Archive:Causes of death statistics at regional level
- Data from March 2011, most recent data: Further Eurostat information, Main tables and Database.
This article takes a look at mortality patterns in the European Union (EU), down to the regional level (NUTS 2). These vary significantly with age and gender, but also between countries and regions. Three types of factor determine mortality: intrinsic factors, such as age and gender; extrinsic factors, such as biological or collective social factors, living or working conditions; and individual factors, such as lifestyle, smoking, alcohol consumption, driving and sexual behaviour.
As a general rule, the mortality rate is higher among men than among women in all age groups. Although there are signs that the mortality gap is narrowing in some Member States, there are still significant differences between genders.
Main statistical findings
Causes of death — malignant neoplasms
Causes of death data give information on diseases leading directly to death, so they can be used as an indicator to plan health services. In the EU-27, the major cause of death was disease of the circulatory system but in France cancer took the lead, with 3 717 more deaths for the average period 2006–08.
In the Netherlands, cancer was also higher than circulatory system diseases, with 661 more deaths in the average period 2007–09.
Looking at the 27 Member States, the three-year average standardised death rate for 2006–08 for all malignant neoplasms show that the highest rates were in Hungary (240.9), Poland (207.7) and the Czech Republic (205.7). The lowest rates were in Cyprus (120.4), Finland (138.6) and Portugal (153.3). Analysing the data by gender, for men, Lithuania and Estonia had the second and third highest rates while Germany had one of the lowest. For women, Ireland has one of the highest rates of malignant neoplasms, in particular of the larynx, trachea, bronchus and lung and breast cancer, while Spain has one of the lowest.
Combined malignant neoplasms of the larynx, trachea, bronchus and lung
The form of cancer with highest death rates in all Member States, for all ages and both sexes, is combined malignant neoplasms of the larynx, trachea, bronchus and lung, with a three-year-average standardised death rate in 2006–08 of 39.6 per 100 000 inhabitants. The highest rates are in Hungary (68.4), Poland (54.9) and the Netherlands (47.3) and the lowest rates are in Cyprus (20.5), Portugal (26.0) and Finland (26.6).
Analysing the data by gender, the 2006–08 three-year-average standardised death rate for all ages for men is 65.8 in the EU-27. The highest rates are in Hungary (114.3), Poland (100.4) and Estonia (90.7). For women, the three-year-average standardised death rate is 18.9 per 100 000 inhabitants in the EU-27. Again, Hungary had the highest rate (35.7) followed by the Netherlands (31.7) and Ireland (28.6). The lowest rates are in Cyprus (7.7), Portugal (8.2) and Lithuania (8.6).
The regions with the highest rates are Eszak-Alfold (80.7), Eszak-Magyarorszag (71.9) and Del-Dunantul (71.7) in Hungary. The lowest rates were found in the French regions of Martinique (13.3), Guadeloupe (13.6) and Guyane (13.8). Analysing the data by gender, the Hungarian regions again had high death rates, followed by the Polish region of Warminsko-Mazurskie (127.0) for men and Flevoland (36.4) for women. The lowest rates for women are the Italian regions of Molise (5.8), Basilicata and Calabria (5.9).
The data can be analysed by age group using the crude death rate. The annual 2008 crude death rate shows that the highest rate was in the age group 80–84 (216.5), followed by 75–79-year-olds, with a rate of 258.3. Some countries, like Latvia, Romania, Slovenia and Slovakia, had higher rates in the age group 70–74. Amongst men, Bulgaria had the highest rate in the younger age group 65–69 (329.5).
The three-year-average standardised death rate shows that for the EU-27, in all ages and both sexes, breast cancer, together with malignant neoplasms of the colon, was the second largest cause of death by cancer, with 13.3 deaths by 100 000 inhabitants. For women, this was the main cause of death in most Member States, with a rate of 23.9 per 100 000 inhabitants; for men the rate is 0.3. Exceptions are Hungary, the Netherlands and Poland, where this form of cancer is second to malignant neoplasms of the larynx, trachea, bronchus and lung. The highest rates of breast cancer for women are in Ireland (29.7), the Netherlands (28.9) and Hungary (26.7) while Spain (18.4), Portugal (19.6), and Finland (20.9) have the lowest rates.
For women, the most-affected regions are Friesland (35.9) in the Netherlands, Trier in Germany (31.7) and Bucureşti - Ilfov in Romania (31.3). The lowest rates were found in the French Réunion (14.1), Cantabria in Spain (15.2) and Ionia Nisia in Greece (15.3). For men, the region with the highest rate is Ciudad Autonoma de Ceuta (1.1).
An analysis of the 2008 crude death rate for women in the EU-27 by age group shows that breast cancer increases with age and that women over 85 are the most affected, with a rate of 223.8 per 100 000 inhabitants. In this age group, the highest rates were in Slovenia, Greece and Ireland and the lowest rates were in Romania, Lithuania and Bulgaria.
Malignant neoplasms of the prostate
Another gender-related form of cancer is malignant neoplasm of the prostate. For men in the EU-27, the three-year-average standardised death rate (2006–08) is 21.4, compared to 230.1 for all malignant neoplasms. Prostate cancer is the second most common cause of death for males in EU-27 countries. High rates are found in Lithuania (36.4), Latvia (34.7), Estonia (33.7) and Slovenia (33.2), with the lowest in Romania (15.1), Italy (16.0), Bulgaria (16.9) and Spain (17.6).
The most affected regions are the French Martinique (47.0) and Guadeloupe (41.1) and the Finish Åland (44.2). The lowest rates are found in the Romanian regions of Sud-Vest Oltenia (10.2) and Sud - Muntenia (10.8) and the Spanish Ciudad Autonoma de Melilla (10.5).
From 2000 to 2008, the crude death rate for males in the EU-27 of all ages increased in 2007 (28.3) and 2008 (28.4). The countries with highest rates in 2008 were Estonia (40.5), Latvia (35.5) and Portugal (34.3) and the lowest rates were in Romania (16.6), Slovakia (19.1) and Luxembourg (19.4). Estonia had the highest increase (from 31.7 to 40.5) and Luxembourg saw a marked decrease from 24.8 to 19.4.
The rate of prostate cancer increases with age. People aged 85 + have the highest rates, 657.0, for the EU 27. In general, prostate cancer starts to be a problem around the age of 50.
Information on causes of death are a prerequisite for monitoring the performance of health policy.
Regional indicators provide an insight into similarities, particularities and differences across regions in Europe.
There can be big differences between regions in the same country, and regions in different countries may be very similar. A thorough analysis of trends and variations in health indicators at regional level is therefore essential to plan and monitor action and programmes, formulate new policies, develop new strategies and contribute to evidencebased health policymaking.
Eurostat’s work on health statistics mainly focuses on further improvements that are needed to make the current data more comparable and complete and to extend regional coverage.
Data sources and availability
Cause of death (COD) statistics are based on information from death certificates. COD statistics record the underlying cause of death, i.e. to quote the definition adopted by the World Health Assembly, ‘the disease or injury which initiated the train of morbid events leading directly to death, or the circumstances of the accident or violence which produced the fatal injury’.
In addition to absolute numbers, crude death rates and standardised death rates for COD are provided at national and regional levels. Regional-level data are provided in the form of three-year averages, along with yearly crude death rates for some age groups. The crude death rate (CDR) indicates mortality in relation to the total population. It is expressed per 100 000 inhabitants, i.e. calculated as the number of deaths recorded in the population over a given period divided by the population in the same period and then multiplied by 100 000. Crude death rates are calculated for five-year age groups.
However, the CDR is strongly influenced by the population structure. In a relatively ‘old’ population there will be more deaths than in a ‘young’ one because mortality is higher in older age groups. For comparisons, the age effect can be taken into account by using a standard population. The standardised death rate (SDR) is a weighted average of age-specific mortality rates. The weighting factor is the age distribution of a standard reference population. The ‘standard European population’ defined by the World Health Organisation (WHO) is used for this purpose. Standardised death rates are expressed per 100 000 inhabitants and calculated for the 0–64 age group (‘premature death’), 65+ and for all ages. Causes of death are classified into the 65 on the ‘European shortlist’, which is based on the international statistical classification of diseases and related health problems (ICD) developed and maintained by the WHO.
Health is an important priority for Europeans, who expect to be protected against illness and disease at home, in the workplace and when travelling across the EU. Health issues cut across a range of topics — including consumer protection (food safety issues), safety at work and environmental and social policies — and thus have a considerable impact on the EU’s revised Lisbon strategy.
Member States generally have the responsibility for organising and delivering health services and healthcare. The EU has the responsibility to give added value by launching initiatives such as those on cross-border health threats and patient mobility, reducing health inequalities and addressing key health determinants. Gathering and assessing accurate, detailed information on health issues is vital for the EU to effectively design policies and target future action.
On 23 October 2007, the European Commission adopted a new strategy ‘Together for health: A strategic approach for the EU 2008–13’ to set objectives that will guide future work on health at European level. Within the European Commission, the strategy is supported by the ‘Second programme of community action in the field of health 2008–13’. This programme has been adopted with three broad objectives that align future act on on health more closely to the objectives of prosperity, solidarity and security, namely:
- improving citizens’ health security;
- promoting health to improve prosperity and solidarity;
- generating and disseminating health knowledge.
To monitor progress on these objectives, Regulation 1338/2008 of the European Parliament and of the Council on Community statistics on ‘public health and health and safety at work’ is the legal framework for compiling the required background statistics. It covers causes of death, health status, health determinants and healthcare.
Further Eurostat information
- Atlas on mortality in the European Union
- Eurostat regional yearbook 2011, chapter 5
- Eurostat regional yearbook 2010, chapter 12
- Who dies of what in Europe before the age of 65 - Statistics in focus 67/2009
- Health, see:
- Public health (t_hlth)
- Causes of death (t_hlth_cdeath)
- Health, see:
- Public health (hlth)
- Causes of death (hlth_cdeath)
- Health, see:
- Public health