National trends and regional disparities in age-standardized premature mortality from noncommunicable diseases in the Republic of Moldova, 2014-2023

Abstract

Introduction Noncommunicable diseases (NCDs) are the leading cause of premature mortality worldwide and in the WHO European Region. Aim of the study To assess trends in age-standardized premature mortality from NCDs in the Republic of Moldova between 2014 and 2023. Material and methods A retrospective ecological study was conducted using depersonalized data from official medical death certificates (Form 106/e). Deaths among persons aged 30-69 years were analysed. Causes of death were classified according to ICD10 into four WHO-defined NCD groups: cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes. Age-standardized premature mortality rates (ASPMR per 100,000) were calculated using the direct standardization method with the 2014 Republic of Moldova census population as the standard. Ninety-five percent confidence intervals were estimated using the Fay and Feuer method, (p<0.05 was considered statistically significant). Analyses were stratified by sex, urban/rural residence, and four administrative regions (Chisinau, North, Centre, South). Temporal trends were evaluated by linear regression and average annual percent change (AAPC). Results A total of 100,524 premature deaths were recorded. Cardiovascular diseases accounted for 60.1% of deaths, followed by cancers (35.5%), chronic respiratory diseases (2.4%), and diabetes (2.1%). Overall ASPMR from all major NCDs declined from 740.8 per 100,000 in 2014 to 584.0 per 100,000 in 2023 (absolute reduction: 156.8 per 100,000; relative reduction: 21%). The trend was statistically significant (AAPC -5.8%; 95% CI: -7.49 to -4.14; p<0.001). ASPMR declined across all subgroups during 2014-2023: males (993.34 to 830.99 per 100,000; -162.35 or -16.3%); females (512.28 to 359.00 per 100,000; -153.28 or -29.9%); urban areas (675.45 to 501.56 per 100,000; -173.89 or - 25,8%); rural areas (786.42 to 644.53 per 100,000; -141.89 or -18.0%). Between 2014 and 2023, the largest overall ASPMR decline occurred in Chisinau (-19.4%), followed by the Centre (-16.7%), North (-14.5%), and South (-12.8%). Cardiovascular diseases were the primary contributor across all regions. Despite improvements, the North and South regions exhibited persistently higher ASPMR than Chisinau, indicating regional disparities in premature NCD mortality. Conclusion The Republic of Moldova achieved substantial progress toward SDG 3.4, with a 21.2% decline in ASPMR primarily driven by improved cardiovascular disease control. Consistent improvements across all demographic and geographic strata reflect the effectiveness of national policies. Regional disparities require targeted interventions, including strengthening rural cardiology services, expanding cancer screening programs and health equity programs to meet SDG targets.