Inequalities and changes in mortality from leading causes in pre-pandemic and during COVID-19 pandemic in Lithuania

The COVID-19 pandemic has profoundly disrupted global health systems, contributing to significant shifts in mortality patterns. Beyond the direct impact of the virus, the pandemic has exacerbated existing health inequalities and introduced new inequalities in mortality from leading causes of death in Lithuania. The aim of this study was to investigate inequalities and trends in mortality from leading causes of death based on residential location, comparing the period prior to the COVID-19 pandemic with the period during the pandemic in Lithuania. This study analyzed mortality data from 2017 to 2023 (pre-pandemic period 2017–2019, pandemic period 2020–2023) by gender, age group (< 65/65+), and place of residence (urban/rural), using data from the State Register of Death Cases and Their Causes and the Statistics Department of Lithuania. Mortality was assessed for three major causes of death: cardiovascular diseases, cancer, and respiratory diseases. The Mann–Whitney U test was used to compare groups, and Join point regression analysis was applied to evaluate trends in mortality inequalities. Among individuals aged 65+, respiratory system-related mortality rates were significantly higher during the pandemic in both urban and rural populations compared to pre-pandemic period (p = 0.001 and p = 0.003). The mortality due to respiratory system diseases showed a notable increase, particularly among females aged 65+. In urban areas, mortality increased from 17.06 to 80.68 per 100,000, while in rural areas, it rose from 25.20 to 110.40 per 100,000 (p = 0.001). Mortality from malignant neoplasms of the rectum significantly declined in rural males (AAC = -6.71, p = 0.01). Pneumonia mortality significantly declined in urban males (AAC = -7.96, p = 0.001), while rural females exhibited a significant decline in chronic obstructive pulmonary disease mortality (AAC = -25.22, p = 0.043). The study reveals urban–rural and gender differences in mortality during the COVID-19 pandemic in Lithuania, with older adults—especially rural males and urban females—experiencing increased deaths from respiratory diseases, including COVID-19. These findings may also support broader discussions on reducing health inequalities and strengthening health system resilience to better prepare for future public health challenges. The COVID-19 pandemic disproportionately affected older adults, with significant increases in respiratory system disease-related mortality among rural males and urban females aged 65 and older, highlighting urban–rural and gender inequalities in health outcomes. These findings emphasize the need to strengthen healthcare system resilience through improved primary care, telemedicine, and crisis preparedness to reduce health inequalities and better respond to future public health crises.