Causes of death

Introduction

Data on the actual number of deaths are collected by Eurostat (at national and regional NUTS 2 level). Data on deaths by cause are usually based on the underlying cause, derived from the certifier's entries in parts I and II of the death certificate. Acceptable causes of death are those listed in the World Health Organization's (WHO) International Classification of Diseases (ICD). All EU countries use either the ninth or the tenth revision of the Classification.

The International Classification of Diseases (ICD) is designed to promote international comparability in the collection, processing, classification, and presentation of mortality statistics. The WHO provides rules and conventions for the user to ensure that consistent and comparable data can be obtained through statistical analysis locally, nationally and internationally. This includes providing a format for reporting causes of death on the death certificate.

The reported conditions are then translated into medical codes using the classification structure and the selection and modification rules contained in the applicable revision of the ICD, published by the WHO. These coding rules improve the usefulness of mortality statistics by giving preference to certain conditions, by consolidating conditions, and by systematically selecting a single cause of death from a reported sequence of conditions. The single selected cause for tabulation is called the underlying cause of death, while the other reported causes are the non-underlying causes of death. The combination of underlying and non-underlying causes is the 'multiple cause of death'.

The ICD has been revised periodically to incorporate changes in the medical field. The tenth revision (ICD-10) differs from the ninth revision (ICD-9) in several respects, although the overall coverage is similar. ICD-10 has alphanumeric categories rather than numeric categories and some chapters have been rearranged, some titles changed and certain conditions regrouped. ICD-10 has almost twice as many categories as ICD-9. Some fairly minor changes have been made in the coding rules for mortality. However, for the coding of diagnoses and procedures associated with hospital utilisation in most EU countries, a version of the ICD-9, [the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)] or the new ICD-10-CM is used.

The International Classification of Diseases 11th Revision is due by 2017.

Eurostat data on causes of death

Causes of death are classified by the 86 causes in the "European shortlist" of causes of death. This shortlist is based on the International Statistical Classification of Diseases and Related Health Problems (ICD).

The standardised death rate (SDR) is the death rate of a population of a standard age distribution. Following the revision of the European standard population in 2012, the standardised death rates were recalculated. The updated standardised death rates take into account the latest population census results and are calculated based on the newly defined standard population. The standardised death rate indicates the number of deaths in relation to the total population, having excluded the differences in the age distribution when comparing different populations. As most causes of death vary significantly with people's age and sex, the use of a standard population to calculate the death rates improves comparability over time and between countries. The standardised death rate is a weighted average of age-specific mortality rates. The weighting factor is the age distribution of a (European) standard reference population as revised in 2012. The revised European Standard Population (ESP) is the unweighted average of the individual populations of EU-27 plus EFTA countries in each 5-year age bracket (with the exception of under 5 and the highest age-group of 95+). The ESP is calculated on the basis of 2010-based population projections, averaged over the period 2011-2030.

The crude death rate (CDR) is a weighted average of the age-specific mortality rates. The weights are the age distribution of the population whose mortality experience is being observed. To compare the CDRs of two or more populations, a comparison is made between combinations of different age-specific death rates and different population structures, which does not reflect any 'real' mortality differences but takes into account the effect of the population structure on the total number of deaths and on the crude death rates.

In 1994, Eurostat began collecting and disseminating mortality data for the EU Member States, broken down by a "shortlist" of 65 causes of death under a gentlemen’s agreement In 2011, the Commission Regulation (EU) No 328/2011 on causes of death has given a legal base to mortality statistics.. The first reference year for this data collection is 2011. Data is available for 86 causes of death by gender, age and NUTS 2 regions in Eurobase, the Eurostat online database. In addition, Eurostat disseminates some public health theme tables for amenable and preventable deaths, infant deaths, deaths due to infectious diseases, transport accidents, or dementia including Alzheimer's disease. The specific ICD codes to be used were compiled by Eurostat Task Force on Satellite Lists whose final report was issued in June 2014.

See also:
European Core Health Indicators (ECHI) on Disease-specific mortality (Data source: Eurostat)
Eurostat Causes of Death - Main tables and metadata
Eurostat Statistics Explained: Life expectancy and mortality
Eurostat Statistics Explained: Causes of death statistics 
Eurostat Statistics Explained: Causes of death statistics - people over 65
Statistical Atlas – Eurostat regional yearbook
Eurostat Atlas on mortality in the European Union, 2009 Statistical book
"Circulatory diseases - Main causes of death for persons aged 65 and more in Europe", 2009 Statistics in focus
"Causes of death in the EU", 2006 Statistics in focus

Cause of death analysis

Eurostat is working on electronic certification of causes of death to establish a modernised, integrated system for causes of death certification, processing and data sharing. The electronic certification of causes of death will allow information on multiple causes of death to be produced, which is of growing interest given the ageing of the population. The aim is to increase timeliness and better comparability of data.

In 2012, the Task Force on revision of the Shortlist for Causes of Deaths (CoD) data presented a revised European Shortlist of 86 causes of death in order to adjust the 1998 shortlist of 65 diseases to current user requirements. The Task Force also recommended that in addition to the shortlist, Eurostat should disseminate complementary lists of CoD data grouped by specific themes, such as on accident related deaths or amenable deaths to health care. The dedicated Task Force on ‘satellite lists for CoD’ made some recommendations for some lists in its 2013 final reportpdf.

Drug-related mortality is a complex phenomenon, which accounts for a considerable percentage of deaths among young people in many European countries. The EMCDDA (European Monitoring Centre for Drugs and Drug Addictions), in collaboration with national experts, has defined an epidemiological indicator with two components at present: deaths directly caused by illegal drugs (drug-induced deaths) and mortality rates among problem drug users.

The HEM - Closing the Gap - Reducing Premature Mortality. Baseline for Monitoring Health Evolution Following Enlargement project, coordinated by the Maria Skłodowska-Curie Institute (Poland), is a Community Health Programme project intended to improve understanding of the underlying causes of health differences between the old 15 EU Member States and the new Member States, taking into account previous EU publications, to identify and quantify major health determinants responsible for the gap between the EU and the former candidate countries, and to assess the impact of the enlargement process, i.e. the entry of candidate countries into the single market, with special regard to alcohol.

The Community Health Programme project Analyse de la mortalité par traumatismes dans l'Union Européenne (ANAMORT) produced relevant indicators that can be used throughout Europe to account for injury mortality. The objective was to evaluate the quality and comparability of injury mortality statistics in Europe and to produce validated results on the causes of death by injury in Europe, thus allowing for comparisons among countries. The analysis permitted the attribution of observed differences in mortality rates either to differences in certification and coding or to real differences in mortality conditions.

Mortality is also analysed at country level: