Aspecte regionale ale speranţei de viaţă în Republica Moldova

In the article, the regional aspects of life expectancy are analyzed based on the calculated abridged life-tables for 2006 year. There is a huge differential of life expectancy between the North and the municipal cities on the one hand and the South and the Centre on the other hand. The contribution of the main age groups to the formation of this regional difference, as well as the correlation between the regional heterogeneity of mortality and population ageing process is shown

Long-term trends in cancer mortality in the Republic of Moldova

Nicolae Testemitanu State University of Medicine and Pharmacy, Republic of MoldovaIntroduction. Cancer ranks second among the cause-of-death mortality patterns in the Republic of Moldova for both sexes and accounts for 16% of the overall mortality. The aim of the study is to analyze trends in cancer mortality by detailed cause in the Republic of Moldova for the period of 1965-2018 based on the continuous cause-of-death time series reconstructed in terms of the 10th revision of the International Classification of Diseases and Causes of Death. Material and methods. This present study was based on the reconstructed cause-ofdeath time series for the Republic of Moldova published in The Human Cause-of-Death Database (www.causesofdeath.org) for the period 1965-2014 and prolonged until 2018. Population counts for 1965-2014 are intercensal estimates and for 2015-2018 are postcensus estimates. The direct method of standardization was used for data analysis. Results. The overall trend in cancer mortality during 1965-2018 is characterized by absolute insensitivity to the social and economic circumstances such as M. Gorbachev’s antialcohol campaign and the socio-economic crisis of the 1990s. After the gradual increase in the 1980s, the trend in cancer mortality reversed and began declining in the 1990s. This downward trend was in sharp contrast with a huge upsurge in cardiovascular mortality and violent deaths due to the social and economic crisis of the 1990s. From the late 1990s onwards, the mortality trend resumed its growth and has continued up to now. Tobacco and alcohol-related cancer mortality (of respiratory system, upper aerodigestive tract and urinary system) manifested a stable increase during 1965-2018. After a quick increase in the 1980s, mortality due to lung cancer showed a moderate decline in the first half of the 1990s followed by a steady growth. To explain the decline in mortality from lung cancer in the 1990s, we assume the hypothesis on competing risks earlier proposed to explain the same phenomenon, at least partially, in Russia and Ukraine. We suggest that the rapid growth of mortality from diseases of the circulatory system and accidents caused by the economic and the social crisis of the 1990s, increased the risk of dying from these causes among people suffering from cancer. Breast cancer has followed a growing tendency for the period under study. Between 1965 and 2018 the standardized mortality rates increased by 2.5 times, which is linked, first, to the late diagnosis of the disease. Uterine cancer mortality, on the contrary, declined, especially fast in the 1970s and 1980s. Standardized mortality rates from stomach cancer reduced more than by three times in males and twice in females between 1965 and 2018. At the same time, the bowel cancer mortality and other digestive organs increased significantly. Conclusions. Although the overall trend in cancer mortality is increasing in males and more or less stable in females in 1965-2018, the analysis of the detailed causes revealed the opposite trends. For certain causes (stomach and uterus cancer) some progress has been achieved, while for other causes (lung, breast and intestine cancer) the situation has deteriorated significantly. The moderate decline in lung cancer in the 1990s must be interpreted with caution

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

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

Cardiovascular mortality in Central and Eastern Europe: differences and similarities

Objective. To identify differences and similarities in trends and patterns of cardiovascular mortality in Central (Romania and Poland) and Eastern (Moldova and Ukraine) European countries before and after the political transition. Material and methods. The mortality series reconstructed according to ICD-10 since 1970 for Moldova, Ukraine and Poland and since 1980 for Romania were used. Directly standardized death rates by sex, age and detailed cardiovascular disease were computed. Results. After a long period of stagnation or rise, cardiovascular mortality started declining after 1991 in Poland, 1995 in Moldova, 1997 in Romania and 2005 in Ukraine. The progress in Romania and Poland was associated with both heart diseases and cerebrovascular diseases. In Moldova and Ukraine, the recent improvements were primarily related to cerebrovascular diseases. Compared to Central Europe, the quality of codification of heart diseases was found poor in Eastern Europe. Conclusions. The lack of effective control of mortality from heart diseases is the major public health problem in Moldova and in pre-war Ukraine. Romania and Poland follow very similar mortality patterns and trends, though with a certain time lag

REGIONAL CHANGES IN LIFE EXPECTANCY AND CAUSES OF DEATH IN MOLDOVA AFTER INDEPENDENCE

After the period of fluctuations related to the socio-economic crisis of the 1990s, life expectancy at birth in Moldova mainly stagnated until 2005 in females and 2010 in males. Recent trends show moderate improvements until the COVID-19 pandemic. The article presents regional differences in mortality in Moldova to identify the most problematic districts. Data and methods: regional data on mortality by cause were analysed for three five-year periods around 1993, 2004 and 2014. Differences in life expectancy at birth between the leading districts and the lagging districts were decomposed by age and cause of death. Results: The gradient in life expectancy was revealed between the northern districts and the municipality of Chisinau, where mortality is low, and the belt of the districts located mainly in the centre, where mortality is high. Cardiovascular and digestive diseases in both sexes, as well as external causes of death in males were responsible for the interregional mortality differentiation. Recent growth in life expectancy was accompanied by an increasing interregional differentiation of mortality from cardiovascular diseases among the elderly and external causes of death among the middle-aged. The progress was the most significant in the municipality of Chisinau, while in the rest of the country, it largely reflected the recovery from the severe socio-economic crisis of the 1990s. Conclusions: The districts falling within the red belt of high mortality have made no progress in terms of population health since independence. In this geographic area, preventive measures aimed at reducing the risk factors associated with cardiovascular disease, liver cirrhosis and external causes of death are needed

Demographic aspects of population health in the Republic of Moldova: trends and perspectives

Catedra de medicină socială și management sanitar, Universitatea de Stat de Medicină și Farmacie „Nicolae Testemiţanu

Tendințele de lungă durată ale mortalității prin cancer în Republica Moldova

Introduction. Cancer is the second cause-of-death mortality pattern in the Republic of Moldova. The study of both cancer mortality by age and its detailed causes is an important tool for evidence-based public health policy. The study aims at comparing recent changes in cancer mortality with long-term trends, depending on specific causes and age. Material and methods. This study was carried out on the reconstructed 1965-2018 death time series, according to the 10th revision of the International Classification of Diseases. Standardized death rates were computed. Results. After a gradual increase in the ‘70s and ‘80s of the last century, cancer mortality rate showed “reversed” patterns and started to decline in the ‘90s. This decline was due to the data quality issue and to the competing risks of dying from other causes sensitive to the social and economic circumstances of the ‘90s. Since the beginning of the millennium, cancer mortality has resumed its growth that continues up to now. Despite the increasing overall trend in cancer mortality rate during 1965-2018, the analysis by age and specific causes revealed opposite trends. Conclusions. The malignant neoplasms specific for certain sites and age groups (stomach, uterus, leukaemia in children) showed, however some therapeutic progress, while the situation for other tumour sites (lung, breast, and intestine) worsened significantly. The moderate decrease in lung cancer in the 1990s should be cautiously interpreted.Introducere. Cancerul ocupă locul al doilea în structura mortalității pe cauze de deces în Republica Moldova. Analiza mortalității pe vârste și cauze detaliate de deces este un instrument important în politica de sănătate publică bazată pe dovezi. Scopul studiului este de a contrasta schimbările recente ale mortalității prin neoplasme, cu tendințele sale pe termen lung, în funcție de cauza detaliată și de vârstă. Material și metode. În acest studiu, ne bazăm pe seriile de timp ale mortalității pentru anii 1965-2018, reconstruite în termenii celei de a 10-a revizuiri a Clasificării Internaționale a Maladiilor, fiind calculate ratele standardizate ale mortalității. Rezultate. După creșterea treptată în anii ‘70 și ’80 ai secolului trecut, tendința mortalității prin cancer s-a inversat și a început să scadă în anii ‘90. Atribuim acest declin problemei calității datelor și riscurilor concurente, de a deceda prin alte cauze mai sensibile la circumstanțele sociale și economice din anii ‘90. De la începutul mileniului, mortalitatea prin neoplasme și-a reluat creșterea, care continuă până în prezent. Deși tendința generală a mortalității prin cancer în anii 1965-2018 este una ascendentă, analiza în funcție de vârstă și de cauză detaliată a relevat tendințe opuse. Concluzii. Pentru neoplasmele maligne ale anumitor localizări și grupe de vârstă (stomac, uter, leucemie la copii) s-au realizat unele progrese, în timp ce pentru alte localizări (plămân, sân și intestin) situația s-a agravat semnificativ. Declinul moderat al mortalității prin cancer pulmonar din anii ‘90 trebuie interpretat cu prudență

Disparitățile spațiale ale mortalității cauzate de deces, în Republica Moldova

Nicolae Testemitanu Department of Social Medicine and Management, Nicolae Testemitanu SUMPhBackground. Previous studies have shown long-term unfavourable changes in mortality in Moldova accompanied by recent improvements. Less is known about the regional mortality differentiation which is an important tool for evidence-based public health policy. Objective of the study. Evaluation of spatial differences in mortality by causes of death in the Republic of Moldova to identify evidence-based modalities to reduce them. Material and Methods. This cross-sectional study is based on the corrected results of the 2014 population census and individual death records for 2012-2016 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. Global Moran’s Index for all causes of death is positive and statistically significant in males (+0.473, p=0.000) and females (+0.438, p=0.000). The most lagging regions in terms of life expectancy at birth from the centre of the country form so called “hot spots” of high-high mortality from cardiovascular diseases and digestive diseases for both sexes and external causes of death for males. The leading northern regions form "cold spots" of low-low mortality for the same causes of death. Liver cirrhosis has the greatest impact on the spatial differentiation of mortality. Conclusion. Cardiovascular, digestive diseases and external causes of death (in males) that determine the unfavourable temporal changes in overall mortality at the national level are also responsible for its spatial disparities.Introducere. Studiile anterioare au arătat schimbări nefavorabile, pe termen lung, ale mortalității în Republica Moldova, însoțite de îmbunătățiri recente. Se cunoaște mai puțin despre diferențierea regională a mortalității, care este un instrument important pentru politica de sănătate publică bazată pe dovezi. Scopul lucrării. Evaluarea diferențelor spațiale ale mortalității cauzate de deces în Republica Moldova, în vederea identificării modalităților bazate pe dovezi de reducere a acestora. Material și Metode. Acest studiu transversal se bazează pe rezultatele corectate ale recensământului populației din 2014 și înregistrările individuale ale deceselor pentru anii 2012-2016, furnizate de Agenția Națională pentru Sănătate Publică. Indicele global al lui Moran și indicatorii locali ai autocorelației spațiale au fost calculați pe baza matricei de contiguitate. Rezultate. Indicele global al lui Moran, pentru toate cauzele de deces, este pozitiv și semnificativ statistic la bărbați (+0.473, p=0.000) și la femei (+0.438, p=0.000). Raioanele aflate în urmă, în ceea ce privește speranța de viață la naștere, din centrul țării, formează așanumitele „puncte fierbinți” de mortalitate ridicată- reprezentate de boli cardiovasculare și de boli ale sistemului digestiv, pentru ambele sexe, precum și de cauze externe de deces la bărbați. Raioanele de frunte, din nordul țării, formează „punctele reci” de mortalitate scăzută-condiționată de aceleași cauze de deces. Ciroza hepatică are cel mai mare impact asupra diferențierii spațiale ale mortalității. Concluzii. Bolile cardiovasculare, cele digestive și cauzele externe de deces (la bărbați), care determină modificările nefavorabile temporale ale mortalității generale la nivel național sunt, de asemenea, responsabile pentru disparitățile spațiale ale acesteia

Cauze de deces şi speranţa de viaţă la naştere în Republica Moldova

Institute of European Integration and Political Sciences of the Academy of Sciences of MoldovaIn the article “Causes of death and life expectancy at birth in the Republic of Moldova”, we present some results of the joint project carried out between the Academy of Sciences of Moldova and the National Institute of Demographic Studies (INED), France. Our study is based on the original method of reconstruction developed at INED (F. Mesle, J. Vallin). We show the impact of broad classes of causes of death to the global changes in life expectancy at birth in Moldova between 1965 and 2008. Cause-specific mortality trends for large groups of cause since the mid 1960s are also presented. Cauze de deces şi speranţa de viaţă la naştere în Republica Moldova În articol sunt prezentate unele rezultate ale proiectului comun între Academia de Ştiinţe a Moldovei şi Institutul Naţional de Studii Demografice din Franţa (INED). Acest studiu se bazează pe metoda originală de reconstituire elaborată la INED (F. Mesle, J. Vallin). Sunt prezentate impactul cauzelor majore ale decesului asupra schimbările globale ale speranţei de viaţă la naştere în perioada anilor 1965-2008, precum şi tendinţele mortalităţii după cauze de deces din mijlocul anilor 1960

Diferențierea geografică a mortalității în Republica Moldova

Introduction. Life expectancy in Moldova after independence either fluctuated in the 1990s or stagnated in the early millennium, followed by moderate improvements since 2010. The objective of the study is to investigate the evolution of regional variations in life expectancy since independence in Moldova and to identify the main demographic components (causes of death and age groups) responsible for interregional mortality inequalities. Material and methods. Five-year average mortality rates by age and cause in the territorial profile were used between: 1991-1995, 2002-2006 and 2012-2016. Abridged life tables and confidence intervals were computed. According to Andreev's method, the difference in life expectancy between the two subpopulations was decomposed. Results. The gap in life expectancy between the best-performing and the worst-performing groups constitutes 6.0 years. Important progress has been made in the municipality of Chisinau and the northern districts of Briceni and Edinet concerning cardiovascular mortality. In 11 districts located mainly in the center, the decline in infant mortality due to respiratory diseases was offset by the growth in adult mortality due to external causes and neoplasms. Conclusions. Regional disparities can be reduced through preventive measures targeting the key risk factors for cardiovascular disease, liver cirrhosis and external causes of death within the backward geographical area.Introducere.Speranța de viață în Republica Moldova, după independență a oscilat în anii 1990 și a stagnat la începutul mileniului, urmată de îmbunătățiri modeste din anul 2010. Obiectivul studiului este de a investiga evoluția variațiilor regionale ale speranței de viață după independență în Republica Moldova și de a identifica principalele componente demografice (cauze de deces și grupe de vârstă) responsabile de inegalitățile interregionale ale mortalității. Material și metode. Ratele medii de mortalitate pe 5 ani în funcție de vârstă și cauză în profil teritorial au fost utilizate pentru trei perioade: 1991-1995, 2002-2006 și 2012-2016. S-au calculat tabelele de mortalitate prescurtate și intervalele de încredere. Diferența privind speranța de viață între două subpopulații a fost descompusă conform metodei lui Andreev. Rezultate. Decalajul în ceea ce privește speranța de viață între grupurile cu cele mai bune performanțe și cele mai slabe performanțe constituie 6,0 ani. S-au înregistrat progrese importante în municipiul Chișinău și în raioanele nordice Briceni și Edineț în ceea ce privește mortalitatea cardiovasculară. În 11 raioane, situate în principal în centru, scăderea mortalității infantile din cauza bolilor respiratorii a fost compensată de creșterea mortalității adulților din cauze externe și neoplasme. Concluzii. Disparitățile regionale pot fi reduse prin măsuri de prevenție care vizează facto-rii majori de risc pentru bolile cardiovasculare, bolile digestive și cauzele externe de deces într-o zonă geografică problematică