Forecasting Spatial Inequalities in Cardiovascular Disease-Related Deaths: A Municipal-Level Assessment of Progress Toward SDG 3.4 in Serbia

Non-communicable diseases (NCDs) are the leading causes of mortality in Serbia, with cardiovascular diseases (CVDs) accounting for a substantial share of premature mortality. In alignment with Sustainable Development Goal (SDG) Target 3.4, which aims to reduce premature mortality from NCD by one-third by 2030 relative to 2015, this study forecasts changes in CVD mortality counts at the municipal level in Serbia. Time-series data for the period 2005–2022 were analyzed within a spatio-temporal forecasting framework implemented in the Space Time Pattern Mining toolbox in ArcGIS Pro (Version 3.1). Three established forecasting models (Curve Fit Forecast, Exponential Smoothing, and Forest-based) were applied, and the most accurate model for each municipality was selected using location-specific municipality-level validation. The results reveal pronounced spatial variation: approximately half of the municipalities (51.2%) are forecasted to experience a decline in CVD mortality counts by 2030, while others are expected to show increases or no statistically significant change. Forecasted differences range from a 15.1% decrease to a 13.9% increase across municipalities, indicating heterogeneous spatial trajectories and suggesting that achieving SDG Target 3.4 may remain challenging without targeted interventions across municipalities where mortality reductions are not forecasted. Although the study does not introduce new forecasting methods, it provides a novel spatially disaggregated application of multi-model forecasting to support municipality-level monitoring of SDG 3.4. The results underscore the need for geographically differentiated public health policies and demonstrate the value of spatial forecasting approaches for supporting equitable and targeted health planning.