Spatial disparities in mortality by causes of death in the Republic of Moldova

Abstract

Background: Previous studies have shown long-term unfavourable changes in mortality in the Republic of Moldova accompanied by recent improvements. Little is known about the regional mortality differentiation which is an important tool for evidence-based public health policy. The aim of the study is to assess the current geographical disparities of all-cause and cause-specific mortality in Moldova and to identify evidence-based modalities to reduce them. Material and methods: This cross-sectional study is based on the corrected results of the 2014 census and individual death records for the 2012-2016 period provided by the National Agency for Public Health. Global Moran’s index and local indicators of spatial autocorrelation were computed based on contiguity matrix. Results: All-cause mortality gradient between the northern and central regions was found for males (Moran’s index=0.47, p<0.001) and females (Moran’s index=0.44, p<0.001). Digestive and cardiovascular diseases for both sexes and external causes of death for males had a statistically significant influence on the inter-regional mortality differentiation. Liver cirrhosis contributed the most to the geographical difference between the North and the Centre (Moran’s index=0.59, p<0.001), especially for females. Conclusions: The results of this study point to the existence of different drinking habits of the Moldovan population between the northern and central regions. The central regions that form the cluster of “high-high” mortality from liver cirrhosis should be considered as primarily targets for antialcohol policies

"Geographical Variation in Mortality Rate From Liver Disease in the Republic of Moldova"

“…The period of decline in liver disease mortality recorded in the country since 2005 in females and since 2010 in males is consistent with the progress of overall mortality 10 . On a geographical level, progress has been made in the northern and southern regions and less in the centre.…”

“…The socioeconomic crisis of the 1990s hit the country immediately after declaring its independence in 1991 following a brutal transition to a market economy. In Moldova, this period was characterized by large fluctuations in mortality from socially sensitive groups of causes of death, mainly cardiovascular diseases and deaths due to injury and poisoning 10 . Liver cirrhosis mortality in the early 1990s stagnated rather than increased, which may be partially explained by the echo of the Soviet anti-alcohol campaign in 1985-1987.…”

“…While the period of stagnation in the first decade of a new millennium was characterized by relatively stable life expectancy, mortality from liver disease began to increase moderately at the national level 10 . Standardized mortality rates associated with liver disease increased across the country, except in the municipality of Chisinau.…”

“…The reduction of standardized death rates from this cause of death was more than 30% between 1984 and 1989 for both sexes. The effect of the anti-alcohol campaign showed a high dependence of the adult mortality on alcohol consumption in Moldova like in other former Soviet republics 9,10 . Following a considerable, but brief decline in the late 1980s, mortality from liver disease stagnated in the 1990s and increased moderately in the first decade of the new millennium.…”

“…The mortality data were aggregated based on a shortlist of main causes of death, including liver disease (571-573 under ICD-9 and K70-K77 under ICD-10). Before the analysis, ill-defined causes of death were redistributed among other causes with a special approach for the 1990s because of the increase in senility deaths 10 .…”