The temporal trend of cause-specific mortality: comparing Estonia and Lithuania, 2001 – 2019
What are the main take-aways?
- Researchers studied differences in life expectancy between the two Baltic countries Estonia and Lithuania.
- The method used was analysis of yearly mortality data, looking at both all-cause mortality and eight major disease categories, including:
- ischemic heart disease,
- cerebrovascular disease, all other cardiovascular disease,
- digestive diseases,
- self-harm and interpersonal violence,
- unintentional injuries and related conditions.
- The results of the analysis show that there has been a steeper decline in both all-cause mortality and in mortality due to ischemic heart disease in Estonia compared to Lithuania.
- Identifying the causal factors leading to the differences found between these countries will require additional studies. However, when it comes to the steeper decline of ischemic heart disease in Estonia, the researchers say that it “could be due to a large increase in alcohol taxation just prior to 2009”.
- Recent alcohol control policy changes have begun to reverse alcohol consumption trends in both countries.
Lithuania has decreased its alcohol consumption from a peak of 14.7 L of pure alcohol consumption per capita (15 + years of age) in 2011, to 11.1 L of pure alcohol consumption per capita (15 + years of age) in 2019.
Estonia, on the other hand, has more substantially decreased its consumption from an earlier peak of 14.8 L of pure alcohol consumption per capita in 2007, to 10.4 L of pure alcohol consumption per capita in 2019.”Tran et al BMC Public Health (2022) 22:1984
Despite being two Baltic countries with similar histories, Estonia and Lithuania have diverged in life expectancy trends in recent years. The researchers investigated this divergence by comparing cause-specific mortality trends.
The researchers obtained yearly mortality data for individuals 20 + years of age from 2001–2019 (19 years worth of data) through Statistics Lithuania, the Lithuanian Institute for Hygiene, and the National Institute for Health Development (Estonia).
Using ICD-10 codes, the researchers analyzed all-cause mortality rates and created eight major disease categories: ischemic heart disease, cerebrovascular disease, all other cardiovascular disease, cancers (neoplasms), digestive diseases, self-harm and interpersonal violence, unintentional injuries and related conditions, and other mortality (deaths per 100,000 population).
The researchers used joinpoint regression analysis, and analyzed the proportional contribution of each category to all-cause mortality.
There was a steeper decline in all-cause mortality in Estonia ( -2.55%) as compared to Lithuania ( -1.26%). For ischemic heart disease mortality Estonia exhibited a relatively larger decline over the 19-year period ( -6.61%) as compared to Lithuania (-2.23%).
Estonia and Lithuania showed distinct mortality trends and distributions of major disease categories.
The study findings highlight the role of ischemic heart disease mortality. Differences in public health care, management and prevention of ischemic heart disease, alcohol control policies may explain these differences.
A significant risk factor of ischemic heart disease is heavy episodic alcohol use, and given the history of high alcohol consumption in Lithuania, it would be reasonable to suspect that alcohol may play a significant role in the burden of disease. Despite a decline in all-cause mortality, there was a relatively high proportion of ischemic heart disease deaths. Heart disease is a product of multiple risk factors, many of which are behaviour-based (e.g., diet, exercise, smoking, alcohol consumption). Improving health outcomes in Lithuania may include reducing alcohol consumption, increasing public awareness of risk factors for ischemic heart disease and developing prevention programs for ischemic heart disease.
Indeed, Estonia transitioned to insurance-based healthcare and increased the number of family medicine/general practitioners (which improves access to medical care, and improves patient involvement in healthcare) earlier than Lithuania. As well, there is less funding spent on emergency care in Estonia, and more spent on healthcare management, preventative measures, and out of hospital care. These factors may have led to better treatment of ischemic heart disease, however the causal impact on mortality is an area for future studies.
The researchers identified periods of change using the joinpoint analysis; specifically in 2007 for all-cause mortality in both countries, and 2009 for IHD in both countries.
A key event that may have been related to the change in mortality in 2007 would be the financial crisis, as declining discretionary spending would decrease alcohol consumption and alcohol-attributable harm, as found elsewhere.
- For Estonia there was a steeper decline in IHD, which could be due to a large increase in alcohol taxation just prior to 2009.
- Other contributing factors may include healthcare spending, or alcohol control policies as they relate to IHD.