Socio-demographic and regional disparities of mortality in the Republic of Moldova: Abstract of the Doctoral Habilitation Thesis in Medical Sciences: 331.03. Social medicine and management

Abstract

Mortality analysis is the primary approach to assessing population health in demography and public health. Over the centuries, mortality has been the main determinant factor of population change and remains so in many developing countries [1]. For decision-making and the evaluation of health policies, mortality analysis has been and continues to be indispensable. In recent years, as all countries have faced an unprecedented COVID-19 pandemic, it has become especially critical. The availability of mortality data in conjunction with the population register or census has facilitated many studies of social and regional differences in mortality trends and patterns. A number of large international projects are looking at international differences in mortality at the regional level, contrasting national borders with “health” borders [2]. “Disparities” or “inequalities” in health are defined in the literature as differences in health outcomes, such as mortality or morbidity rates, or in the distribution of health determinants among different population groups (e.g., by sex, place of residence, level of education or marital status) [3]. Sociodemographic and regional disparities in mortality within a country or region are wellknown and very persistent in many countries, even in the highly developed states of Western Europe [4]. Significant differences in health were found between socioeconomic groups of the population, with people with lower levels of education, occupation or income being at greater risk of premature death [5]. Health inequalities result from differences between population groups in a wide range of health determinants, such as living conditions, education, occupation and income; health-related behaviours; health care, disease prevention and health promotion services; and public policies that influence the quantity, quality and distribution of these factors [6]. The issue of high mortality is critical for the Republic of Moldova (or Moldova), which ranks last in Europe for life expectancy at birth. In 2019, these figures were 66.8 years for men and 75.0 years for women, 13.0 and 10.4 years, respectively, lower than in France and 12.0 and 8.3 years lower than in Germany. High mortality has significant negative consequences for any country. It accelerates the process of depopulation, devalues investment in education and training of skilled workers, hampers economic growth and limits the possibilities for insuring pensioners. Previous studies on mortality show that, in spite of large fluctuations in the late 1980s and 1990s, life expectancy at birth in Moldova is at the same level as in the mid-1960s for men and the late 1970s for women [7]. The lack of significant progress in life expectancy stems from persistent differences in health status between different demographic, regional and social groups of the Moldovan population. For these reasons, analysis of mortality at the national level alone is often insufficient to develop effective interventions to overcome the current public health crisis. Reducing inequalities in population health is the main objective outlined in all major national and international health policy documents. An effective solution to the problem of high mortality in Moldova should aim to reduce mortality in a manner that also addresses disparities between regions and various socio-demographic groups. In the case of Moldova, the objective analysis of demographic processes is complicated by the lack of reliable population estimates for the years preceding the last census conducted in 2014, which has led to an information and scientific vacuum regarding the evolution of the main demographic processes in the country. Several researchers have addressed the issue of mortality in Moldova in different contexts: maternal and infant mortality (Gh. Paladi and C. Etco), sociomedical aspects of old-age mortality (D. Tintiuc), epidemiological aspects of cancer mortality (T. Grejdean), mortality related to cerebrovascular diseases (E. Zota and L. Spinei); socio-medical aspects of mortality in the working-age population in urban (O. Lozan) and rural areas (N. Bologan), trends in premature mortality from various cardiovascular diseases (E. Raevschi), the evolution of mortality (O. Gagauz et al.) and demographic processes (C. Matei, V. Sainsus) after the proclamation of independence. Although a large number of studies have been conducted in the field of mortality analysis in Moldova, no in-depth analyses of socio-demographic and regional differences in mortality have been carried out in the context of assessing the quality of primary statistical data. The aim of the thesis is to examine the long-term trends and social and regional differences in mortality in the Republic of Moldova in the context of a data quality assessment and to elaborate recommendations for improving mortality monitoring and reducing disparities in mortality. [...]