Sainbayar Altanchimeg, Gombojav Davaa, Lundeg Ganbold, Byambaa Boldbaatar, Meier Jens, Dünser Martin W, Mendsaikhan Naranpurev
Department of Critical Care and Anesthesia, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.
Intensive Care Unit, Mongolia Japan Hospital, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.
Lancet Reg Health West Pac. 2023 Aug 7;39:100867. doi: 10.1016/j.lanwpc.2023.100867. eCollection 2023 Oct.
Little is known about the proportion and causes of out-of-hospital deaths in Mongolia. In this study, we aimed to determine the proportion and causes of out-of-hospital deaths in Mongolia during a six-month observation period before the COVID-19 pandemic.
In a retrospective study, the Mongolian National Death Registry was screened for all deaths occurring from 01 to 06/2020. The proportion and causes of out-of-hospital deaths, causes of out-of-hospital deaths likely treatable by emergency/critical care interventions, as well as sex, regional and seasonal differences in the proportion and causes of out-of-hospital deaths were determined. The primary endpoint was the proportion and causes of out-of-hospital death in children and adults. Descriptive statistical methods, the Fisher's Exact, multirow Chi-or Mann-Whitney-U-rank sum tests were used for data analysis.
Five-thousand-five-hundred-fifty-three of 7762 deaths (71.5%) occurred outside of a hospital. The proportion of out-of-hospital deaths was lower in children than adults (39.3% vs. 74.8%, < 0.001). Trauma, chronic neurological diseases, lower respiratory tract infections, congenital birth defects, and neonatal disorders were the causes of out-of-hospital deaths resulting in most years of life lost in children. In adults, chronic heart diseases, trauma, liver cancer, poisonings, and self-harm caused the highest burden of premature mortality. The proportion of out-of-hospital deaths did not differ between females and males (70.5% vs. 72.2%, = 0.09). The proportion (all, < 0.001; adults, < 0.001; children, < 0.001) and causes (adults, < 0.001; children, < 0.001) of out-of-hospital deaths differed between Mongolian regions and Ulaanbaatar. The proportion of out-of-hospital deaths was higher during winter than spring/summer months (72.3% vs. 69.9%, = 0.03). An expert panel estimated that 49.3% of out-of-hospital deaths were likely treatable by emergency/critical care interventions.
With regional and seasonal variations, about 75% of Mongolian adults and 40% of Mongolian children died outside of a hospital. Heart diseases, trauma, cancer, and poisonings resulted in most years of life lost. About half of the causes of out-of-hospital deaths could be treated by emergency/critical care interventions.
Institutional funding.
蒙古国院外死亡的比例及原因鲜为人知。在本研究中，我们旨在确定新冠疫情大流行前六个月观察期内蒙古国院外死亡的比例及原因。
在一项回顾性研究中，对蒙古国国家死亡登记处2020年1月至6月期间发生的所有死亡病例进行筛查。确定院外死亡的比例及原因、可能通过急诊/重症护理干预治疗的院外死亡原因，以及院外死亡比例及原因在性别、地区和季节上的差异。主要终点是儿童和成人院外死亡的比例及原因。采用描述性统计方法、Fisher精确检验、多行卡方检验或Mann-Whitney-U秩和检验进行数据分析。
7762例死亡中有5553例（71.5%）发生在院外。儿童院外死亡比例低于成人（39.3%对74.8%，<0.001）。创伤、慢性神经系统疾病、下呼吸道感染、先天性出生缺陷和新生儿疾病是导致儿童院外死亡损失生命年数最多的原因。在成人中，慢性心脏病、创伤、肝癌、中毒和自残导致的过早死亡负担最高。女性和男性的院外死亡比例无差异（70.5%对72.2%，P = 0.09）。蒙古国不同地区与乌兰巴托之间院外死亡的比例（所有地区，<0.001；成人，<0.001；儿童，<0.001）及原因（成人，<0.001；儿童，<0.001）存在差异。冬季院外死亡比例高于春季/夏季（72.3%对69.9%，P = 0.03）。一个专家小组估计，49.3%的院外死亡可能通过急诊/重症护理干预进行治疗。
存在地区和季节差异，约75%的蒙古国成人和40%的蒙古国儿童死于院外。心脏病、创伤、癌症和中毒导致生命年数损失最多。约一半的院外死亡原因可通过急诊/重症护理干预进行治疗。
机构资助。
