Mortality from external causes in Lithuania: looking for critical points in time and place.
OBJECTIVE
A study was undertaken to analyse trends in mortality from major external causes of death, and to detect urban/rural differences by cut points over the period of socioeconomic transition.


METHODS
Information on deaths from major external causes (traffic accidents, suicides, and homicides) for the 1990-2000 period was obtained from Lithuanian Department of Statistics. Mortality rates were age standardized, using the European standard, and analysed, according to (urban/rural) residence and sex. The Jointpoint analysis was used to identify the best-fitting points, wherever a statistically significant change in mortality occurred.


RESULTS
The most critical point for external causes of mortality during the period of transition was the year 1994, when an increasing mortality trend reversed to a decreasing one. Mortality from suicides primarily caused these positive changes. Changes in mortality from traffic accidents were not significantly associated with the period under analysis. Numerous less favourable trends in rural areas, including suicide rates, traffic accidents, and homicides, are likely to stratify urban/rural health outcomes in the future.


CONCLUSIONS
Despite a recent decline, mortality from external causes remains at an extremely high level in Lithuania. Future progress requires sustained improvements in prevention, and serious attention to external causes of death in health policy development.
Kalediene
Ramune
R
Faculty of Public Health, Department of Social Medicine, Kaunas University of Medicine, Kaunas, Lithuania. kaleda@kaunas.omnitel.net
Starkuviene
Skirmante
S
Petrauskiene
Jadvyga
J
D002423:Cause of Death / Q000639:trends*; D005260:Female; D006801:Humans; D008097:Lithuania / Q000453:epidemiology; D008297:Male; D012424:Rural Population / Q000706:statistics & numerical data; D012922:Social Change; D012935:Social Justice; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data