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. 2025 Sep 25;61(10):1743.
doi: 10.3390/medicina61101743.

Evolution in Laryngeal Cancer Mortality at the National and Subnational Level in Romania with 2030 Forecast

Andreea-Mihaela Banța  1   2 , Nicolae-Constantin Balica  2 , Simona Pîrvu  3 , Karina-Cristina Marin  2 , Kristine Guran  1 , Ingrid-Denisa Barcan  1 , Cristian-Ion Moț  2 , Bogdan Hîrtie  1 , Victor Banța  4 , Delia Ioana Horhat  2
Affiliations

Evolution in Laryngeal Cancer Mortality at the National and Subnational Level in Romania with 2030 Forecast

Andreea-Mihaela Banța et al. Medicina (Kaunas). .

Abstract

Background and Objectives: Laryngeal cancer imposes a disproportionate burden on speech, airway protection and long-term quality of life. Contemporary population-based data for Central and Eastern Europe remain scarce, and the post-pandemic trajectory is uncertain. Materials and Methods: We performed a nationwide, retrospective ecological time-series study using Romanian mortality registers and hospital-discharge files for 2017-2023. Crude and age-standardised mortality rates (ASMRs) were calculated, county-level indirect standardisation and spatial autocorrelation assessed and joinpoint regression quantified temporal trends. Forecasts to 2040 combined Holt-Winters/ARIMA models with Elliott-wave heuristics anchored to Fibonacci retracements. Results: In 2023, 798 laryngeal cancer deaths yielded a crude mortality of 3.65/100,000 (95% CI 3.41-3.91). Male mortality (7.07/100,000) exceeded female mortality 18-fold. Rural residents experienced a higher rate than urban counterparts (4.26 vs. 3.04/100,000), a difference unchanged after indirect age standardisation. National ASMR fell by 3.7% annually (p < 0.01), yet five counties formed a high-risk corridor (standardised mortality ratios 1.59-1.82); Moran's I = 0.27 (p < 0.01) indicated significant spatial clustering. Pandemic-era surgical throughput collapsed by 48%, generating a backlog projected to persist beyond 2030. Ensemble forecasting anticipates a doubling of discharges and mortality between 2034 and 2037 unless smoking prevalence falls by ≥30% and radon exposure is curtailed. Conclusions: Although overall laryngeal cancer mortality in Romania is declining, the pace lags behind Western Europe and is threatened by geographic inequities and pandemic-related care delays. Aggressive tobacco control, radon-remediation policies and expansion of surgical and radiotherapeutic capacity are required to avert a forecasted surge in the next decade.

Keywords: Romania/epidemiology; forecasting; geographic information systems; laryngeal neoplasms/mortality; rural health; smoking/adverse effects; time series studies.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Analysis of inequalities in the standardised mortality rate from laryngeal cancer at the national level for the year 2023.
Figure 2
Figure 2
Age-standardised mortality rates (ASMR) for laryngeal cancer by county, Romania (2023). Global Moran’s I = 0.27, permutation p < 0.01 (queen contiguity, 999 permutations). LISA high–high and low–low clusters were identified with FDR q = 0.10.
Figure 3
Figure 3
Annual laryngeal cancer discharges: actual (2017–2023) and hybrid forecast (2024–2040).
Figure 4
Figure 4
National age-standardised mortality rate (ASMR): actual (2017–2023) and hybrid forecast (2024–2040).
See this image and copyright information in PMC

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