in the epidemiological situation under the influence of the COVID-19 pandemic. Conclusion and scope of application. In general, we suppose that a decrease in the growth rate in incidence indicators in the Russian Federation and the Far Eastern Federal District during the pandemic of a new coronavirus infection cannot have a long-term impact on epidemiological indicators of diseases of the circulatory system. However, it indicates the necessity to develop reserves of the healthcare system in order to prevent such situations in future.

BACKGROUND: The reduction in morbidity and mortality rates from diseases of the circulatory system (DCS) is one of the greatest challenges in primary care, and the implementation of the Family Health Program provides access to the multisectoral and integrated measures required for dealing with these diseases. OBJECTIVE: To analyze DCS mortality and hospitalization rates before and after the implementation of the Family Health Program, in Londrina, Parana. METHODS: This was an ecological study, comparing DCS, cerebrovascular disease (CbVD) and ischemic heart disease (IHD) mortality rates and hospitalization rates by the SUS, in residents of Londrina, in two 4-year periods: 1997 to 2000, and 2002 to 2005. The data were obtained from the Mortality Information System and the Hospital Information System of the SUS. The ratios between the rates were calculated for both periods at 95% confidence interval. RESULTS: The DCS was the first cause of death in the city, in both quadrennia. The CbVD and IHD accounted for more than 63% of DCS deaths. In comparing the two quadrennia, there was a reduction in CbVD mortality rates, which was significant only for subjects over 59 years, in both genders, and the hospitalization rates increased by 10%. For IHD, no significant change occurred in mortality rates, and there was a 40% increase in hospitalization rates. CONCLUSION: The significant reduction only in CbVD mortality in the elderly suggests the need for expanding health assistance coverage to different population groups and the development of preventive and health promotion measures.

Significance. Diseases of the circulatory system are a class of diseases of high social importance and a reservoir for reducing mortality and increasing life expectancy, primarily through improving specialized medical care for working-age patients. The purpose of this study is to assess the results of improving specialized medical care for cardiovascular patients under the federal project “Fight against cardiovascular diseases”. Material and Methods. The analysis is based on data from statistical collections of the Federal Research Institute for Health Organization and Informatics of the Ministry of Health of the Russian Federation, and was focused on evaluating target and actual indicators of the federal project “Fight against cardiovascular diseases”. The content analysis of normative legal documents regulating provision of medical care to patients with cardiovascular diseases has been undertaken. Results. Results of the federal project implemented from October 1st, 2018 to December 31st, 2023, are as follows: 374 regional vascular centers and primary vascular departments were re-equipped (retrofitted); more than 310,000 therapeutic X-ray endovascular interventions were performed; 95.5% of patients who underwent through major cardiovascular surgery are provided with free medications; more than 70% of patients with a high risk of acute cardiovascular event are under medical follow-up and received medical care; hospital mortality from myocardial infarction is under 10%, and hospital mortality from acute cerebrovascular accidents is under16.2%. The standardized mortality rate from diseases of the circulatory system in Russia as a whole decreased by 6.0% in 2022 compared to 2018 and equaled to 408.8 per 100,000population. Conclusion. Implementation of the federal project “Fight against cardiovascular diseases” has made it possible to increase effectiveness of specialized medical care delivery in the Russian Federation primarily due to improved material and technical resources of health care facilities. Coverage of cardiovascular patients with quality clinical follow-up is a hard-to-implement component of the overall process of care delivery to such patients, requiring on-going improvements in the implementation approaches. Progress towards this target is the lowest. In order to achieve quality results in reducing morbidity and mortality from cardiovascular diseases, it is important to timely improve the regulatory framework rather than only develop the resource component.

This paper reports on the findings from the study of mortality from diseases of the circulatory system (DCS) in Russian nuclear workers of the Mayak Production Association (22 377 individuals, 25.4% female) who were hired at the facility between 1948 and 1982 and followed up until the end of 2018. Using the AMFIT module of the EPICURE software, relative risks (RRs) and excess RRs per unit absorbed dose (ERR/Gy) for the entire Mayak cohort, the subcohort of workers who were residents of the dormitory town of Ozyorsk and the subcohort of migrants from Ozyorsk were calculated based on maximum likelihood. The mean cumulative liver absorbed gamma-ray dose from external exposure was 0.45 (0.65) Gy (mean (standard deviation)) for men and 0.37 (0.56) Gy for women. The mean cumulative liver absorbed alpha dose from internal exposure to incorporated plutonium was 0.18 (0.65) Gy for men and 0.40 (1.92) Gy for women. By the end of the follow-up, 6019 deaths with DCS as the main cause of death were registered among Mayak Production Association workers (including 3828 deaths in the subcohort of residents and 2191 deaths in the subcohort of migrants) over 890 132 (622 199/267 933) person-years of follow-up. The linear model that took into account non-radiation factors (sex, attained age, calendar period, smoking status and alcohol drinking status) and alpha radiation dose (via adjusting) did not demonstrate significant associations of mortality from DCS, ischaemic heart disease (IHD) and cerebrovascular disease with gamma-ray exposure dose in the entire cohort, the resident subcohort or the migrant subcohort (either in men or women). For the subcohort of residents, a significant association with gamma dose was observed for mortality from ischaemic stroke in men with ERR/Gy = 0.43 (95% CI 0.08; 0.99); there were no significant associations with liver absorbed gamma dose for any other considered outcomes. As for internal exposure, for men no significant associations of mortality from any DCS with liver absorbed alpha dose were observed, but for women positive associations were found for mortality from DCS (the entire cohort and the resident subcohort) and IHD (the entire cohort). No significant associations of mortality from various types of DCS with neutron dose were observed either in men or women, although neutron absorbed doses were recorded in only 18% of the workers.

Among the conclusions of the article by Krestinina et al. (2013) was that chronic radiation exposure of the Techa River Cohort resulted in a radiation-related excess risk of death from diseases of the circulatory system (DCS) and from ischemic heart disease (IHD) in particular. At the same time, estimation of mortality risk from cerebrovascular disease did not reveal any statistically significant dependence on the dose. The relatively high mortality rates from cardiovascular disease in Russia compared to Western Europe were commented previously (Jargin 2013). Since the Soviet time, autopsy has remained obligatory for patients dying in hospitals; however, the attitude toward postmortem examinations has become in places less rigorous (Jargin 2008). Autopsies have been sometimes performed incompletely, without much insight. If a cause of death is not entirely clear, it is common practice to write into the death certificate the diagnosis of IHD, acute or chronic cardiac insufficiency, or a similar formulation. These facts are well known by pathologists with experience of autopsy in the former Soviet Union (SU). There is a tendency to overdiagnose cardiovascular diseases in unclear cases also in the people dying at home and not undergoing autopsy. This is likely to be one of the causes of the dramatic increase in cardiovascular mortality in the former SU since the 1970s, especially in men (Zatonski 2007; Zatonski and Bhala 2012). This is confirmed by Davydov and coworkers who wrote: ‘‘Increases and decreases in mortality [have been] related to cardiovascular diseases (CVD), particularly to ‘other forms of acute and chronic ischemia’ and ‘atherosclerotic heart disease,’ but not to myocardial infarction, the proportion of which in Russian CVD-related mortality is extremely low’’ (Davydov et al. 2007). The explanation for this controversy is evident for an inside observer: The diagnosis of myocardial infarction is usually based on clear clinical and/or morphological criteria, while IHD and cardiac insufficiency are often diagnosed postmortem without sufficient evidence. Analogous explanations pertain also to the fact that Krestinina et al. (2013) did not find any statistically significant dependence on the radiation dose of the mortality risk from cerebrovascular diseases: The latter usually have clear symptoms and are not habitually overdiagnosed. At least for the former SU, there is a tendency: The higher the quality of postmortem diagnostics, the lower the fraction of cardiovascular diseases among all causes of death. In this connection, the cause of the sixfold ethnic difference of the excess relative risk (ERR) per 100 mGy for all the DCS deaths (Krestinina et al. 2013) appears clear: the less thorough diagnostics in the ethnic minorities. Furthermore, according to the dose distribution in the cohort studied by Krestinina et al. (2013), only 2.7 % (n = 800) of the cohort members had dose estimates above 350 mGy, while 94.7 % of the cohort received individual doses below 150 mGy in the period 1950–2003. To the best of my knowledge, no association with cardiovascular or other diseases has ever been reliably proven for such a low dose level and rate (Jargin 2012). Doses above 0.5 Gy were reported to be associated with an elevated risk of both stroke and heart disease among the atomic bomb survivors, but the dose–response effect was not statistically significant when the calculation was limited to the dose range 0–0.5 Gy (Shimizu et al. 2010). For acute radiation doses above 1–2 Gy, a number of mechanisms were proposed, including damage to the endothelial cells in capillaries or larger blood vessels and the up-regulation of inflammatory S. V. Jargin (&) Peoples’ Friendship University of Russia (Moscow), Clementovski per 6-82, 115184 Moscow, Russia e-mail: sjargin@mail.ru

Significance. According to World Health Organization, in the structure of deaths among youths, external causes and diseases of the circulatory system combined account for 72.0%. The study analyzed prevalence and incidence of diseases of the circulatory system, the 2027 forecast and the structure of incidence of diseases of the circulatory system for the period from 2014 to 2022. Purpose. To identify trends in prevalence and incidence of diseases of the circulatory system in children aged 15-17, and their forecast. Material and methods. The study used materials of the statistical reporting of the Russian Research Institute of Health on prevalence and incidence of diseases of the circulatory system in children aged 15-17 in 2014-2022 within the territory of the Russian Federation, the Volga Federal District, the Udmurt Republic and bordering regions: the Kirov Region and the Republic of Bashkortostan. Results The study found that within the territory of the Udmurt Republic, in 2014-2022, there was a tendency towards decreasing prevalence and incidence of diseases of the circulatory system in children aged 15-17 – by 15.7 and 38.1% (from 7540.2 to 6353.7 and from 1915.3 to 1185.0, respectively). The 2027 forecast is also characterized by a downward trend – a decrease by 11.6 and 6.4% (from 6353.7 to 5620.0 and from 1185.0 to 1044.4, respectively). Conclusion. The diseases identified in the structure of incidence of diseases of the circulatory system (incidence of chronic rheumatic heart diseases, prevalence and incidence of diseases characterized by high blood pressure and prevalence of other heart diseases), in comparison with the Russian Federation, the Volga Federal District, the Republic of Bashkortostan and the Kirov region require the implementation of evidence-based studies at the regional level in order to identify morbidity risk factors and to develop relevant prevention programs. Keywords: morbidity trends in children aged 15-17; diseases of the circulatory system; morbidity dynamics; chronic rheumatic heart disease; high blood pressure; other heart diseases; regional characteristics; forecast; prevention.

Corporate health programs are a common measure for the primary and secondary prevention of chronic non-communicable diseases.Aim. To study the first implementation results of a Targeted comprehensive program to reduce morbidity and prevent mortality from circulatory system diseases and early cancer detection in employees of JSC "Russian Railways" for the period from 2019 to 2023.Material and methods. The study used a survey of employees of locomotive crews (RLC), which was conducted twice: in the summer of 2018 and February-March 2021. The survey was conducted using a specially designed questionnaire that takes into account the health status of drivers and their assistants, production, and non-production risk factors. In 2018, 10476 questionnaires were collected (>7% of employees), and in 2021 — 14403 questionnaires (>10% of employees). The age structure of railways has not changed, which made it possible to analyze the frequency of occurrence of risk factors in dynamics.Results. In general, the mention of the RLC of the interfering effect of the noise factor, uncomfortable temperature, and undesirable odors in the driver’s cabin decreased for JSC "Russian Railways". The number of smokers on the South-Eastern Railway significantly increased during the study period. The number of people consuming insufficient amounts of vegetables and fruits has increased on the Far Eastern, West Siberian, Krasnoyarsk, and Volga railways. The frequency of workers’ meals at fast food restaurants has increased on the Southeastern Railway. The number of people with a good commitment to the basic principles of a healthy lifestyle has increased on the East Siberian, Trans-Baikal, West Siberian, Kuibyshev, Oktyabrskaya, Sverdlovsk, North Caucasian, and South Ural railways.Conclusion. The conducted research has shown the effectiveness of the initial stage of the implementation of the corporate program to reduce morbidity and prevent mortality from diseases of the circulatory system in RLC. The heterogeneity of the results for different railways was revealed.

In the Russian Federation, as in many European countries, for many years the system of circulatory diseases has been a significant threat to public health and the medical and demographic situation, which supports the increase in mortality from these causes in many regions. The purpose of the study is to study current trends in morbidity and mortality of the population in class “IX. Diseases of the circulatory system» in comparison with the planned target indicators of the regional program and identify priority areas for improving strategic health care planning at the regional level (Republic of Buryatia). Material and methods. The information base consisted of various scientific publications and regulatory documents on strategic management in the territory of the Republic of Buryatia and the Far Eastern Federal District. The analysis was also carried out using statistical data from the database of Rosstat and the Ministry of Health of Russia and on the basis of content analysis of draft strategies that were available on the official websites of government bodies, constituent entities of the Russian Federation, etc. The analysis methodology included the method of studying and generalizing experience, the mathematical-statistical method and content analysis. Results. Based on available statistical information, the publication analyzes current trends in morbidity and mortality from diseases of the circulatory system in the Republic of Buryatia for 2017–2021. and compared with the target indicators of the regional program adopted within the framework of the federal project “Combating Cardiovascular Diseases”. Conclusions. The results of the analysis can be used in strategic planning for the development of territorial healthcare in the Russian Federation and in the development of strategies, concepts and programs for protecting public health.

<jats:p>INTRODUCTION Chronic non-contagious diseases: heart and blood vessel diseases, malignant tumors, diabetes, obstructive pulmonary disease, injuries and poisoning, mental health disorders and others, have dominated the world and our national pathology for decades. Arterial hypertension is one of the most common diseases of the present, which affects in more than 60% of people over the age of 60, and represents a risk factor for infarction, insult, chronic heart failure, renal insufficiency, progressive atherosclerosis and dementia, indicating the importance of hypertension frequency testing in the geriatric population in our country and in the world. OBJECTIVE is to point out the specificity, the high frequency and the risk of hypertension in the geriatric population in our country and in the world. METHODS We analyzed the data and literature in the field of geriatrics, internal medicine, neurology, public health, social medicine and health statistics in the part dealing with the protection of the health of the elderly in our country and in the world. The research was conducted through the analysis of previous scientific research obtained from the literature and the search of electronic databases in accordance with the areas defined in the aim of the work. Using the analytical observational method, all necessary data on this topic were collected, recorded and analyzed. A systematic review of the literature in the researched area was carried out, with the aim of reviewing the methodological characteristics of published studies in the mentioned area. Relevant papers based on this search were collected in full text. Data were extracted from such works, analyzed and presented in this paper. RESULTS AND DISCUSSION Cardiovascular disease is the primary cause of elderly mortality, and it is believed that by removing it in people over the age of 65, the life expectancy would be prolonged for 16 years. The results of some studies show that a third of patients over the age of 65 have isolated systolic hypertension, which is a significant risk factor for apoplexy. In developed countries, the geriatric population is on the rise and reaches more than 30% of the general population, and cardiovascular disease is one of the most common diseases and causes of mortality in this population. Studies have shown that the incidence of myocardial infarction and cerebrovascular events is doubled in patients over 65 years of life with hypertension. Only two groups of diseases, heart and blood vessels diseases and malignant tumors, account for over half of all causes of death. In the Republic of Serbia, in 2021 the population aged 65 and over accounted for 21.28% of the population, while the percentage representation of very old people, over 85 years of age, is constantly increasing. Observed since 2002, more than 100,000 people die annually in Serbia from all causes of death, and almost every second resident of Serbia dies from diseases of the heart and blood vessels. The burden of diseases of the circulatory system or diseases of the heart and blood vessels is on the rise globally, and in recent years in Serbia, on average, 55% of people who have died are victims of one of the diseases from this group. The most common diagnosis within the group of diseases of the cardiovascular system is essential arterial hypertension. The most common causes of death in 2021 belong to the following groups of diseases (according to ICD-10 - International Classification of Diseases of the World Health Organization): Diseases of the circulatory system 41.4%; Tumors 15.1%; Diseases of the respiratory system 5.3%; Diseases of glands with internal secretion, nutrition and metabolism 2.6%. Diseases of the heart, blood vessels and malignant tumors accounted for over half (55.7%) of all causes of death in 2021 in Serbia. As many as 41.4% of all deaths were the result of dying from diseases of the circulatory system, and every sixth person who died (15.1%) was a victim of a malignant tumor. Studies have shown that in patients over 65 years of age with hypertension, the frequency of myocardial infarction and cerebrovascular events is twice as high. CONCLUSION Hypertension is very common in elderly and is a growing problem for them, their family and entire community, as it significantly affects the quality of their lives. The number of elderly in general population is increasing and a growing number of them is with hypertension. Successful prevention can significantly affect the reduction in the incidence of this disease in the population of elderly, which would certainly be one of the priority tasks in improving their health and quality of life.</jats:p>

Introduction. Diseases of cardiovascular system are the leading causes of morbidity and mortality among the able-bodied population. There have been no studies of the impact of the COVID-19 epidemic on cardiovascular mortality in Russian Railways. The study aims to analyze the mortality of Russian Railways employees from diseases of the circulatory system during the COVID-19 pandemic with the working-age population of the Russian Federation. Materials and methods. The study was carried out on the basis of data obtained during the COVID-19 pandemic (2019-2021). Information on the mortality of employees of JSC "Russian Railways" is formed on the basis of the data of the CHUZ of JSC "Russian Railways". Information about the natural movement of the working-age population was formed on the basis of data from the Unified State Register of Civil Status Records. Results. During the pandemic, the mortality rate in JSC "Russian Railways" was 2.2 times lower compared to the working-age population of the country. Excess mortality by road polygons was different. The maximum mortality rate (3.4 per 1000 employees) was among employees of enterprises of central subordination, the minimum (2.1) was on the Northern Railway. 82.5% of deaths occurred in men, while the mortality rate among men is 2 times higher compared to women. The main cause of death of workers were diseases of the circulatory system (BSC) - 28.7%. The mortality rate from BSK in JSC "Russian Railways" was 0.656, which is 2.9 times lower than for the working-age population of Russia. Conclusion. The study showed that under the conditions of a new coronavirus infection, the mortality rate from circulatory system diseases in Russian Railways employees is lower than in working-age population of Russia. Ethics. We have carried out this study in accordance with the rules of good clinical practice and the Helsinki Declaration. The study did not require the conclusion of the Ethics committee.

Introduction One of the most common and serious problems in the practice of Occupational Health Services (OHS) are musculoskeletal diseases. The aim The aim of this study was to clarify the subjective impression of OHS for diseases generating the most frequent and long-term sick leaves from work and representing the most serious health problems for workers. Methods We implemented online based and direct survey of OHS from the official Register of the Ministry of Health (the total number of OHS there was 495), the questionnaire consists of 18 questions. We received 77 completed questionnaires, statistically analysed with SPSS 11.1. A special attention was paid on the questions x 12 A, 12 B and 15. The respondents could give more than one answer. Results It was found that the diseases generating the most frequent sick leave were the diseases from Class X(diseases of the respiratory system), followed by Class IX (diseases of the circulatory system) and Class XIII (diseases of the musculoskeletal system and connective tissue), n = 74 – IX-11 ( 14.86%), X-68 (91.89%), XIII-9 (12.16%). The diseases that generate long-term sick leave were leaded by the diseases Class II, IX, XIX XIII, n = 69, II-40 (57.97%), IX-36 (52.17%), XIII-15 (21.74%), XIX-20 (28.99%). The most serious health problems of workers related to their work (question x15), according to OHS are diseases of the musculoskeletal system and connective tissue – 32 (50.79%), diseases of the circulatory system – 28 (31.75%) and Nervous System – 20 (31.75%), n = 63. Conclusion The results confirm the importance of musculoskeletal disorders in occupational pathology and point to the use of all achievements of science to reduce them in cooperation of the whole healthcare system.