Directorate General Health & Consumers
Major and chronic diseases
Causes of death
Data on the actual number of deaths are collected by Eurostat (at national
and regional NUTS 1 and 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
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
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.
WHO launched the review of ICD-10 to achieve the ICD-11 by around 2015.
Eurostat data on causes of death
Causes of death are classified by the 65 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 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.
The standardised death rate (SDR) is the death rate of a population of a standard age distribution. Since for most causes of death the rate varies significantly by age and sex, the use of standardised death rates improves comparability over time and between countries, since they aim at measuring death rates independently of different population age structures. To ensure international comparability, the SDRs used here are calculated by Eurostat using the standard European population as defined by WHO.
Eurostat began collecting and disseminating mortality data for the EU Member States, broken down by a "shortlist" of causes of death, in 1994. Data are available for 65 causes of death by gender, age and NUTS 2 regions in the Eurostat database NewCronos.
Broadly speaking, the EU has witnessed a very significant reduction in mortality during the last century or so. There have been four main developments: a decline in infectious diseases (in the second half of the 19th century); an increase in degenerative diseases (at the end of the 19th century); a slowdown in the increase in life expectancy (the 1960s); and a narrowing of differences between the sexes. Cardiovascular diseases are currently the biggest single cause of death in the EU. They account for about 40% of deaths in both sexes. Others are cancer (a quarter of all deaths), diseases of the respiratory system, digestive diseases and external causes of injury and poisoning, which includes (car) accidents. One out of every five deaths is caused by a preventable disease. However, this general pattern varies by sex and, especially, by age. Mortality during the first year of life has decreased in recent decades in all Member States, where present levels are among the lowest in the world. However, given the persistence of differences in existing infant mortality levels among social groups or territories, further improvements can still be achieved.
See Eurostat Causes of Death - Main tables and metadata
See Eurostat Atlas on mortality in the European Union, 2009 Statistical book
See Who dies of what in Europe before the age of 65, 2009 Statistics in focus
See Causes of death in the EU, 2006 Statistics in focus
See Eurostat Atlas on mortality in the European Union, 2004 Statistical book
See Eurostat Mortality in the EU 1997 - 1999
See Health statistics, Atlas on mortality, 2002 edition
Cause of death analysis
- Within the framework of the Task Force 'ICD-10 up-dates and ACME implementation in Europe', Eurostat provided in January 2007 a methodological information on the introduction to multiple cause coding for ACME (Automatic Classification of Medical Entry). It is based on a manual prepared by the Centre for Epidemiology of the Swedish National Board for Health and Welfare).
- The Eurostat
training package on certification of causes of death (COD) was developed by
the Italian Statistical Institute (ISTAT) in 2004 for European use. The project
was funded by Eurostat. Since national certification practices vary
between countries, the training package is designed so that each element can be
adapted according to national practices and legal requirements. The EU training
package consists of three elements: a basic EU manual on certification, a
web-based training tool to be used in combination with the EU manual and the
- The Key-indicator drug-related deaths project has been developed by the EMCDDA (European Monitoring Centre for Drugs and Drug Addictions). Data on drug-related deaths constitute one of the five epidemiological key-indicators of the EMCDDA to be implemented in the EU Member States. EMCDDA's ultimate goal is thus to establish objective and reliable figures on drug-related deaths that are comparable between Member States. Comparability will be achieved when a similar procedure is followed in all Member States to estimate the number of drug-related deaths.
- The Eurostat Automated coding in Member States project had as its main objective the development of recommendations and guidelines for the application of Automated Coding Systems for causes of death (ACS) in order to achieve more comparable statistics at European level. These recommendations and guidelines are based on the examination of existing ACS and on the analysis of requirements where ACS has not been implemented for technical or other reasons. Issues related to the use of ACS include staff problems, loss of expertise, and changes in trends. This study focuses on the process of coding the medical causes of death reported on the death certificate. It does not consider other aspects not related to coding which could affect international comparability (in particular the certification process).
- The Health Monitoring Programme and Eurostat Task Force on Causes of death project comparability and quality improvement in European causes of death statistics: the objectives were to produce a precise assessment of death certification procedures in Europe, with recommendations for improvement and harmonisation, and to establish an extensive knowledge database on the 65 causes of death (Eurostat Shortlist) so as to develop a method of analysis to be applied to a selection of pathologies. These objectives have been achieved and have yielded the following results:
- A detailed survey of current knowledge on death certification practices in 17 European countries;
- A series of 39 recommendations on certification procedures proposed by the network of experts;
- A knowledge base of 532 articles related to the 65 causes of death (Eurostat Shortlist);
- A method of analysis tested on four groups of pathologies (suicide and controversial cases, cardiovascular diseases, respiratory diseases - including cancer of the lung, and breast cancer).
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
- The Community Health Programme project Analyse de la mortalité par traumatismes dans l'Union Européenne 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:
- Luxembourg: La mortalité au Luxembourg, Evolution historique, situation actuelle et perspectives futures dy sustème national de surveillance de la mortalité – Avril 2010
- Switzerland: Statistique des causes de décès Causes de mortalité en 2003 et 2004 (2007)
- Italy: Decessi: caratteristiche demografiche e sociali 2003 (diffuso: 2007)
- Spain: Defunciones según la Causa de Muerte 2005 (INE, 2007)
- France: Mortalité aux grands âges : encore des écarts selon le diplôme et la catégorie sociale (INSEE première, 2007)
- France: La mortalité maternelle en France : bilan et perspectives (InVS, 2006)
- Portugal: Risco de Morrer em Portugal 2004 (Direcção-Geral da Saúde, 2006)