Causes of death statistics

Data extracted in March 2024.

Planned article update: March 2025.

Highlights

Circulatory diseases accounted for close to one-third (32.4 %) of all deaths in the EU in 2021. The second most common cause was cancer (21.6 %).

COVID-19 accounted for 10.7 % of all deaths of EU inhabitants in 2021 and was the third most common cause of death.

Among the EU Member States, Finland had the lowest standardised death rate from COVID-19 in 2021, while Bulgaria had the highest rate.

Standardised death rate for deaths from circulatory diseases, cancer and COVID-19, 2021

^{Country codes}

This article uses the most recent available statistics on causes of death in the European Union (EU). It is important to identify and record the underlying reasons for deaths and make the information available to policymakers, health services and the public. With these data, it is possible to describe and understand the frequency of deaths from each cause as well as trends in mortality.

The data also serve to give information on changing epidemiological circumstances. Most causes of death vary significantly by age and by sex. This article gives an overview of the main causes of death and standardised death rates for the EU as a whole and for EU Member States with analyses by age and sex of the deceased. The use of standardised death rates facilitates comparisons both over time and between countries, independent of population age structures.

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

Major causes of death in the EU in 2021

In total, 5.29 million deaths of EU inhabitants were reported across the EU in 2021. Around 84 % of all deaths in the EU occurred among people aged 65 years and over.

The leading causes of death among EU inhabitants were diseases of the circulatory system and cancer (malignant neoplasms) – see Figure 1. The third most frequent cause of death in 2021 was COVID-19, followed by respiratory diseases^[1]. COVID-19 and respiratory diseases are age-related, with the vast majority of deaths from these diseases recorded among older people.

Figure 1: Share of main causes of death, EU, 2021
(%)
Source: Eurostat (hlth_cd_aro)

Diseases of the circulatory system include those related to high blood pressure, heart disease and diseases of veins and arteries. The most common causes of death from diseases of the circulatory system are ischaemic heart disease (such as heart attacks) and cerebrovascular diseases (such as strokes) – see Figure 2.

The most common causes of death from cancer are malignant neoplasms of the trachea, bronchus and lung (hereafter referred to as lung cancer) and malignant neoplasm of the colon, rectosigmoid junction, rectum, anus and anal canal (hereafter referred to as colorectal cancer), followed by breast cancer and prostate cancer. Breast cancer occurs mainly in women and prostate cancer exclusively in men (see below for more information). Ischaemic heart disease and lung cancer top the list of avoidable deaths in the EU; see preventable and treatable mortality statistics.

Figure 2: Shares of main types of deaths from circulatory diseases and from cancer, EU, 2021
(%)
Source: Eurostat (hlth_cd_aro)

COVID-19

Among the EU Member States, Bulgaria reported the highest standardised death rate from COVID-19 in 2021, with 373.5 deaths per 100 000 inhabitants (see Figure 3). The next highest standardised death rate was reported in Slovakia (316.9 deaths per 100 000 inhabitants), while Poland, Hungary and Czechia recorded the third to fifth highest rates, within the range of 250–270 deaths per 100 000 inhabitants. Four other Member States also recorded standardised death rates of over 200.0 deaths per 100 000 inhabitants. The lowest standardised death rate was reported in Finland, with 15.4 deaths per 100 000 inhabitants; rates were also below 50.0 deaths per 100 000 inhabitants in Denmark, Malta and Sweden.

Compared with 2020, a majority of EU Member States reported higher standardised death rates from COVID-19 in 2021 than in 2020. In relative terms, the rate in 2021 was at least double the 2020 rate in 11 of the Member States. The largest relative increases were in Cyprus (where the 2021 rate was a factor of 4.5 times as high as the 2020 rate), Latvia (a factor of 6.2 times as high) and Estonia (a factor of 8.7 times as high). By contrast, the largest decrease was observed in Belgium, where the rate in 2021 was less than half (down 53.7 %) its 2020 rate.

Figure 3: Standardised death rates from COVID-19, 2020 and 2021
(per 100 000 inhabitants)
Source: Eurostat (hlth_cd_asdr2)

Standardised death rate by sex and age

The most common causes of death differ between men and women. With the exception of breast cancer, the EU standardised death rates were higher for men than for women in 2021 for all of the main causes of death. Breast cancer accounted for 30.6 deaths per 100 000 female inhabitants across the EU in 2021. Differences between women and men in relation to the leading causes of death are also age related (briefly described below, for more information see causes of death statistics by age group).

Males aged less than 65 years

In 2021, the main cause of death of male inhabitants in the EU aged less than 65 years was ischaemic heart disease, with 29.5 deaths per 100 000 male inhabitants aged less than 65 years (see Table 1). This was followed by COVID-19 (28.6 deaths per 100 000 male inhabitants aged less than 65 years), accidents (20.9) and lung cancer (19.1).

Females aged less than 65 years

Among female inhabitants of the EU aged less than 65 years, the main cause of death in 2021 was COVID-19 with 14.5 deaths per 100 000 female inhabitants aged less than 65 years (see Table 1). This was followed by breast cancer (12.4 deaths per 100 000 female inhabitants aged less than 65 years) and lung cancer (10.1).

Men aged 65 years and over

As for younger men, ischaemic heart disease was also the main cause of death in 2021 among male inhabitants of the EU aged 65 years and over, with 673.0 deaths per 100 000 older male inhabitants (see Table 1). This cause was followed by COVID-19, cerebrovascular diseases, lung cancer and chronic lower respiratory diseases (such as asthma). Prostate cancer caused 171.2 deaths per 100 000 older male inhabitants.

Women aged 65 years and over

As for older men, ischaemic heart disease was the main cause of death in 2021 among female EU inhabitants aged 65 years and over, with 399.5 deaths per 100 000 older female inhabitants (see Table 1). COVID-19 and cerebrovascular diseases were the second and third leading causes of death (as was the case for older men), with, respectively, 390.6 and 308.7 deaths per 100 000 older female inhabitants. Dementia caused 162.7 deaths per 100 000 female inhabitants within this age group, followed by lung cancer and breast cancer.

Table 1: Main causes of death by age and sex, EU, 2021
(standardised death rate per 100 000 inhabitants)
Source: Eurostat (hlth_cd_asdr2)

Developments from 2011 to 2021

Between 2011 and 2021, there were declines in the standardised death rates of the leading causes of death in the EU ^[2]: ischaemic heart diseases (down 21.0 %), respiratory diseases (down 13.6 %) and cancer (down 12.2 %) – see Figure 4.

Among the different types of cancer, the death rate of lung cancer decreased by 14.2 % in the EU between 2011 and 2021. The rates for breast cancer and for prostate cancer also decreased, down 9.7 % and 9.5 %, respectively.

The standardised death rate of transport accidents decreased by 33.8 % in the EU between 2011 and 2021, while the rate for intentional self-harm fell by 17.4 %.

Figure 4: Standardised death rates from selected causes of death, EU, 2011 and 2021
(per 100 000 inhabitants)
Source: Eurostat (hlth_cd_asdr2)

Source data for tables and graphs

Causes of death: tables and figures

Data sources

Statistics on the underlying causes of death provide information on mortality patterns. 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.

Legal basis for the data collection

Since the 2011 reference year, reporting countries have submitted data to Eurostat based on the requirements of Regulation (EC) No 1338/2008 on Community statistics on public health and health and safety at work, and Regulation (EU) No 328/2011 on Community statistics on public health and health and safety at work, as regards statistics on causes of death. For data before the 2011 reference year, countries submitted data to Eurostat based on a gentleman's agreement established within the context of Eurostat's Working Group on Public Health Statistics.

There are currently 33 countries submitting data on causes of death to Eurostat:

all 27 EU Member States,
EFTA countries (Iceland, Liechtenstein, Norway and Switzerland),
two candidate countries (Serbia and Türkiye).

National and regional (NUTS level 2) data are collected.

Classification of the causes of death

Statistics on the causes of death are based on the medical information provided in the death certificate. Causes of death are classified by the 86 causes in the European shortlist which is based on the International Classification of Diseases and Related Health Problems (ICD).

When the outbreak of COVID-19 started, the WHO introduced emergency codes in the ICD version 10 (ICD-10) that countries could use to report deaths from COVID-19. In Eurostat's dissemination database, the codes are available as follows.

U071 – COVID-19, virus identified (deaths where COVID-19 has been confirmed by laboratory testing)
U072 – COVID-19, virus not identified (COVID-19, virus not identified)
U_COV19_OTH – COVID-19 other (COVID-19 death not elsewhere defined)

The data for COVID-19 reported in this article were calculated by adding the data for these three codes, however the data disseminated in Eurostat's dissemination database are for each separate code. More information about ICD-10 codes can be found on the ICD website.

Standardised death rate

The number of deaths from a particular cause of death can be expressed relative to the size of the population. A standardised death rate is adjusted to a standard age distribution. This facilitates comparisons of rates over time and between countries. The European standard population used for the standardisation of crude rates is based on the European Standard Population (ESP) in use since summer 2013.

Context

Statistics on causes of death are among the oldest medical statistics available. They provide information on developments over time and differences in causes of death between countries. These statistics 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 investment in research might increase the life expectancy of the population.

There is a general lack of comprehensive European morbidity statistics. Therefore, data on causes of death are often used as a tool for evaluating health systems in the EU and policymakers may use them 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 by improving prevention and control.

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Notes

↑ Data on respiratory diseases do not include data for COVID-19.
↑ Apart from COVID-19, as 2020 was the first year that countries reported COVID-19 as a cause of death.

[1] Data on respiratory diseases do not include data for COVID-19.

[2] Apart from COVID-19, as 2020 was the first year that countries reported COVID-19 as a cause of death.

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