Amenable Mortality Inequalities and Their Changes by Sex and Place of Residence During 1990-2023: The Case of Lithuania

Introduction Although it is stated that healthcare and access to healthcare services in Lithuania are good, the research results show that people living in rural areas face greater challenges in accessing healthcare [1–3]. Amenable mortality indirectly demonstrates the efficiency and quality of the healthcare system. According to the Institute of Hygiene, the mortality rate in Lithuania that could be avoided through quality healthcare measures was higher in rural areas than in urban areas [4]. Although avoidable mortality indicators are used in political documents to evaluate healthcare, the long-term changes in this indicator have not been thoroughly examined [5,6]. Aim The aim of this study was to analyse inequalities of amenable mortality by sex and place of residence and its changes in Lithuania during 1990–2023. Methods Information on deaths was obtained from the State Data Agency and the Institute of Hygiene. Mortality rates from amenable causes of death by urban and rural among men and women were calculated per 100,000 population and were standardized by age. Inequalities in mortality were assessed using rate differences. For the assessment of the trends of mortality and its inequalities during 1990–2023, joinpoint regression analysis was applied. Results During 1990–2023, amenable mortality of men and women in rural areas was higher compared to urban areas (P < 0.05). During the analysed period, mortality trends for men and women in urban and rural areas varied unevenly. In urban areas, male mortality statistically significantly increased only during 1999–2006, while female mortality statistically significantly increased during 1990–1995 in urban areas and 1990–1994 in rural areas. Mortality decreased in urban areas only during 2007–2023, while in rural areas it decreased during 1994–2007 and 2007– 2018. The fastest decline in female mortality occurred in rural areas during 2007–2018 (on average, by 3.76% per year). During 1990–2023, differences in male and female mortality rates varied unevenly. Inequalities of men’s mortality decreased during 1990–2001 and 2005–2012, and inequalities of women’s mortality decreased during 1993–2006, 2006–2021 (P < 0.05). Inequalities of men’s mortality decreased most rapidly during 2005–2012 (on average, by 10.67% per year), while inequalities of women’s mortality decreased most rapidly during 2006–2021 (on average, by 10.92% per year) (P < 0.05). Conclusions During 1990–2023, inequalities in amenable mortality among rural and urban men and women in Lithuania remained high and changed unevenly. Male inequalities declined in 1990–2001 and 2005–2012, while female inequalities decreased in 1993–2006 and 2006–2021. Mortality decreased in urban areas (2007–2023) and in rural areas (1994–2007, 2007–2018). Persistent disparities highlight the need for targeted health policies, especially for men.