Causes of death - monthly statistics

Data extracted in May 2024

Planned article update: May 2025

Highlights

In 2021, the highest number of deaths in the EU (data available for 21 countries) was reported in January and the lowest in June.

Malta was the only EU country to record a monthly standardised death rate for COVID-19 of 0 deaths per 100 000 inhabitants in June.

There were 10 863 deaths from heart attacks reported in January 2021 in the 21 EU countries for which data are available.

Monthly COVID-19 standardised death rate, 2021
(per 100 000 inhabitants)
Source: Eurostat (hlth_cd_msdr2)
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This article presents data on monthly causes of death in the European Union (EU). Eurostat began collecting monthly data on causes of death in 2021, for reference year 2019.

This data describe the cause-specific mortality rates and trends. The purpose of this new voluntary data collection is to inform policymakers, and the public on changing epidemiological circumstances. Most causes of death vary significantly by age and by sex, and some also vary by month or season. This article gives an overview of the monthly number of deaths and standardised death rates for EU countries with analyses by country of residence and age of the deceased. The use of standardised death rates facilitates comparisons both over time and between countries, independent of different population age-structures. Please note that data are only available for 21 EU countries, so there is no EU aggregate; data are also available for two EFTA countries: Iceland and Norway, and two candidate countries: Türkiye and Serbia.

Full article

Monthly deaths in 2020 and 2021

There were 3.29 million deaths in total^[1] in 2020, and 3.32 million in 2021, across the 21 countries for which monthly mortality data are available.

In 2021, the highest number of deaths, 333 418, was reported in January and the lowest number was reported in June, 233 183 deaths. In comparison, in 2020, the highest number of deaths, 342 575, was reported in November and the lowest number was reported in June, 222 208 deaths. More deaths were recorded in 2021 for most months when compared to 2020 (in the 21 EU countries for which data are available).

Figure 1: Total and COVID-19 mortality, 2020 and 2021 (Number for 21 EU countries)

The novel coronavirus 2 (SARS-CoV-2, also known as COVID-19) virus was first identified in Wuhan, China in December 2019. The WHO declared it a Public Health Emergency of International Concern on 30 January 2020, and characterised it as a pandemic on 11 March 2020. Mortality codes for COVID-19 were established in April 2020.

The first deaths reported as caused by COVID-19 within the EU were in France in January 2020 (11 deaths). By the end of March 2020, there had been at least one COVID-19 death reported in all but one (Malta) of the EU countries for which data are available. The highest number of deaths from COVID-19 in 2020 were reported in November, with 80 970 deaths from COVID-19 reported across the 21 EU countries. The lowest number of deaths reported, not including January and February, was recorded in July with 2 277 deaths from COVID-19. In the 21 EU countries for which data are available, there were over 39 000 more deaths from COVID-19 in 2021 than in 2020. The only months that reported a higher number of deaths from COVID-19 in 2020 were March, April, November, and December. The highest number of deaths from COVID-19 in 2021 were reported in January, with 63 324 deaths from COVID-19 reported across the 21 EU countries, whereas the lowest number of deaths was reported in July, with 3 406 deaths from COVID-19.

Leading causes of death in 2021

Diseases of the circulatory system were the leading cause of death in the EU in 2021. In the 21 EU countries for which data are available, diseases of the circulatory system was the leading cause of death throughout the year in ten of them. Romania recorded the highest monthly standardised death rate in October with 125.1 deaths from diseases of the circulatory system per 100 000 inhabitants. The lowest monthly standardised death rate was reported by France for June at 12.8 deaths per 100 000 inhabitants.

The standardised death rate for cancer remained relatively stable throughout the year and across the 21 EU countries for which data are available. The standardised death rate for cancer across the 21 EU countries for which data are available, ranged from 14 to 26 deaths per 100 000 inhabitants throughout 2021. The only country to record a lower rate was Malta in April, at 12.2 deaths from cancer per 100 000 inhabitants. The standardised death rate for cancer surpassed that of circulatory diseases in ten countries. In Belgium, Ireland, Spain, Cyprus, Luxembourg, Malta and Slovenia this occurred in at least one month during the year. Denmark and France were the only EU countries (for which data is available) to record a standardised death rate for cancer that was higher than that of circulatory diseases across 2021.

Figure 2: Standardised death rate for major causes of mortality by month, 2021 (per 100 000 inhabitants)

In 2021, COVID-19 was the third leading causes of death in the EU. In terms of monthly deaths, the number of deaths across the 21 EU countries for which data are available varied greatly over the course of 2021.

Most countries experienced two peaks in the standardised death rate for COVID-19, at the beginning and at the end of the year. Almost half (10) of the countries for which data are available reported the highest monthly death rate in January, and five countries reported it in March. Four countries reported the highest monthly standardised death rate in November or December. The only country to report the highest monthly standardised death rate in the middle of the year, was Cyprus with a standardised death rate of 14.95 deaths from COVID-19 per 100 000 inhabitants in August.

The majority of countries experienced the lowest rate of deaths from COVID-19 in the summer months, with 15 of the 21 countries recording the lowest rate of deaths in July. In this month, only three countries recorded a standardised death rate over 2.0: Cyprus, Spain and Greece; Cyprus was the only country with a standardised death rate over 3 (8 deaths per 100 000 inhabitants). Malta was the only EU country to record a monthly standardised death rate for COVID-19 of 0 deaths per 100 000 inhabitants in June.

Respiratory diseases represented the fourth leading cause of death in the EU in 2021. Across the year, the standardised death rate for respiratory diseases ranged from 27.8 deaths per 100 000 inhabitants in November in Slovakia, to 1.99 deaths from respiratory diseases per 100 000 inhabitants in August in Slovenia.

Figure 3: Share of major causes of mortality, 2021 (% of deaths in 21 EU countries)

In terms of share of deaths in the 21 EU countries for which data are available, the share of deaths from diseases of the circulatory system in 2021, ranged from 34.4 % in June to 30.7 % in January and the share of deaths from cancer, ranged from 25.8 % in July to 18 % in January. In 2021, the highest share of deaths from COVID-19 among the 21 EU countries for which data are available was recorded in January at 19 %, and the smallest share was reported in July, at 1.4 %. The share of deaths from respiratory diseases, ranged from 5.6 % in January to 7.4 % in November.

Comparing respiratory diseases and COVID-19

Figure 4 shows the share of deaths from influenza, asthma, pneumonia, chronic lower respiratory diseases, and COVID-19 out of the deaths from respiratory diseases and COVID-19 in 2021, among the 21 EU countries for which data are available. The share of respiratory deaths from COVID-19 in 2021 was highest in January, where it accounted for 77 % of all deaths from either respiratory diseases or COVID-19; the share of deaths from COVID-19 was lowest in July, at 18 %.

The share of deaths from asthma ranged from 1.4 % in July to below 0.4 % in April.

Figure 4: Share of deaths from Respiratory diseases(¹), and COVID-19: 2019 and 2020 (% of deaths in 21 EU countries)

The share of respiratory deaths from chronic lower respiratory diseases in 2021 was highest in July, where is accounted 32 % of all deaths from either respiratory diseases or COVID-19. The month with the lowest share of deaths from chronic respiratory diseases was January, at 8 %.

In 2021, the highest share of deaths from pneumonia was in July, when 22 % of deaths from respiratory diseases and COVID-19 were due to pneumonia. The lowest share of deaths from pneumonia was recorded in January, at 7 %. In 2021, the share of deaths from influenza remained below 0.15 % throughout the year.

Causes of death that vary by month

The frequency of many causes of death varies by month. Figure 5 shows the number of deaths in the 21 EU countries, for which data are available, for selected causes: dementia (ICD10 F01-F03), heart attack (classified as acute myocardial infarction including subsequent myocardial infarction (ICD-10 codes I21-I22), intentional self-harm (ICD10 codes X60-X84_Y870), and transport accidents (ICD10 codes V01-V99, Y85).

Out of the four selected causes of death, heart attack was the most frequent; the highest number of deaths from heart attacks in the 21 EU countries for which data are available was recorded at the beginning and at the end of 2021, with over 10 863 deaths from heart attacks reported in January, and 10 365 reported in December. A significant drop in the number of deaths from heart attacks in the 21 EU countries for which data are available was recorded between January and February (down by 1 878 deaths), and a significant increase occurred between September and October (up by 2 097 deaths). The lowest number of deaths from heart attacks was reported in July (8 065 deaths).

The number of deaths from dementia in the 21 EU countries for which data are available range from 6 192 in April to 8 461 in December. The only other month to report less than 6 300 deaths from dementia was February when 6 294 deaths from dementia were recorded.

Figure 5: Frequency of selected causes of death by month, 2021 (Number for 21 EU countries)

The frequency of deaths from intentional self-harm in the 21 EU countries for which data are available was highest in the summer months; over
2 500 deaths from intentional self-harm were recorded monthly between May and August, with the highest number recorded in July with 2 720 deaths in the 21 EU countries for which data are available. January, February, November, and December all recorded less than 2 300 deaths from intentional self-harm in the 21 EU countries for which data are available, with the lowest number reported in February with 2 132 deaths from intentional self-harm.

The lowest number of deaths from transport accidents was reported in February, with 867 deaths; the number of deaths steadily increased from February to 1 544 in July, which was the month with the highest number of deaths from transport accidents. Between July and December, the number of deaths decreased to 1 192 deaths.

Source data for tables and graphs

Monthly 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 reference year 2011, reporting countries submit 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 statistics on causes of death.

There are currently 33 countries submitting the CoD data to Eurostat:

All 27 EU countries;
EFTA countries (Iceland, Liechtenstein, Norway and Switzerland);
Candidate countries and potential candidates (Serbia and Türkiye).

As of 2021, Eurostat invited countries to provide month of death starting with reference years 2019 and 2020, following consultations on potential Public Health data collections on the COVID-19 pandemic. Data on month of death was provided by 21 EU countries; Germany, Latvia, the Netherlands, Poland, Portugal and Sweden have not been able to provide data on month of death.

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 was calculated by adding these three codes, however the data disseminated in Eurostat's dissemination database are separated by code. For more information about ICD-10 codes, click here.

Dying with COVID or dying from COVID-19
The Eurostat causes of death data collection is based on confirmed death certificates established by medical experts assessing the underlying cause of death. The rules for the selection of the underlying cause of death are set by WHO in the International Classification of diseases, 10th revision. There is difference in the coding of cases of COVID-19 deaths, where COVID-19 was the established underlying cause of death (deaths from COVID-19), and where deaths occurred in someone who had a positive COVID-19 test at or close to the time of death (deaths with COVID-19). Here, death certificates may establish another cause of death despite the deceased dying with COVID-19. Nevertheless, there may be differences in how countries determined the underlying cause of death, particularly in cases where the deceased had multiple morbidities, or coinfections with other respiratory diseases (e.g. pneumonia).

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 the summer of 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.

Therefore, data on causes of death are often used as a tool for evaluating health systems in the EU and policy makers may use them for evidence-based health policy. The EU promotes a comprehensive approach to tackling major and chronic diseases, including a cancer plan for Europe, through integrated action on risk factors across sectors and combined with efforts to strengthen health systems towards improved prevention and control.

COVID-19 pandemic
The COVID-19 pandemic highlighted the need to prioritise public health, and strengthen healthcare systems across the EU and globally. In response to the pandemic, the European Commission took a series of actions to contain the spread of the coronavirus, support national health systems and counter the socio-economic impact of the pandemic, at both national and EU level.
This included:

Supporting research and development in vaccines, and implementing a vaccine strategy.
Launching the European Health Emergency preparedness and Response Authority (HERA), which aims to prevent, detect, and rapidly respond to health emergencies.
Participating in COVAX, the world's facility for fair and universal access to COVID-19 vaccines.
Laying the foundation for establishing a European Health Union, based on two pillars:
- A stronger health security framework, and
- More robust EU agencies.

You can read more about the Commission’s response to the COVID-19 pandemic here.

Mental Health

Among other topics, a comprehensive, prevention-oriented and multi-stakeholder approach to mental health has been developed after extensive consultation with countries, stakeholders and citizens, summarised in the 2023 Communication on mental health.

The new approach recognises that mental health is about more than just health and, therefore, strongly involves areas such as education, digitalisation, employment, research, urban development, environment and climate.

In case you or somebody you know is struggling with the issues mentioned in this article, you can find a support service on the following Mental Health Europe page.

Direct access to

Notes

↑ European statistics in the domain of ‘causes of death’ cover all registered deaths and stillbirths occurring in each country, based on death certificates. Not all deaths are accompanied by a death certificate, therefore there may be differences to the total number of deaths reported under other data collections. In this article, ‘total deaths’ refers to all registered deaths from age 0 days (the variable ‘All causes of death (A00-Y89) excluding S00-T98’ in Eurostat’s dissemination database).

[1] European statistics in the domain of ‘causes of death’ cover all registered deaths and stillbirths occurring in each country, based on death certificates. Not all deaths are accompanied by a death certificate, therefore there may be differences to the total number of deaths reported under other data collections. In this article, ‘total deaths’ refers to all registered deaths from age 0 days (the variable ‘All causes of death (A00-Y89) excluding S00-T98’ in Eurostat’s dissemination database).

[1]