Respiratory diseases statistics


Data extracted in July 2018.

Planned article update: August 2019.

Highlights

Diseases of the respiratory system accounted for 8.5 % of all deaths in the EU in 2015.

More than two thirds of the elderly population of the United Kingdom and the Netherlands were vaccinated against influenza in 2016, the highest proportions among the EU Member States.

Influenza vaccination rate, people aged 65 years and over, 2016

This article presents an overview of European Union (EU) statistics related to diseases of the respiratory system and focuses on the following aspects: deaths from diseases of the respiratory system and healthcare for diseases of the respiratory system.

The respiratory system is a series of organs that are responsible for breathing; the lungs are the primary organ of this system, which also includes the nasal passage, oral cavity, pharynx, larynx, trachea, bronchi and bronchioles. Diseases of the respiratory system are one of the main causes of death in the EU and include conditions such as chronic obstructive pulmonary disease, pneumonia or asthma. Note that the statistics presented in this article do not cover cancer of the respiratory system (such as lung cancer), which is treated in a separate article.

This article is one of a set of statistical articles concerning health status in the EU which forms part of an online publication on health statistics.

Full article

Deaths from diseases of the respiratory system

Diseases of the respiratory system accounted for 8.5 % of all deaths in the EU

In 2015, there were 442 thousand deaths in the EU-28 resulting from diseases of the respiratory system, equivalent to 8.5 % of all deaths. Table 1 shows that the proportion of deaths in the United Kingdom from respiratory diseases was considerably higher than the EU-28 average, at 14.1 %, while respiratory diseases also accounted for at least 1 in 10 deaths in Ireland, Portugal, Spain, Greece, Denmark, Belgium and Malta; among the EFTA and enlargement countries for which data are available, more than 1 in 10 deaths were from respiratory diseases in Liechtenstein, Turkey and Norway.

Table 1: Causes of death — diseases of the respiratory system, residents, 2015
Source: Eurostat (hlth_cd_aro) and (hlth_cd_asdr2)

A higher proportion of men than women in the EU-28 died in 2015 from diseases of the respiratory system (9.0 % compared with 8.0 %). This situation was repeated across most of the EU Member States and the difference was most pronounced in Spain (where the gender gap was 2.6 percentage points), Lithuania (2.2 points), Romania (2.1 points), Latvia and Estonia (both 2.0 points). By contrast, a higher proportion of deaths among women (rather than men) were attributed to diseases of the respiratory system in eight Member States, with the largest gender gap in Ireland (1.3 points); an even larger gap (3.0 points) with a higher share for women than for men was observed in Iceland.

Standardised death rates for respiratory diseases were consistently higher for men than for women …

The EU-28’s standardised death rate for diseases of the respiratory system was 88.4 deaths per 100 000 inhabitants in 2015; the death rate for men was 1.8 times as high as that for women. Standardised death rates for men were higher than those for women in each of the EU Member States; this may, at least in part, be attributed to different smoking habits between the sexes or to occupational risks (for example, more men work(ed) in extractive industries such as coal mining). Death rates for men were at least three times as high as those for women in all three Baltic Member States, while they were more generally between 1.4 and 2.4 times as high. At the lower end of this range — with a standardised death rate for men for respiratory diseases that was 1.4 times as high as that for women — were Denmark, Ireland, the United Kingdom, Sweden, Luxembourg and Greece. Among the EFTA and enlargement countries, Iceland stood out with a lower rate for men than for women.

Deaths in younger ages can be considered as premature. Indeed Table 1 also shows that standardised death rates for diseases of the respiratory system were particularly high at advanced ages, explaining concerns over, for example, winter influenza epidemics. The EU-28’s standardised death rate from respiratory diseases for those aged 65 and over was 43 times as high as the standardised death rate for persons aged less than 65; this can be compared with the same ratio for all causes of death, where the death rate for those aged 65 and over was 21 times as high.

A more detailed analysis of causes of death for diseases of the respiratory system is presented in Table 2, which shows that the main causes of death among respiratory diseases were lower respiratory diseases and pneumonia, while standardised death rates for asthma and for influenza were considerably lower.

Table 2: Standardised death rates — diseases of the respiratory system, residents, 2015
(per 100 000 male/female inhabitants)
Source: Eurostat (hlth_cd_asdr2)

In 2015, the highest standardised death rates for chronic lower respiratory diseases among the EU Member States were recorded in Hungary, Denmark, the United Kingdom and Ireland, while the highest rates for pneumonia were registered in Slovakia, Portugal, the United Kingdom and Poland. Among the diseases with much lower mortality rates, Latvia, Ireland, the United Kingdom, Estonia and Spain recorded the highest standardised death rates for asthma and status asthmaticus, while Sweden had the highest standardised death rate for influenza.

… although at a more detailed level, the standardised death rate for asthma was higher among women

EU-28 standardised death rates for men were, with the exception of asthma and status asthmaticus, consistently higher than those for women for each of the causes of death presented in Table 2. Gender differences were most pronounced for other lower respiratory diseases and chronic lower respiratory diseases as the standardised death rates for men in the EU-28 were more than twice as high as the corresponding rates for women. The standardised death rate for asthma and status asthmaticus was higher for women (1.6 deaths per 100 000 female inhabitants) than the corresponding rate for men (1.1 deaths per 100 000 male inhabitants). This difference was greatest in Luxembourg, where the female standardised death rate for asthma and status asthmaticus was 3.7 times as high as that recorded for men, while the female rate was 2.8 times as high as the male rate in Spain.

Self-reporting of respiratory diseases

The data presented in Figures 1 and 2 are derived from the second wave of the European health interview survey (EHIS) which was conducted between 2013 and 2015 and which covers persons aged 15 and over. The survey included questions on self-assessment of an individual’s health and data on respiratory diseases, which are available for all EU Member States, Iceland, Norway and Turkey. The next wave of the survey will be conducted in 2019 and it will be run at regular five-year intervals thereafter.

Lithuanians reported the highest prevalence of chronic lower respiratory diseases other than asthma …

Chronic lower respiratory diseases (excluding asthma) cover a collection of lung diseases that include chronic bronchitis, emphysema and other chronic obstructive pulmonary diseases; the main cause of these diseases is smoking. Patients with chronic lower respiratory diseases have difficulties in breathing, as the walls of the airways to their lungs are damaged, scarred and narrowed (airflow obstruction).

In 2014, some 4.1 % of the EU-28 population stated that they had some form of chronic lower respiratory disease (other than asthma) diagnosed by a medical doctor (see Figure 1). Lithuania (6.1 %) recorded the highest share among the EU Member States, followed by Portugal, France, Luxembourg, the Netherlands, Germany and Italy — each with shares of at least 5.0 %. At 7.7 %, the share in Turkey was considerably higher than in any of the EU Member States. By contrast, less than 2.0 % of the population in Malta and Sweden declared they suffered from chronic lower respiratory diseases (other than asthma).

Figure 1: Share of the population reporting that they had chronic lower respiratory diseases
(excluding asthma), 2014
(%)
Source: Eurostat (hlth_ehis_cd1e)

An analysis by sex reveals that women were usually more likely to report that they had chronic lower respiratory diseases than men. Across the EU-28, 4.3 % of women reported such an illness, compared with 3.9 % for men. This gender difference was particularly pronounced in Lithuania, where the gap between the sexes was 2.7 percentage points and where the highest share of the female population (7.3 %) reported that they suffered from a chronic lower respiratory disease (other than asthma). By contrast, the highest share among men was recorded in Luxembourg (5.7 %) where, as in a further nine EU Member States, a higher share of men (compared with women) reported that they had a chronic lower respiratory disease (other than asthma).

… while the prevalence of asthma was highest in the United Kingdom

Asthma is a chronic inflammation of the airways characterised by reversible airflow obstruction and bronchospasm that causes coughing, wheezing, chest tightness or a shortness of breath. It may result from a range of triggers, which include (among others): pollution, tobacco smoke, solvents, pollens, cold air or strenuous exercise.

Within the EU-28, some 5.9 % of the adult population reported that they suffered from asthma. The highest share of self-reported asthma among the EU Member States was recorded in the United Kingdom (9.4 %), where 10.7 % of all women and 8.0 % of all men stated that they had asthma (see Figure 2). The next highest overall shares were in Finland, Ireland, France and Sweden.

Figure 2: Share of the population reporting they suffered from asthma, 2014
(%)
Source: Eurostat (hlth_ehis_cd1e)

Within the EU-28, the share of women reporting that they suffered from asthma was 6.6 %, which was 1.4 percentage points higher than the corresponding share recorded among men. A closer analysis reveals that a higher proportion of women (than men) declared they had asthma in all but two of the EU Member States: the proportion (4.4 %) of men in Belgium who declared they had asthma was 0.2 percentage points higher than the share for Belgian women, while in Denmark the shares for both sexes were equal (6.5 %). By contrast, a much higher proportion of women (than men) reported they had asthma in Finland, Sweden, the United Kingdom, Slovakia, Malta and the Netherlands (shares for women were at least 2.0 percentage points higher than those for men). The share of women suffering from asthma was also considerably higher than that for men in Turkey (5.3 percentage points difference), as well as in Iceland (3.9 points) and Norway (2.8 points).

Respiratory healthcare

Influenza (International Classification of Diseases (ICD) codes J09–J11) is an annual, seasonal infectious disease caused by the influenza virus; it affects Europe in the winter. The majority of people who die from influenza are aged 65 and over and face complications based on chronic diseases such as cardiovascular diseases or chronic lung diseases. During an influenza epidemic there may be significant costs for national health services (associated with caring for those who fall sick) and for businesses in general (lost production as a result of time taken off work).

More than two thirds of the elderly population of the United Kingdom and the Netherlands were vaccinated against influenza

It may be argued that many of the deaths and some of the costs associated with influenza epidemics could be avoided through a wider uptake of influenza vaccinations. Among the EU Member States there are a range of different policies with respect to making vaccines available to the general public— often they are specifically targeted at groups of older people.

Figure 3 shows the take-up of vaccinations against influenza among people aged 65 and over: it is striking that in the majority of EU Member States for which data are available (no comparison for Belgium, Bulgaria, Czechia, Greece, Malta and Austria; no data for Cyprus) there was a considerably lower share of the elderly vaccinated against influenza in 2016 than there was in 2011. The biggest differences (at least 10.0 percentage points) were recorded in Germany (2012-2016; note there is a break in series), Italy and Hungary. Finland, Portugal (2011-2015), Lithuania, Sweden, Latvia and Estonia were the only Member States to record a higher proportion of people aged 65 and over who were vaccinated against influenza in 2016 than in 2011; this was also the case in Norway (note there is a break in series).

Figure 3: Influenza vaccination rate, people aged 65 years and over, 2011 and 2016
(%)
Source: Eurostat (hlth_ps_immu)

Figure 3 also shows considerable differences between EU Member States in relation to the overall uptake of influenza vaccinations, with more than two thirds of the elderly being vaccinated in the Netherlands (66.8 %; 2015 data) and the United Kingdom (70.5 %), while less than 10 % of the elderly population was vaccinated in Slovenia, Poland (2014 data), Romania, Latvia, Estonia and Bulgaria (also 2014 data).

In 2016 approximately 6.7 million in-patients with diseases of the respiratory system were discharged from EU hospitals

Across the EU in 2016 (2015 data for Hungary and Portugal; no recent data for Greece), in-patients with diseases of the respiratory system (International Classification of Diseases (ICD) codes J00-J99) spent a total of 49.63 million days in hospital. By far the highest number of in-patient days was spent in German hospitals (20.6 % of the EU total), while the United Kingdom (14.2 %) and Italy (11.0 %) were the only other EU Member States to record double-digit shares.

Around 6.7 million in-patients with diseases of the respiratory system were discharged from EU hospitals in 2016 (2015 data for Hungary, Poland and Portugal; no recent data for Greece). In-patient discharges of those treated for respiratory diseases accounted for 12.1 % of the total number of hospital discharges in Spain, while these diseases accounted for a share in excess of 10.0 % of all in-patient discharges in Ireland, the United Kingdom, Romania, and Lithuania. Among EFTA and enlargement countries, this share rose as high as 12.7 % in Turkey and 11.5 % in Montenegro. By contrast, respiratory diseases accounted for a relatively low proportion of the total number of in-patient discharges in Croatia (5.9 %) and France (5.7 %), while relatively low shares were also recorded in two EFTA countries: 5.9 % in Switzerland and 5.0 % in Iceland.

Bulgaria had highest number of in-patient discharges per 100 000 inhabitants

Relative to population size, Bulgaria, Romania and Lithuania recorded the highest number of discharges among those treated for diseases of the respiratory system (see Figure 4), all over 2.3 thousand per 100 000 inhabitants in 2016, peaking at 3.0 thousand per 100 000 inhabitants in Bulgaria. Portugal (2015 data) and Cyprus had by far the lowest in-patient discharge rate for diseases of the respiratory system, less than 800 per 100 000 inhabitants, while the Netherlands, Croatia and Italy were the only other EU Member States to record ratios that were below 1 000 discharges per 100 000 inhabitants. Among the EFTA countries, Liechtenstein and Iceland also reported very low in-patient discharge rates for respiratory diseases.

Figure 4: Hospital discharge rates for in-patients with diseases of the respiratory system, 2016
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_disch2)

The length of hospital stays for in-patients with diseases of the respiratory system was generally close to the average for all types of disease

Table 3 presents an analysis of the average length of hospital stays for in-patients treated for a respiratory disease in 2011 and 2016 (earlier data for some EU Member States). The average hospital stay in 2016 ranged from 4.9 days in Estonia up to 9.9 days in Czechia. In Estonia, the average length of a hospital stay for those treated for a disease of the respiratory system was 2.5 days less than the average for all diseases. Aside from Estonia, the average length of a hospital stay due to a disease of the respiratory system was also shorter than the average for all diseases — by at least 1.5 days — in France, Luxembourg and Croatia. However, the majority of the EU Member States reported that patients being treated for a disease of the respiratory system spent a similar length of time in hospital as the average for all patients (differences of no more than +/- 1.5 days).

Table 3: In-patient average length of stay for respiratory diseases, 2011 and 2016
(days)
Source: Eurostat (hlth_co_inpst)

Among the 27 EU Member States for which data are available (no data for Greece), the average length of a hospital stay for those treated for a disease of the respiratory system generally fell between 2011 and 2016. Malta recorded the largest increase (1.0 days) in the average time spent in hospital for these diseases, while eight other Member States reported increases of between 0.1 and 0.9 days (the latter being recorded by Czechia). By contrast, the average time spent in hospital for in-patients treated for a disease of the respiratory system fell by between half a day and one day in Poland (2011-2015), Ireland, Bulgaria, Austria and the Netherlands, with the biggest decrease recorded in Finland (an average of 3.3 days less spent in hospital).

The remainder of Table 3 provides a more detailed analysis of the average length of hospital stays for in-patients diagnosed with five different types of respiratory diseases. On average, in-patients with pneumonia (codes J12-J18) and with asthma and status asthmaticus (codes J45-J46) spent the highest number of days in hospital. These figures are of interest, insofar as pneumonia was one of the leading causes of death among respiratory diseases, in contrast to asthma, which has a death rate that was relatively close to zero. The average stay in hospital for in-patients being treated for asthma varied considerably across the EU Member States, from a high of 13.5 days in Germany and 13.4 days in Czechia to less than 3.0 days in Ireland, Sweden and Denmark.

Source data for tables and graphs

Data sources

Key concepts

An in-patient is a patient who is formally admitted (or ‘hospitalised’) to an institution for treatment and/or care and stays for a minimum of one night or more than 24 hours in the hospital or other institution providing in-patient care. An in-patient or day care patient is discharged from hospital when formally released after a procedure or course of treatment (episode of care). A discharge may occur because of the finalisation of treatment, signing out against medical advice, transfer to another healthcare institution, or because of death.

The number of deaths from a particular cause of death can be expressed relative to the size of the population. A standardised (rather than crude) death rate can be compiled which is independent of the age and sex structure of a population: this is done as most causes of death vary significantly by age and according to sex and the standardisation facilitates comparisons of rates over time and between countries.

Healthcare resources and activities

Statistics on healthcare resources (such as personnel and medical equipment) and healthcare activities (such as information on surgical operations and procedures and hospital discharges) are documented in this background article which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions.

For hospital discharges and the length of stay in hospitals, the International Shortlist for Hospital Morbidity Tabulation (ISHMT) is used to classify data from 2000 onwards; Chapter X covers diseases of the respiratory system:

  • Acute upper respiratory infections and influenza (1001);
  • Pneumonia (1002);
  • Other acute lower respiratory infections (1003);
  • Chronic diseases of the tonsils and adenoids (1004);
  • Other diseases of upper respiratory tract (1005);
  • Chronic obstructive pulmonary disease and bronchiectasis (1006);
  • Asthma (1007);
  • Other diseases of the respiratory system (1008).

For country specific notes on this data collection, please refer to this background information document.

Health status

Self-reported statistics covering the health status of the population for a range of chronic diseases is provided by the European health interview survey (EHIS). This source is documented in more detail in this background article which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions. The data presented in this article refer to the share of the population aged 15 or over reporting to have been diagnosed by a medical doctor with chronic bronchitis, chronic obstructive pulmonary disease, emphysema, or asthma (allergic asthma included) which occurred during the 12 months prior to the survey.

Causes of death

Statistics on causes of death provide information on mortality patterns, supplying information on developments over time in the underlying causes of death. This source is documented in more detail in this background article which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions.

Causes of death are classified according to the European shortlist (86 causes), which is based on the International Statistical Classification of Diseases and Related Health Problems (ICD). Chapter X of the ICD covers diseases of the respiratory system:

  • J00-J06 Acute upper respiratory infections
  • J09-J18 Influenza and pneumonia
  • J20-J22 Other acute lower respiratory infections
  • J30-J39 Other diseases of upper respiratory tract
  • J40-J47 Chronic lower respiratory diseases
  • J60-J70 Lung diseases due to external agents
  • J80-J84 Other respiratory diseases principally affecting the interstitium
  • J85-J86 Suppurative and necrotic conditions of lower respiratory tract
  • J90-J94 Other diseases of pleura
  • J95-J99 Other diseases of the respiratory system

For country specific notes on this data collection, please refer to this background information document.

Note on tables: the symbol ‘:’ is used to show where data are not available.

Context

There is a wide range of factors that play a role in affecting the health of a person’s respiratory system. Most of these are linked to lifestyle or environmental factors, such as smoking or pollution. Indeed, smoking tobacco is the main cause of lung disease in Europe (note that the data presented in this article do not cover cancer), while it is also considered to be a major contributory factor to the incidence of chronic obstructive pulmonary disease (COPD) and the development of asthma in children and adults; furthermore, respiratory diseases also occur among those who are subject to passive smoking.

According to Special Eurobarometer 458, slightly less than one third of all men (30 %) and slightly more than one fifth (22 %) of all women in the EU-28 smoked in March 2017.

The EU’s Member States have taken various tobacco control measures in the form of legislation, recommendations and information campaigns in an attempt to reduce the number of smokers. From a public health perspective, these measures aim to protect citizens from the hazardous effects of smoking and other forms of tobacco consumption.

Air pollution is a major respiratory health issue: activities involving the burning of fossil fuels, such as some industrial activities, power generation, vehicle emissions and household heating/cooking, as well as natural phenomena (such as volcanic eruptions or dust storms) have the potential to cause respiratory diseases. Most sources of outdoor air pollution are beyond the control of individuals and demand action by urban, national or international policymakers. Those countries that reduce air pollution are likely to benefit from a reduced burden from heart disease, lung cancer, chronic and acute respiratory diseases (including asthma). Policies that can potentially alleviate air pollution include support for cleaner transport, energy-efficient housing or better municipal waste management in urban areas, and policies aimed at reducing agricultural waste incineration, forest fires and certain agro-forestry activities in rural areas.

Indoor air pollution is also generated by a variety of sources, including: human activity (smoking, fuel used for heating or cooking, the use of cleaning materials); buildings (poor ventilation); pets, plants, dust or damp.

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Self-reported chronic morbidity (hlth_srcm)
People reporting a chronic disease, by disease, sex, age and educational attainment level (%) (hlth_ehis_st1)
Health care activities (hlth_act)
Hospital discharges and length of stay for inpatient and curative care (hlth_co_dischls)
Hospital discharges - national data (hlth_hosd)
Length of stay in hospital (hlth_hostay)
Preventive services (hlth_prev)
Vaccination against influenza of population aged 65 and over (hlth_ps_immu)
General mortality (hlth_cd_gmor)
Causes of death - deaths by country of residence and occurrence (hlth_cd_aro)
Causes of death - standardised death rate by residence (hlth_cd_asdr2)