Fatal outcomes analysis in pneumonia patients in St. Petersburg (2020–2024)

Background: pneumonia, together with other lower respiratory tract infections, remains one of the leading causes of mortality worldwide. Aim: to analyze the fatal outcomes of pneumonia among patients in St. Petersburg during the period of 2020–2024. Materials and Methods: statistical data on pneumonia-related mortality in St. Petersburg from 2022 to 2024 were evaluated. Additionally, medical records and pathoanatomic autopsy reports for 127 patients who died from cancer in hospitals in St. Petersburg in 2024 were analyzed. Results: in 2020, pneumonia was recorded as the primary cause of death in 821 cases (1.2% of the total mortality in St. Petersburg). The number of cases was similar in 2021 (822, or 1.0%), but a significant increase was observed in the following years: 1415 cases in 2022 (2.3%), 1569 cases in 2023 (2.8%), and 1837 cases from January 1 to December 18, 2024 (3.4%). From 2022 onwards, an increasing prevalence of comorbid conditions was noted in patients who died from pneumonia. Chronic coronary heart disease was reported in 7.1% of pneumonia- related deaths in both 2020 and 2021. By 2022, this figure had increased to 19.6%, reaching 31.4% in 2023 and 29.9% in 2024. An analysis of the medical records of 127 deceased patients revealed that pneumonia was of exceptional or predominant significance in 56 cases (44.0%). In 52 cases (41.0%), the disease severity and the presence of competing pathologies were of comparable influence, making it challenging to determine the definitive cause of death. In 19 cases (15.0%), pneumonia played a questionable role in the fatal outcome, with death being primarily attributable to progressive competing diseases or with the diagnosis of pneumonia itself being uncertain. It is speculated that the elevated designation of pneumonia as a cause of death might be linked to the higher reimbursement rates for hospitalization provided by the Federal Compulsory Medical Insurance Fund (FFOMS) in comparison with other competing conditions. Conclusion: the observed increase in pneumonia-related mortality in St. Petersburg may, in part, be attributed to overdiagnosis of pneumonia as the initial cause of death. This phenomenon appears to be influenced by the financial incentives associated with pneumonia-related hospitalizations. To address this issue, revisions to the FFOMS tariff policies are warranted. Furthermore, enhanced monitoring of the accuracy and consistency in the completion of medical death certificates is recommended. Keywords: pneumonia, mortality from pneumonia, concomitant diseases in patients with pneumonia, mortality from chronic coronary heart disease, overdiagnosis of pneumonia, compulsory medical insurance. For citation: Titova O.N., Kuzubova N.A., Kozyrev A.G., Dvorakovskaya I.V., Kroshkina I.Yu., Pogromskaya M.N., Svirido D.A., Stepanenko T.A., Kharitonenko E.Yu., Chermensky A.G. Fatal outcomes analysis in pneumonia patients in St. Petersburg (2020–2024). RMJ. 2025;1:7–12. DOI: 10.32364/2225-2282-2025-1-2