Temporal trends in cause-specific mortality in French Guiana, 2001–2023: an analysis of age-standardized mortality rates compared with mainland France and neighboring countries

Background French Guiana is a French overseas territory with a young, rapidly growing population, a high burden of tropical infectious diseases, and an accelerating transition toward non-communicable diseases. This study describes temporal trends in age-standardized mortality rates across 17 cause-of-death categories over 2001–2023, compares trajectories with mainland France, and contextualizes findings within the regional South American environment. Methods Age-standardized mortality rates trends were assessed using the Mann–Kendall test. Territorial divergence was evaluated via difference-in-slopes z-tests. Regional comparisons used WHO World Standard Population rates against GBD 2023 estimates for four North Brazilian border states and Suriname. Results Significant declines were observed for infectious diseases (4.4%/year men, −3.9%/year women), circulatory diseases (−2.0%/year men, −2.5%/year women), perinatal conditions, and male cancer mortality. Significant improvements were concentrated in 2001–2017; post-2017 trends were generally non-significant. Against mainland France, six causes showed significantly divergent trends: perinatal mortality declined toward the national rate; respiratory mortality crossed from below to above the national level; and cancer and circulatory mortality declined more slowly. Subcause analysis identified AIDS/HIV (−8.5%/year, 81% reduction) and alcohol-related disorders (−7.5%/year, now below the national rate) as the most marked improvements. Metabolic disease mortality (rate ratio 2.44 × in 2023) remained persistently elevated. Regionally, French Guiana had substantially lower mortality than neighbors for most causes, while exceeding North Brazilian cancer rates, likely reflecting better ascertainment. Conclusions French Guiana has made substantial mortality gains, particularly for HIV/AIDS, perinatal conditions, and cardiovascular disease, and compares favorably with its South American neighbors. However, its transition remains incomplete: diabetes mortality is widening relative to mainland France, respiratory mortality has crossed to above-national levels, and the 2017 social crisis followed by the COVID-19 crisis appears to have interrupted progress.