Statistics Explained

Causes of death statistics



Data extracted in March 2022.

Planned article update: 20 April 2023.

Highlights

In 2019, the standardised death rate from circulatory diseases in the EU was almost five times higher in Bulgaria than in Spain.

In 2019, the largest difference in standardised death rate from cancer between the elderly and people below 65 years old in the EU was found in Sweden and the smallest difference in Romania.

The lowest standardised death rate from cancer among the EU countries in 2019 was reported in Cyprus.

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Death from circulatory diseases and cancer by country - standardised death rate 2019

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 policy-makers, health services and the public. With this data, it is possible to describe and understand the rate and 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 causes of death and the standardised death rates at EU level, by country of residence of the deceased, by age and by sex. The use of standardised death rates facilitates comparisons both over time and between countries, independent of population age structures.


Full article


Major causes of death in the EU in 2017


In total, 4.65 million deaths of EU residents were reported in the EU in 2017[1]. Over 83 % of all deaths in the EU occurred among people aged 65 years and over (hereafter referred to as ‘the elderly’).

The leading causes of death in European Union (EU) residents were diseases of the circulatory system and cancer (malignant neoplasms) (Figure 1). The third most frequent cause of death was respiratory disease. Respiratory diseases are age-related, with the vast majority of deaths from these diseases recorded among the elderly.

Figure 1: Causes of death by frequency, EU, 2017
(%)
Source: Eurostat (hlth_cd_aro)


Diseases of the circulatory system include those related to high blood pressure, heart disease and diseases of the veins and arteries. The most common causes of death from diseases of the circulatory system are ischaemic heart disease (such as heart attack) and cerebrovascular diseases (such as stroke) (Figure 2). The most common causes of death from cancer are malignant neoplasms of the trachea, bronchus and lung (hereafter 'lung cancer') and malignant neoplasm of colon, rectosigmoid junction, rectum, anus and anal canal (hereafter 'colorectal cancer'), followed by breast cancer and prostate cancer. Breast cancer occurs mainly in women and prostate cancer exclusively in men (see further below). Ischaemic heart disease and lung cancer top the list of avoidable deaths in the EU, see also Preventable and treatable mortality statistics.

Figure 2: Deaths from circulatory diseases and cancer, EU, 2017
(%)
Source: Eurostat (hlth_cd_aro)


Standardised death rate by sex and age


The causes of death differ between men and women. The EU standardised death rates were higher for men than for women for all of the main causes of death in 2017 with the exception of breast cancer. Breast cancer accounted for 32.2 deaths per 100 000 female inhabitants across the EU in 2017. Differences between women and men in the causes of death are also age related (briefly described below, for more information, see Causes of death statistics by age group).

Men below 65 years old

The main cause of death of men below 65 years old was lung cancer with 24.5 death per 100 000 male inhabitants below 65 years (Table 1). This was followed by accidents, with 22.1 deaths, heart attack and intentional self-harm, with 16.3 and 14.0 deaths respectively per 100 000 male inhabitants below 65 years.

Women below 65 years old

In women below 65 years old the main cause of death was breast cancer with 13.6 deaths per 100 000 female inhabitants below 65 years old (Table 1), followed by lung cancer with 12.1 deaths, cerebrovascular diseases, colorectal cancer and accidents, each with around 5.5 deaths per 100 000 female inhabitants below 65 years.

Men 65 years old and above

Cerebrovascular disease was the main cause of death in men aged 65 years old and above with 412.4 deaths per 100 000 elderly male inhabitants (Table 1), followed by lung cancer, heart attack, and chronic lower respiratory disease (such as asthma). Prostate cancer caused almost 182 deaths per 100 000 elderly male inhabitants.

Women 65 years old and above

Cerebrovascular disease also dominated as a cause of death in women aged 65 years old and above with 351.2 deaths per 100 000 female elderly inhabitants (Table 1). Dementia caused 168.8 deaths per 100 000 female inhabitants of this age group, followed by heart attack, breast cancer and chronic lower respiratory diseases.

Table 1: Main causes of death by age and sex, EU, 2017
(standardised death rate per 100 000 inhabitants)
Source: Eurostat (hlth_cd_asdr2)


Developments from 2011-2017


There were declines in the standardised death rates of the leading causes of death, ischaemic heart disease (-17 %) and cancer (-6 %), between 2011 and 2017 in the EU (Figure 3). Of the different types of cancer, the death rate of prostate cancer decreased by 5.9 %, lung cancer by 5.6 % and breast cancer by 4.1 %. The standardised death rate of transport accidents decreased by 21 % and intentional self-harm by 15%. The rate of respiratory disease as a cause of death increased by 5.2 % and is strongly affected by seasonal influenza.

Among the causes of death on the European shortlist that declined the most from 2011 to 2017 were human immunodeficiency virus [HIV] disease, tuberculosis and assault. These causes were already among the rarest with a standardised death rate below 0.8 per 100 000.

Figure 3: Causes of death, EU - standardised death rate 2011 and 2017
(per 100 000 inhabitants)
Source: Eurostat (hlth_cd_asdr2)



Main causes of death by country in 2019


The rate of circulatory diseases as cause of death vary widely between countries

The EU Member States[2] with the highest standardised death rates from circulatory diseases were Bulgaria and Romania, reporting 1052 and 830 deaths per 100 000 inhabitants in 2019, respectively (Figure 4). These countries were also among those with the highest overall standardised death rate. The EU Member States with the lowest standardised death rate from circulatory diseases in 2019 were Spain with 214.5 deaths and Denmark with 215.4 deaths per 100 000 inhabitants (France is shown in Figure 4 but data relate to the year 2017). The range of the standardised death rate is therefore very wide and the death rate from circulatory diseases in Spain is only 20 % of that in Bulgaria. The rate of circulatory diseases as cause of death in elderly people was more than 30 times that of people below 65 years old for all countries except Latvia, where it was 27.4 times higher.

Of the reporting countries that are not EU Member States, the highest standardised death rate of circulatory diseases was reported in Serbia with 816.3 deaths, and the lowest in Norway with 208.4 deaths per 100 000 inhabitants (Figure 4).


Figure 4: Death from circulatory diseases and cancer by country - standardised death rate 2019
(per 100 000 inhabitants)
Source: Eurostat (hlth_cd_asdr2)



Cancer as cause of death most common in Hungary and Croatia

The highest standardised death rates of cancer were reported in Hungary and Croatia, each with more than 300 deaths per 100 000 inhabitants in 2019 (Figure 4). The lowest rate was reported in Cyprus; 195.4 deaths from cancer per 100 000 inhabitants. Hence, for cancer as a cause of death, the difference between EU countries is smaller than for circulatory diseases. The death rates in elderly people were between 8.7 (Romania) and 20 times (Sweden) that of younger people. A smaller difference between age groups may point to a shorter time of survival when living with cancer.

Of the reporting countries that are not EU Member States, Turkey and Lichtenstein reported the lowest standardised death rates from cancer with 167.6 and 183.2 deaths per 100 000 inhabitants, respectively (Figure 4).

Lung cancer is the most common cause of death from cancer in the total population, and is the cancer with the highest standardised death rate for men (Table 1). In women, breast cancer is the most common cause of death from cancer (Table 1). The highest standardised death rate for lung cancer was reported in Hungary with 122.4 deaths per 100 000 male inhabitants, followed by Croatia with 107.7 (Figure 5). In men, the lowest death rate from lung cancer was reported in Sweden (35.2 per 100 000 male inhabitants), but Sweden is also the only EU country where the lung cancer standardised death rate is almost the same in men as in women (34.1 per 100 000 female inhabitants). Cyprus reported the lowest lung cancer death rate for women, 12.4 per 100 000 female inhabitants.

The lung cancer standardised death rate of women in Iceland was higher than that of men in 2019 (Figure 5). However, the absolute number of deaths was small for both sexes.


Figure 5: Death from lung cancer by country - standardised death rate, 2019
(per 100 000 male/female inhabitants)
Source: Eurostat (hlth_cd_asdr2)



External causes of death

External causes of death include, among others, deaths resulting from intentional self-harm (suicide). Although suicide is not a major cause of death and the data for some reporting countries are likely to be under-reported, it is often considered as an important indicator of societal issues. In the EU Member States, the lowest standardised death rates for suicide in 2019 were recorded in Malta (3.9 per 100 000 inhabitants), Cyprus and Greece (both below 5 per 100 000 inhabitants respectively).

The standardised death rate from intentional self-harm in Lithuania (22.9 deaths per 100 000 inhabitants) was the highest in the EU, however, it was the lowest rate reported in Lithuania since the start of the data collection in 2011. Slovenia also reported a comparatively high standardised death rate from suicide with 18.2 deaths per 100 000 inhabitants.



Source data for tables and graphs

Excel.jpg 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 Community statistics on public health and health and safety at work, as regards statistics on causes of death. Countries submitted data to Eurostat based on a gentleman's agreement established in the framework of Eurostat's Working Group on "Public Health Statistics" until data with reference year 2010.

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

  • All 27 EU Member States
  • EFTA countries (IS, LI, NO and CH)
  • Candidate countries and potential candidate countries (RS and TR)

Data are collected at NUTS0 and NUTS2 level.


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.

Tables in this article use the following notation:

Value in italics     data value is forecasted, provisional or estimated and is therefore likely to change;
: not available, confidential or unreliable value.


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.

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 policy makers 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 and combined with efforts to strengthen health systems towards improved prevention and control.

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Notes

  1. The latest statistics related to causes of death at EU level are available for the year 2017 while data on individual Member States are mostly available until 2019. The reference years 2018 and 2019 are missing for France. Therefore, statistics concerning residents are indicated as preliminary in Eurostat's dissemination database since France is missing. The (generally) small number of residents of other reporting countries who died in France are not yet included.
  2. Data concerning all causes of death are missing for France for 2018 and 2019.