Regional differences in determining cardiovascular diseases as the cause of death in Poland: time for change.

BACKGROUND: Data regarding deaths in many countries is a reliable source of information on population health status, due to the legal obligation to register the fact of a death and its cause. Such data is widely used to analyse regional health differences, changes in health over time, and to pursue and monitor the effects of health policies. Therefore, it is extremely important that the data is reliable and comparable across the country.

AIM: To analyse death rates from cardiovascular diseases in 2007-2009 among residents of large Polish cities, where medical universities are located, in order to assess the magnitude of differences in mortality in those populations.

METHODS: The information on deaths was collected from a routine death registration system run by the Central Statistical Office. We analysed mortality by accessing individual death records of the residents of the following cities: Bialystok, Bydgoszcz, Gdansk, Katowice, Krakow, Lublin, Lodz, Poznan, Szczecin, Warsaw and Wroclaw. The following causes of death were taken into account: diseases of the circulatory system in total (ICD-10: I00-I99); ischaemic heart disease (I20-I25) including myocardial infarction (I21-I22); pulmonary heart disease and other heart diseases (I26-I51) including cardiac arrest (I46); heart failure (I50); complications and ill-defined descriptions of heart disease (I51); cerebrovascular diseases (I60-I69); and atherosclerosis (I70). The death rates were age-standardised by the direct method, taking as a standard the so-called 'European age structure'.

RESULTS: Comparison of mortality rates in the studied cities revealed substantial and unjustified differences in the values of the rates for individual groups of diseases. The death rate from myocardial infarction in Katowice was nearly three times higher than those in Wroclaw and Krakow (74.8/100,000 against 25.2 and 25.7/100,000). Mortality rates from pulmonary heart disease and other heart diseases in Warsaw, Lodz, Bydgoszcz, and Szczecin were in the range of 12-19/100,000, while in the other cities it was lower than 1/100,000 residents. The death rates from atherosclerosis in Wroclaw and Krakow were several (6-9) times higher than in Bialystok, Katowice, Warsaw and Szczecin.

CONCLUSIONS: As one of the main reasons that may be responsible for such substantial regional differences in death rates, the authors assume that different criteria are used to determine the causes of death, perhaps resulting from insufficient training of health professionals in this field. Therefore actions to develop and implement uniform rules for determining causes of death, appropriate training of doctors responsible for completing death certificates, and adequate education in this area during medical studies must be urgently undertaken.