Leading causes of death of women of reproductive age in the Republic of Georgia: findings from the National Reproductive Age Mortality Survey (2014)

Abstract

PurposeAn understanding of women’s health problems during the reproductive years, based on reliable cause-of-death data, is of critical importance to avoid premature female mortality. This study aimed to investigate mortality levels, cause-specific patterns, and trends in women of reproductive age in Georgia.Materials and methodsThe National Reproductive Age Mortality Survey (2014) was conducted to identify all causes of death for women aged 15–49 years in 2012. The leading causes were compared with those in 2006, using directly age-standardized death rates (ASDRs). The accuracy of official cause-of-death data was assessed against verbal autopsy (VA) diagnoses, using kappa statistics, sensitivity, positive predictive value, and misclassification analyses.ResultsOf 913 eligible deaths, VAs were completed for 878 deaths. Noncommunicable diseases (NCDs) were the dominant causes of death (69.6% or 53.1/100,000), with cancer taking a major toll (45.2% or 34.5/100,000), followed by injuries (18.6% or 14.2/100,000). Breast cancer (12.5%), road injuries (9.1%), cervical cancer (6.5%), cerebrovascular diseases (5.2%), uterine cancer (4.1%), brain cancer (3.4%), suicide (3.1%), stomach cancer (3.0%), maternal disorders (2.6%), and liver cirrhosis (2.2%) contributed to the 10 leading specific causes of death, with the majority being substantially underreported in official statistics. This was primarily due to a significantly higher proportion (84%, p<0.05) of deaths routinely assigned ill-defined codes. Since 2006, statistically significant changes in ASDRs, with declines, were observed only for undetermined causes (40%, p<0.05) and ovarian cancer (54%, p<0.05); ovarian cancer and tuberculosis were replaced by stomach cancer and liver cirrhosis in the top 10 cause-of-death list.ConclusionNCDs continue to be the major health threats for Georgian women of reproductive age. The VA method proved a feasible tool to yield essential cause-of-death information for this population. Further research is needed to inform national health promotion and disease prevention interventions to be focused on NCDs and reproductive health needs with an integrated approach.

<p>Socio-Demographic Determinants of Road Traffic Fatalities in Women of Reproductive Age in the Republic of Georgia: Evidence from the National Reproductive Age Mortality Study (2014)</p>

“…9,13,15,35 While graduated licensing schemes may also provide an efficient avenue towards the prevention of risky road use and fatal or severe traffic crashes in young adults, 27,28,35 it seems critical the seat-belt law in Georgia to cover not only front but also rear seat occupants, with a potential to reduce fatal injuries by up to 25% when combined with strong and sustained enforcement. 1,19 The observed evidence of a non-significant association between ethnic background and fatal traffic injuries echoes the results from previous national cohort studies in Switzerland and Sweden, showing country of origin to have no strong effect on RTI mortality, 36,37 which is also true for the flat ethnic/racial gradient derived from the US nationally representative study. 11 This pattern has been supported by the longitudinal evidence from Netherlands for female victims overall, including car occupants, and 15-24-year age group, but not for female pedestrians and those aged 25-49 years, with the ethnic minorities' strong disadvantage.…”

“… 9 , 13 , 15 , 35 While graduated licensing schemes may also provide an efficient avenue towards the prevention of risky road use and fatal or severe traffic crashes in young adults, 27 , 28 , 35 it seems critical the seat-belt law in Georgia to cover not only front but also rear seat occupants, with a potential to reduce fatal injuries by up to 25% when combined with strong and sustained enforcement. 1 , 19 …”

“…Information on premortem illness signs and symptoms, as well as socio-demographic characteristics and place of death was obtained by skilled interviewers using the VA instrument developed for the first national RAMOS 2008. 18 , 19 Of the 913 eligible deaths, 878 VAs were successfully completed, thus yielding a response rate of 96.2%.…”

“…20 The detailed data collection and cause-of-death certification approaches for the RAMOS 2014 have been previously described elsewhere. 19 …”

“…4 The neglected incongruity between the unabated trends in fatal traffic injuries and effective response has been reflected in the findings from the two national reproductive age mortality surveys (RAMOS 2008 andRAMOS 2014), documenting the significant underestimation of RTI-related deaths in routine statistics, while also identifying RTIs as the second leading cause of death in women of reproductive age (15-49 years) and the principle cause of death among those aged 15-35 years both in 2006 and 2012, with a worrying mortality plateau over this period of time. 18,19 Such a disturbing trend brings into focus the need for research-based and contextsensitive countermeasures to curb RTI epidemics and thus, redress social injustice in this area.…”