Regional mortality disparities in Central and Eastern Europe 2000-22

European integration significantly influenced regional development in Central and Eastern Europe (CEE), yet evidence on regional mortality disparities is scarce. This study examines regional disparities in all-cause, cancer, cardiovascular, and external death rates in Czechia, Estonia, Lithuania, Poland, Romania, and Slovakia during 2000-22.

We collected official data on population and death counts by sex, age, cause, and region. A spline-based model was used to smooth the mortality surface and estimate stable age-standardized death rates (SDR). We calculated measures of absolute and relative disparities in regional SDR and examined their trends using segmented regression.

In most CEE countries, absolute disparities in all-cause, cardiovascular, and external SDR have reduced over time, while relative disparities in cardiovascular SDR have increased. Trends in cancer SDR disparities varied between the countries. We detected increases in absolute, but not relative (except in Czechia), all-cause mortality disparities during the COVID-19 pandemic.

While reduced absolute mortality disparities represent a significant public health victory, increased relative disparities and overall disparities in some settings indicate the emergence of regions falling behind in mortality improvements. Our findings point to possible regional differences in health system capacities to address emerging or complex diseases by rapidly implementing health innovations.