Causes of death statistics
From Statistics Explained
- Data from September 2012. Most recent data: Further Eurostat information, Main tables and Database.
This article gives an overview of recent statistics on causes of death in the European Union (EU). By relating all deaths in the population to an underlying cause of death, the risks associated with death from a range of specific diseases and other causes can be assessed; these figures can be further analysed by age, sex, nationality and region (NUTS level 2), using standardised death rates.
Main statistical findings
The latest provisional information for the EU-27 relating to causes of death is available for the 2010 reference period; Table 1 shows that diseases of the circulatory system and cancer were, by far, the leading causes of death.
Between 2000 and 2010 there was a 10.9 % reduction in EU-27 death rates relating to cancer and much larger reductions were recorded in relation to deaths from ischaemic heart disease or from transport accidents (where rates fell by more than 30 %) – see Figures 1 and 2.
Diseases of the circulatory system
Diseases of the circulatory system include those related to high blood pressure, cholesterol, diabetes and smoking; although, the most common causes of death are ischaemic heart diseases and cerebrovascular diseases. Ischaemic heart diseases accounted for 76.5 deaths per 100 000 inhabitants across the EU-27 in 2010. The EU Member States with the highest death rates from ischaemic heart disease were the Baltic Member States, Slovakia and Hungary – all above 200 deaths per 100 000 inhabitants in 2010. At the other end of the range, France (2009), Portugal, the Netherlands, Spain and Luxembourg had the lowest death rates from ischaemic heart disease – below 50 deaths per 100 000 inhabitants in 2010.
Cancer was a major cause of death – averaging 166.9 deaths per 100 000 inhabitants across the EU-27 in 2010. The most common forms of cancer in the EU-27 in 2010 included malignant neoplasms of the larynx, trachea, bronchus and lung, colon, breast, and those that the International classification of diseases (ICD) classifies as ‘stated or presumed to be primary, of lymphoid, hematopoietic and related tissue’.
Hungary, Slovakia, Poland, Slovenia, the Czech Republic, Latvia and Lithuania were most affected by this group of diseases – with upwards of 190 deaths per 100 000 inhabitants in 2010; this was also the case in Croatia. Hungary recorded, by far, the highest death rates from lung cancer among EU Member States in 2010 (71.3 deaths per 100 000 inhabitants), followed by Poland and Denmark (2009); a high rate was also recorded in Croatia (48.8).
After circulatory diseases and cancer, respiratory diseases were the third most common cause of death in the EU-27, with an average of 41.2 deaths per 100 000 inhabitants in 2010. Within this group of diseases, chronic lower respiratory diseases were the most common cause of mortality followed by pneumonia. Respiratory diseases are age-related with the vast majority of deaths from these diseases recorded among those aged 65 or more.
The highest death rates from respiratory diseases among the EU Member States were recorded in the United Kingdom (67.7), Denmark (66.5, 2009), Ireland (60.3) and Belgium (60.2, 2006).
External causes of death
This category includes deaths resulting from intentional self-harm (suicide) and transport accidents. Although suicide is not a major cause of death and the data for some EU Member States may suffer from under-reporting, it is often considered as an important indicator that needs to be addressed or considered by society. On average, there were 9.4 deaths per 100 000 inhabitants resulting from suicide in the EU-27 in 2010.
The lowest suicide rates in 2010 were recorded in Greece (2.9 deaths per 100 000 inhabitants) and Cyprus (3.8), and relatively low rates – of less than 7.5 deaths per 100 000 inhabitants – were also recorded in Italy (2009), Spain, the United Kingdom and Malta. The death rate from suicide in Lithuania (28.5) was approximately three times the EU-27 average, while rates in Hungary (21.7) were around double the average.
Although transport accidents occur on a daily basis, the number of deaths caused by transport accidents in the EU-27 in 2010 (6.5 per 100 000 inhabitants) was lower than the incidence of suicides.
Romania (2009), Lithuania, Greece, Poland, Latvia, Cyprus and Belgium (2006) had the highest death rates (10 or more deaths per 100 000 inhabitants) resulting from transport accidents in 2010, while the United Kingdom, Malta, Sweden and the Netherlands each reported fewer than four deaths from transport accidents per 100 000 inhabitants. Among the non-member countries shown in Table 1, Croatia (10.3) recorded a relatively high death rate from transport accidents while the rates in Switzerland (4.0) and Iceland (4.2, 2009) were relatively low.
Analysis by sex
Except for breast cancer, EU-27 death rates were higher for men than for women for all of the main causes of death in 2010 – see Figure 3. Death rates for ischaemic heart diseases were about twice as high for men (105.7 deaths per 100 000 inhabitants) as for women (53.1 deaths per 100 000 inhabitants), while this gender-based ratio rose to four to five times higher for drug dependence and alcohol abuse, and three to four times higher for suicide (intentional self-harm), AIDS (HIV) and cancer of the larynx, trachea, bronchus and lung.
The incidence of death from cancer was also generally higher for men than for women. There are, however, a number of cancers which are prevalent among only one of the sexes, such as breast cancer or cancer of the uterus for women, or prostate cancer for men.
Mortality figures for cancer of the larynx, trachea, bronchus and lung in the EU-27 rose for women during the period 2000 to 2010, while they decreased for men. The incidence of deaths among women increased by 20.9 % (see Figure 2) in contrast to a reduction of more than 16 % for men (see Figure 1). However, while the gap between the sexes was closing, death rates for men remained considerably higher than those for women.
Breast cancer accounted for 22.6 deaths per 100 000 female inhabitants across the EU-27 in 2010. The highest rates were recorded for Denmark (28.9, 2009) and Belgium (28.3, 2006), while there were also high rates recorded for Switzerland (28.1) and Croatia (27.6). At the other end of the range, there were less than 20 deaths per 100 000 female inhabitants from breast cancer in 2010 in Spain, Sweden, Bulgaria and Poland, as well as in Norway.
The incidence of death from suicide was systematically higher for men in each of the EU Member States. The highest death rates were recorded in the Baltic Member States and Hungary – see Figure 5 – peaking at 51.4 deaths per 100 000 male inhabitants in Lithuania. By contrast, death rates from suicide remained relatively low among women, with the highest incidence registered in Belgium (2006), Lithuania, Hungary and Finland – all less than 10 deaths per 100 000 female inhabitants.
Analysis by age
For people below 65 years of age the leading causes of mortality were somewhat different in terms of their relative importance (see Table 2). Cancer was the most prominent cause of death within this age group – averaging 70.3 deaths per 100 000 inhabitants in the EU-27 in 2010 – followed by diseases of the circulatory system. Contrary to the data for the whole of the population, diseases of the respiratory system did not figure among the four most prevalent causes of mortality for those aged less than 65.
EU-27 death rates for persons aged less than 65 fell between 2000 and 2010 for each of the main causes of death shown in Figure 6. This was particularly the case for transport accidents and ischaemic heart diseases, where the incidence of death fell by 45.6 % and 34.7 % respectively.
Data sources and availability
Eurostat began collecting and disseminating mortality data in 1994, analysed by:
- a shortlist of 65 causes of death based on the international classification of diseases (ICD), developed and maintained by the World Health Organisation (WHO);
- geographical region (NUTS level 2).
Annual data are provided in absolute numbers, as crude death rates and as standardised death rates. Since most causes of death vary significantly by age and according to sex, the use of standardised death rates improves comparability over time and between countries as death rates can be measured independently of the population’s age structure.
Statistics on the causes of death are based on two pillars: medical information contained on death certificates, which may be used as a basis for ascertaining the cause of death; and the coding of causes of death following the WHO-ICD system. All deaths in the population are identified by the underlying cause of death, in other words ‘the disease or injury which initiated the train of morbid events leading directly to death, or the circumstances of the accident or violence which produced the fatal injury’ (a definition adopted by the World Health Assembly).
The validity and reliability of statistics on the causes of death rely, to some degree, on the quality of the data provided by certifying physicians. Inaccuracies may result for several reasons, including:
- errors when issuing the death certificate;
- problems associated with the medical diagnosis;
- the selection of the main cause of death;
- the coding of the cause of death.
Sometimes there is ambiguity in the cause of death: besides the illness leading directly to death, the medical data on the death certificate should also contain a causal chain linked to the suffering of the deceased. Other substantial health conditions may be indicated, which did not have a link to the illness leading directly to death, but may have unfavourably affected the course of a disease and thus contributed to the fatal outcome. Indeed, there is sometimes criticism that the coding of only one illness as a cause of death appears more and more unrealistic in view of the increasing life expectancy and associated changes in morbidity. For the majority of the deceased of 65 years and older the selection of just one out of a number of possible causes of death may be somewhat misleading. For this reason, some of the EU Member States have started to consider multiple-cause coding. Eurostat has supported EU Member States in their efforts to develop a joint automated coding system called IRIS for the improvement and better comparability of causes of death data in Europe.
In April 2011, a European Commission Regulation was adopted specifying in detail the variables, breakdowns and metadata that EU Member States must deliver in relation to Regulation 328/2011 on statistics on causes of death.
Statistics on causes of death, which are among the oldest medical statistics available, provide information on developments over time and differences in causes of death between EU Member States. Statistics on causes of death play a key role in the general information system relating to the state of health in the EU. They may be used to determine which preventive and medical-curative measures or which investments in research might increase the life expectancy of the population.
As there is a general lack of comprehensive European morbidity statistics, data on causes of death are often used as a tool for evaluating health systems in the EU and may also be employed for evidence-based health policy.
The EU promotes a comprehensive approach to tackling major and chronic diseases, through integrated action on risk factors across sectors, combined with efforts to strengthen health systems towards improved prevention and control, through:
- making national statistics as reliable and comparable as possible, so they can serve as a good guide to policy effectiveness;
- supporting campaigns related to raising public-awareness and disease-prevention that actively target high-risk groups and individuals;
- systematically integrating policy and action to reduce inequalities in health;
- providing partnerships in relation to specific diseases, for example, cancer.
Further Eurostat information
- Causes of death in the EU - Statistics in focus 10/2006 (available in English, French and German)
- Health in Europe – Data 1998-2003, Eurostat pocketbook 2006
- Health statistics - Atlas on mortality in the European Union
- Health, see:
- Public health (t_hlth)
- Causes of death (t_hlth_cdeath)
- Health, see:
- Public health (hlth)
- Causes of death (hlth_cdeath)
- Health, see:
- Public health
Methodology / Metadata
- Causes of death statistics (ESMS metadata file - hlth_cdeath_esms)