Socio-Demographic Determinants of Mortality from Chronic Noncommunicable Diseases in Women of Reproductive Age in the Republic of Georgia: Evidence from the National Reproductive Age Mortality Study (2014)

Nino Lomia; Nino Berdzuli; Ekaterine Pestvenidze; Lela Sturua; Nino Sharashidze; Maia Kereselidze; Marina Topuridze; Tamar Antelava; Babill Stray-Pedersen; Arne Stray-Pedersen

doi:10.2147/IJWH.S235755

Socio-Demographic Determinants of Mortality from Chronic Noncommunicable Diseases in Women of Reproductive Age in the Republic of Georgia: Evidence from the National Reproductive Age Mortality Study (2014)

Int J Womens Health. 2020 Feb 27:12:89-105. doi: 10.2147/IJWH.S235755. eCollection 2020.

Authors

Affiliations

¹ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
² Department of Noncommunicable Diseases, National Center for Disease Control and Public Health, Tbilisi, Georgia.
³ Department of Clinical and Research Skills, Faculty of Medicine, Iv. Javakhishvili Tbilisi State University, Tbilisi, Georgia.
⁴ Department of Medical Statistics, National Center for Disease Control and Public Health, Tbilisi, Georgia.
⁵ Health Promotion Division, Department of Noncommunicable Diseases, National Center for Disease Control and Public Health, Tbilisi, Georgia.
⁶ EVEX Medical Corporation, Tbilisi, Georgia.
⁷ Department of Obstetrics and Gynecology, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
⁸ Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway.

Abstract

Purpose: Worldwide, noncommunicable diseases (NCDs) are the leading cause of premature death of women, taking the highest toll in developing countries. This study aimed to identify key socio-demographic determinants of NCD mortality in reproductive-aged women (15-49 years) in Georgia.

Materials and methods: The study employed the verbal autopsy data from the second National Reproductive Age Mortality Survey 2014. Univariate and multivariate logistic regression models were fitted to explore the association between each risk factor and NCD mortality, measured by crude and adjusted odds ratio (AOR) with respective 95% confidence intervals (95% CI).

Results: In the final sample of 843 women, 586 (69.5%) deaths were attributed to NCDs, the majority of which occurred outside a hospital (72.7%) and among women aged 45-49 years (46.8%), ethnic Georgians (85.2%), urban residents (60.1%), those being married (60.6%), unemployed (75.1%) or having secondary and higher education (69.5%), but with nearly equal distribution across the wealth quintiles. After multivariate adjustment, the odds of dying from NCDs were significantly higher in women aged 45-49 years (AOR=17.69, 95% CI= 9.35 to 33.50), those being least educated (AOR=1.55, 95% CI= 1.01 to 2.37) and unemployed (AOR=1.47, 95% CI= 1.01 to 2.14) compared, respectively, to their youngest (15-24 years), more educated and employed counterparts. Strikingly, the adjusted odds were significantly lower in "other" ethnic minorities (AOR=0.29, 95% CI= 0.14 to 0.61) relative to ethnic Georgians. Contrariwise, there were no significant associations between NCD mortality and women's marital or wealth status, place of residence (rural/urban) or place of death.

Conclusion: Age, ethnicity, education, and employment were found to be strong independent predictors of young women's NCD mortality in Georgia. Further research on root causes of inequalities in mortality across the socioeconomic spectrum is warranted to inform equity- and life course-based multisectoral, integrated policy responses that would be conducive to enhancing women's survival during and beyond reproduction.

Keywords: education; mortality; noncommunicable diseases; socioeconomic factors; unemployment; women’s health.