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Background Romania has the third highest preventable mortality rate in the European Union that is more than double the average rate in the European Union in 2018. Breast cancer (BC) is a significant driver of global preventable mortality but a few studies from Romania have quantified the degree to which BC influences mortality and morbidity. This study aimed to determine differences in BC mortality between Romania and the European Union. The study also examined urban/rural BC mortality across the eight regions of Romania. Methods Age-standardized BC mortality rates among women were calculated by urban/rural places of residence and by subnational region for 2000–2020, using data provided by the Romanian National Center for Statistics in Public Health, National Institute of Public Health. Age-standardized all-cause, all-cancer, and BC mortality rates were explored for Romania and the European Union for 2000–2017, using data obtained from Eurostat. Urban and rural age-standardized BC mortality rates among women were compared across regions of Romania to national and European rates to examine differences in BC mortality across the country and between urban and rural areas. Joinpoint Trend Analysis was employed to further analyze patterns in mortality rates. Results Age-standardized national BC mortality rate in Romania decreased from 39.60/100,000 women in 2000 to 38.35/100,000 women in 2020, however rates increased in several regions of the country. While BC mortality rates decreased more in urban areas (by 11.1%) than in rural areas (by 1.6%), urban areas still had a higher BC mortality (46.24/100,000 women in 2020) than rural areas (29.37/100,000 women in 2020) throughout the study period. Conclusion The higher BC mortality in Romania compared to other countries in the European countries, the higher mortality rates in urban than rural areas, and the regional variation in mortality rates call for future studies to investigate the possible health care system and care seeking behaviors and the environmental determinants that may have contributed to observed mortality profile. Improving the quality of incidence data in the country through efficient cancer registries could also lead to a better understanding of the variation in mortality rates, which is the premise for more targeted health policies.

Estimates of influenza-associated mortality are important for national and international decision making on public health priorities. Previous estimates of 250 000–500 000 annual influenza deaths are outdated. We updated the estimated number of global annual influenza-associated respiratory deaths using country-specific influenza-associated excess respiratory mortality estimates from 1999–2015. We estimated country-specific influenza-associated respiratory excess mortality rates (EMR) for 33 countries using time series log-linear regression models with vital death records and influenza surveillance data. To extrapolate estimates to countries without data, we divided countries into three analytic divisions for three age groups (<65 years, 65–74 years, and ≥75 years) using WHO Global Health Estimate (GHE) respiratory infection mortality rates. We calculated mortality rate ratios (MRR) to account for differences in risk of influenza death across countries by comparing GHE respiratory infection mortality rates from countries without EMR estimates with those with estimates. To calculate death estimates for individual countries within each age-specific analytic division, we multiplied randomly selected mean annual EMRs by the country's MRR and population. Global 95% credible interval (CrI) estimates were obtained from the posterior distribution of the sum of country-specific estimates to represent the range of possible influenza-associated deaths in a season or year. We calculated influenza-associated deaths for children younger than 5 years for 92 countries with high rates of mortality due to respiratory infection using the same methods. EMR-contributing countries represented 57% of the global population. The estimated mean annual influenza-associated respiratory EMR ranged from 0·1 to 6·4 per 100 000 individuals for people younger than 65 years, 2·9 to 44·0 per 100 000 individuals for people aged between 65 and 74 years, and 17·9 to 223·5 per 100 000 for people older than 75 years. We estimated that 291 243–645 832 seasonal influenza-associated respiratory deaths (4·0–8·8 per 100 000 individuals) occur annually. The highest mortality rates were estimated in sub-Saharan Africa (2·8–16·5 per 100 000 individuals), southeast Asia (3·5–9·2 per 100 000 individuals), and among people aged 75 years or older (51·3–99·4 per 100 000 individuals). For 92 countries, we estimated that among children younger than 5 years, 9243–105 690 influenza-associated respiratory deaths occur annually. These global influenza-associated respiratory mortality estimates are higher than previously reported, suggesting that previous estimates might have underestimated disease burden. The contribution of non-respiratory causes of death to global influenza-associated mortality should be investigated. None.

The neglected zoonosis cystic echinococcosis affects mainly pastoral and rural communities in both low-income and upper-middle-income countries. In Europe, it should be regarded as an orphan and rare disease. Although human cystic echinococcosis is a notifiable parasitic infectious disease in most European countries, in practice it is largely under-reported by national health systems. To fill this gap, we extracted data on the number, incidence, and trend of human cases in Europe through a systematic review approach, using both the scientific and grey literature and accounting for the period of publication from 1997 to 2021. The highest number of possible human cases at the national level was calculated from various data sources to generate a descriptive model of human cystic echinococcosis in Europe. We identified 64 745 human cystic echinococcosis cases from 40 European countries. The mean annual incidence from 1997 to 2020 throughout Europe was 0·64 cases per 100 000 people and in EU member states was 0·50 cases per 100 000 people. Based on incidence rates and trends detected in this study, the current epicentre of cystic echinococcosis in Europe is in the southeastern European countries, whereas historical endemic European Mediterranean countries have recorded a decrease in the number of cases over the time.

Abstract In the framework of the European Population Health Information Research Infrastructure (PHIRI) project, we analysed the healthcare use for depression and/or anxiety during the coronavirus disease 2019 (COVID-19) pandemic. Aggregated monthly number of diagnoses were obtained from electronic health records and databases in Austria, Estonia, Finland, Latvia, Romania, Wales (UK), and Aragon (Spain) and analysed using the PHIRI federated research infrastructure. Rates of diagnosis, prescriptions and visits to primary care, hospital or emergency department were calculated by 10 000 population. Segmented Poisson regression to estimate changes in outcomes after the COVID-19 pandemic declaration was produced controlling for baseline levels and trends for the period January 2017 to December 2021. Following pandemic declaration, level change of incident diagnoses fell in Romania, Aragon (Spain), and Wales (UK) [log rate −0.853 (95% confidence interval −1.045 to −0.661), −0.338 (−0.434 to −0.242), and −0274 (−0.365 to −0.183), respectively]; level change of visits to primary care decreased in Romania and Wales (UK) [−0.347 (−0.555 to −0.138) and −0.272 (−0.368 to −0.177), respectively], and increased in Latvia [0.065 (0.004–0.126)]; level change for hospital admissions diminished in Latvia, Romania and Wales (UK) [−0.206 (−0.393 to −0.019), −0.947 (−1.143 to −0.752) and −0.116 (−0.202 to −0.030), respectively]; and level change of visits to emergency units fell in Latvia and Romania [−0.290 (−0.429 to −0.151) and −0.865 (−1.040 to −0.690), respectively] and increased in Aragon (Spain) [0.880 (0.259 to 1.502)]. COVID-19 pandemic declaration altered the use of mental health resources. This study highlights the potential use of harmonized data for providing evidence for future pandemic preparedness.

Tobacco is the leading preventable cause of death globally and tobacco taxation is a cost-effective method of reducing tobacco use in countries and increasing revenue. However, without adequate enforcement some argue the risk of increasing illicit trade in cheap tobacco makes taxation ineffective. We explore this by testing sub-national variations in the impact of tobacco tax increases from 2009 to 2011, on seven smoking-related diseases in adults in Romania, to see if regions that are prone to cigarette smuggling due to bordering other countries see less benefit. We use a pragmatic natural experiment study approach to analyse the study period 2009-15. Findings from hospital episodes data relating to smoking-attributable diseases are analysed for six regional subgroups which are compared according to border characteristics with other countries. At a national level smoking-attributable diseases reduced over the study period especially around the tax increase years, with asthma showing the most significant decline. Sub-nationally there was no statistically significant correlation in variations between central regions and those bordering other countries. There is a reassuring decline in hospitalizations for smoking-related diseases associated with the tax increases, and no sub-national association with smuggling risk measured by variation in the size of this effect and regions that border other countries. More comprehensive and progressive tobacco control in Romania should be implemented in line with the WHO Framework Convention for Tobacco Control.