Spatial and temporal inequalities in non-communicable disease mortality across the East African community: a Bayesian spatio-temporal analysis

Abstract

Introduction: Non-communicable diseases (NCDs) are increasing rapidly across Sub-Saharan Africa, yet spatial inequalities in mortality across disease groups remain insufficiently characterized for effective regional health planning. Methods: We examined mortality from cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes across seven East African Community countries from 2000 to 2019. Using WHO Global Health Observatory estimates, we constructed a balanced panel of 560 country-disease-year observations and fitted a multivariate Bayesian spatio-temporal shared-component model in INLA with environmental and socioeconomic covariates. Results: Socioeconomic context showed the strongest associations with mortality risk. GDP per capita was positively associated with NCD mortality, while healthcare expenditure, urbanization rate, and population density showed inverse associations. Environmental variables were weaker and statistically uncertain at country scale. Spatial patterns showed elevated cardiovascular and respiratory mortality risk in eastern areas, a west-to-east gradient for diabetes, and relatively uniform cancer mortality. Shared spatial effects identified persistent multi-disease high-risk clustering centered on Rwanda, Uganda, and Tanzania. Discussion: NCD mortality risk in the EAC is spatially structured and associated with contextual socioeconomic and environmental conditions, underscoring the importance of geographically targeted prevention strategies and spatially informed health-system planning.