Changes in mortality inequalities between rural and urban populations in the Republic of Moldova after independence

Abstract

In the Republic of Moldova, life expectancy started growing moderately since 2005 after decades of deterioration. Little is known about changes in mortality differences between rural and urban populations. The research aimed to analyse rural-urban disparities in mortality by sex and cause of death in the Republic of Moldova since independence. Material and methods. Age-standardized death rates were computed by sex and cause for different periods since 1991. Absolute and relative inequalities in mortality were computed with 95% confidence intervals. Results. A positive rural-urban gradient was identified for major cause-of-death groups, except for neoplasms and infectious diseases. The socioeconomic crisis of the 1990s was accompanied by a reduction in mortality disparities as a result of considerable growth in cardiovascular mortality among urban men and women. In rural areas, the crisis led to an increase in mortality, mainly from respiratory system diseases and digestive system diseases. Recent progress in population health observed nationally after 2005 has been accompanied by a widening rural-urban gap due to faster improvements in urban areas. Conclusions. Even though all-cause mortality was consistently lower for the urban population than for the rural population, the former was more sensitive to the socioeconomic crisis of the 1990s and the COVID-19 pandemic than the latter. To reduce rural-urban inequalities in mortality, preventive measures need to target key risk factors for diseases of the circulatory, digestive and respiratory systems and external causes in rural areas. The study was carried out in the framework of Project 21.00208.8007.02/PD “Socio-demographic and regional mortality disparities in the Republic of Moldova”