Causes of Fluctuating Mortality in Romania

During the post-communist transition, Romanians experienced some of the highest mortality rates in eastern Europe, some of the greatest fluctuations in life expectancy and some of the greatest delays in recovery. This study examines the shifts in cause-specific mortality underlying these fluctuations. Using demographic methods to understand the peaks and troughs in life expectancy during the past twenty years, we explore several explanations for these fluctuations: changes in exposure and behaviour associated with the social, economic and political changes; changes in health care affecting amenable causes of death and the progression of the epidemiologic transition. Throughout this period, there is a continuing shift from infectious towards chronic diseases mortality. Psycho-social stress during the period of transition affected survival, evidenced by increases in suicides and differences in mortality between men and women. Amenable causes of death took a greater toll on life expectancy, and increases in tuberculosis and congenital heart abnormality mortality provide evidence of a weakening of health services. However, decreases in vaccine-preventable mortality demonstrate that the health system did not fully fail. Policy changes also affected survival, including decreasing abortion-related mortality and, after initial increases in accidental mortality, new improvements, especially in traffic fatalities.