Lomia Nino, Berdzuli Nino, Pestvenidze Ekaterine, Sturua Lela, Sharashidze Nino, Kereselidze Maia, Topuridze Marina, Antelava Tamar, Stray-Pedersen Babill, Stray-Pedersen Arne
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Department of Noncommunicable Diseases, National Center for Disease Control and Public Health, Tbilisi, Georgia.
Int J Womens Health. 2020 Feb 27;12:89-105. doi: 10.2147/IJWH.S235755. eCollection 2020.
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.
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).
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.
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.
在全球范围内，非传染性疾病（NCDs）是女性过早死亡的主要原因，在发展中国家造成的损失最大。本研究旨在确定格鲁吉亚生殖年龄妇女（15 - 49岁）非传染性疾病死亡率的关键社会人口学决定因素。
本研究采用了2014年第二次全国生殖年龄死亡率调查的口头尸检数据。采用单变量和多变量逻辑回归模型，以粗比值比和调整后的比值比（AOR）及其各自的95%置信区间（95%CI）来衡量，探讨每个风险因素与非传染性疾病死亡率之间的关联。
在843名妇女的最终样本中，586例（69.5%）死亡归因于非传染性疾病，其中大多数发生在医院外（72.7%），且发生在45 - 49岁的妇女中（46.8%）、格鲁吉亚族妇女（85.2%）、城市居民（60.1%）、已婚妇女（60.6%）、失业妇女（75.1%）或受过中等及高等教育的妇女（69.5%）中，但在财富五分位数中分布几乎相等。多变量调整后，45 - 49岁的妇女死于非传染性疾病的几率显著更高（AOR = 17.69，95%CI = 9.35至33.50），受教育程度最低的妇女（AOR = 1.55，95%CI = 1.01至2.37）和失业妇女（AOR = 1.47，95%CI = 1.01至2.14），分别与其最年轻（15 - 24岁）、受教育程度更高和就业的同龄人相比。令人惊讶的是，相对于格鲁吉亚族，“其他”少数民族的调整后几率显著更低（AOR = 0.29，95%CI = 0.14至0.61）。相反，非传染性疾病死亡率与妇女的婚姻或财富状况、居住地点（农村/城市）或死亡地点之间没有显著关联。
年龄、种族、教育和就业被发现是格鲁吉亚年轻女性非传染性疾病死亡率的强有力独立预测因素。有必要对社会经济各阶层死亡率不平等的根本原因进行进一步研究，以便为基于公平和生命历程的多部门综合政策应对提供信息，这将有助于提高妇女在生育期间及之后的生存率。
