Geographical divides in male premature mortality in the CEE-FSU European region: an ecological study of 2320 spatial units in 12 countries, 2003-2019.

Introduction: Male premature mortality has been one of the most critical components of the persistent health disadvantage observed in the countries of the former Soviet Union (FSU) and Central-Eastern Europe (CEE). The spatial dimension of this phenomenon has remained largely unexplored. Methods: We created a unique collection of harmonised regional cause-specific mortality data to assess spatiotemporal patterns of male premature mortality across 2320 territorial units in 12 FSU and CEE countries during 2003-2019. As an indicator of premature mortality, we apply the age-standardised mortality rate for the age group 20-64 years. Choropleth maps are employed to visualise the spatial patterns for all-cause and cause-specific mortality as well as statistically significant Results: Between 2003 and 2019, there was a substantial reduction in mortality levels across all countries and spatial units as well as a slight reduction in regional inequality. The most pronounced mortality disparities are visible within the FSU block: between regions of Russia and the Baltic States as well as between the neighbouring regions of Belarus and Ukraine. Several countries exhibit spatial gradients that are occasionally extending into neighbouring countries. The most notable gradients include a North-West-South gradient in Russia and East-West mortality divides in Hungary, Romania and Poland. Conclusion: Despite notable political and socioeconomic differences between the former socialist countries, the spatial mortality patterns have remained remarkably persistent across and within them. Historical and sociocultural contexts should be considered while interpreting contemporary mortality patterns.