Causes of death statistics - methodology

Latest update of text: February 2026

This background article explains causes of death statistics, a dataset that provides information on mortality patterns in the European Union (EU).

The article provides information on the main features of these data, their historical development and current legal bases, some main methodological features, information concerning data quality and finally an overview of the uses of the data that come from this source.

This article is one of a set of background articles concerning the methodology for the production of health statistics in the EU. Together with a number of statistical articles, these background articles make up the online publication Health in the European Union – facts and figures.

Main features

Statistical objectives

Statistics on the underlying causes of death, which are among the oldest medical statistics available, provide information on developments over time as well as geographical differences. These statistics play a key role in the general information system relating to the state of health. They may be used to determine which preventive and medical-curative measures, or which investments in research, might increase the life expectancy of the population.

Data on causes of death are often used to evaluate the performance of health systems in the EU and may also be used to inform evidence-based health policy.

Key definition – underlying cause of death

All deaths in the population are identified by the underlying cause of death, in other words ‘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’. This definition was adopted by the World Health Assembly and is included in Volume 2 of the 2019 update of the international statistical classification of diseases and related health problems – 10th revision (ICD-10). It should be noted that special rules apply for some diseases or injuries. By relating all deaths in the population to an underlying cause of death, the risks associated with death from a range of specific diseases and other causes can be assessed.

Development and legal bases

Development and history

Eurostat began collecting and disseminating data on causes of death in 1994.

Until 2010, EU countries provided data on the basis of a gentlemen’s agreement, in other words, without a legal obligation. Specifications common with the World Health Organization (WHO) were used in the data collection up to 2010, although Eurostat also collected regional data. Since 2011, these data have been provided under specific legal acts.

Legal bases

A Regulation on Community statistics on public health and health and safety at work (EC) No 1338/2008 was adopted by the European Parliament and the Council in December 2008. Within the context of this Regulation, the European Commission Regulation 328/2011 on statistics on causes of death was adopted in April 2011 specifying in detail the variables, analysis (breakdowns) and metadata that EU countries must deliver. The first data submitted according to the new legal bases were for reference year 2011.

Methodology

Detailed methodological information – methodology manual

Detailed information on the methodology employed for causes of death statistics are available in the Causes of death statistics manual (2025 edition). This comprehensive manual includes guidelines for data providers when transmitting data to Eurostat, both for the mandatory and voluntary parts of the data collection. These guidelines describe the elements involved in the workflow for causes of death data validation as well as the metadata and quality reporting.

Although explicitly designed for providers of causes of death statistics, the manual also provides detailed information of interest to data users, particularly Chapter 2 (methodology), Chapter 3 (classifications (definitions)) and Chapter 4 (data dissemination), which include subjects such as:

various types of analyses – cause of death, year (and sometimes month) of death, sex, age and region/country of residence
geographical coverage
statistical unit and population
definitions
classifications
treatment of statistical confidentiality
aggregates for the EU
calculation of death and mortality rates as well as other derived indicators.

Main sources

Statistics on causes of death are based on two pillars:

medical information contained on death certificates, which may be used as a basis for ascertaining the cause of death
the coding of causes of death following the 2019 update of the 10th revision of the ICD-10; this classification is managed and regularly revised and updated by the WHO.

The medical certification of death is an obligation in all EU countries. The information provided in medical certificates is used to code the cause of death.

Statistical units and the statistical population

The statistical unit for causes of death statistics is the individual (the deceased person). Deaths are reported by certifiers, in most cases a physician.

General mortality data are presented in terms of the number of deaths, as crude death rates and using standardised death rates. They are also used to derive the indicator of potential years of life lost. Data on public health themes are presented in terms of the number of deaths and as standardised death rates (per 100 000); see below for more information.

The statistical population includes residents and non-residents. Resident means ‘usual resident’ in the place where a person normally spends the daily period of rest, regardless of temporary absences for purposes of recreation, holidays, visits to friends and relatives, business, medical treatment or religious pilgrimage. However, national legal requirements as well as national practices concerning the registration of residents dying abroad and domestic deaths of non-residents are not yet fully harmonised across Europe.

For calculating crude and standardised death rates, the annual average population is used. This population measure, also known as the mid-year average population, is calculated as an average of the January population data of the reference year (T) and the following year (T+1). These data are available in Eurostat’s demography database.

Main concepts and definitions

Reference period: calendar year. For some countries data is also provided by month on a voluntary basis.

Crude death rate

The crude death rate describes mortality in relation to the total population. Expressed in deaths per 100 000 inhabitants, it is calculated as the number of deaths recorded in the population for a given period divided by the size of the population in the same period and then multiplied by 100 000.

Crude death rates are calculated for 5-year age groups. At this level of detail, comparisons between countries and regions are meaningful. The crude death rate for the total population (all ages) however, is a weighted average of the age-specific mortality rates. The weighting factor is the age distribution of the population whose mortality is being observed. Thus, the population structure strongly influences this indicator for broad age classes. In a relatively ‘old’ population, there will be more deaths than in a relatively ‘young’ population because mortality is higher among older age groups.

Standard population and standardised death rates

For statistics concerning causes of death, one of the key methods to control for different age distributions among populations and over time is age standardisation: a standard population is used to produce standardised death rates to compare mortality rates. As most causes of death vary significantly with people’s age and sex, the use of standardised death rates improves comparability over time and allows rates for different geographical areas to be compared independently from the population’s age structure. The standardised death rate is a weighted average of age-specific (crude) mortality rates where the weighting factor is the age distribution of a standard reference population. Eurostat uses the European standard population for this purpose. Standardised death rates are calculated for the age group 0 to 64 years (one of several definitions that may be used to analyse ‘premature deaths’), 65 years and over and for the total of all ages (the whole population).

The current European standard population is a revision of the former European standard population taking into account population projections that were made in 2010 for the period 2011 to 2030. The current European standard population is an unweighted average of the individual populations of EU ^[1] and EFTA countries in each 5-year age band (with the exception of under 5 years and the highest age-group of 95 years and over). It has been in use since the summer of 2013.

Infant, foetal, perinatal and neonatal mortality rates Data on infant deaths are presented in terms of the number of deaths and as mortality rates. Infant mortality data are also presented with an analysis by age showing the proportion of deaths in each age group as a percentage of all infant deaths.

The infant mortality rate is calculated as the ratio of the number of deaths of children under 1 year of age to the number of live births. The value is expressed per 1 000 live births.
The neonatal mortality rate is calculated as the ratio of the number of deaths between day 0 and day 27 (inclusive) compared with the number of live births. The value is expressed per 1 000 live births.
The early neonatal mortality rate is calculated as the ratio of the number of deaths between day 0 and day 6 (inclusive) compared with the number of live births. The value is expressed per 1 000 live births.
The late foetal mortality rate is calculated as the ratio of the number of stillbirths to the number of births. The value is expressed per 1 000 births.
The perinatal mortality rate is calculated as the number of stillbirths plus deaths between day 0 and day 6 (inclusive) divided by the number of births. The value is expressed per 1 000 births.

In addition to the total number of stillbirths, two detailed groups of late foetal death are displayed:

group 1 records stillbirths with a birth weight from 500 to 999 grams, gestational age from 22 to 27 weeks (when birth weight does not apply) or crown–heel length from 25 to 34 cm (when neither of the two applies)
group 2 reports stillbirths with a birth weight of 1 000 grams and more, gestational age after 27 completed weeks (when birth weight does not apply), or crown–heel length of 35 cm or more (when neither of the two applies).

The sum of the two groups is not necessarily equal to the total number of stillbirths, as stillbirths with unknown birth weight, gestational age or crown–heel length are not reported in either of the two groups but are recorded in the total number of stillbirths.

Potential years of lost life

The number of potential years of life lost is an indicator estimating the potential years lost due to premature death, in other words, death before the age of 70 years. This measure is used to help quantify social and economic loss owing to premature death. It is calculated by summing the number of years between the age at death and 70 years for each premature death. The rate is expressed per 100 000 people under 70 years of age in the age-standardised population. Eurostat also publishes data for potential years of life lost for people under 75 years of age.

Avoidable mortality

Indicators of avoidable mortality can provide an indication of the quality, performance and effectiveness of health care systems and of (wider) public health policies. There are two aspects of avoidable mortality: preventable deaths and treatable causes of death:

preventable mortality – causes of death that can be mainly avoided through effective public health and primary prevention interventions (in other words, before the onset of diseases/injuries, to reduce incidence)
treatable (or amenable) mortality – causes of death that can be mainly avoided through timely and effective health care interventions, including secondary prevention and treatment (in other words, after the onset of diseases, to reduce case-fatality).

The age up to which a death can be considered avoidable is set at 74 years (inclusive) to reflect life expectancy. The list of diseases/conditions and the age limit reflect current health expectations, medical technology and knowledge, and developments in healthcare public policy. As such, they are subject to change.

A selected list of avoidable causes of death for statistical dissemination has been agreed between OECD and Eurostat in 2018. See also the article on preventable and treatable mortality statistics for more information on the relevant causes of death.

Main classifications

Causes of death are classified by the 86 causes in the European shortlist which is based on ICD-10. EU countries submit data to Eurostat either using this short list or the 4-digit level of the full classification.

Additionally, a few new categories have been added to the European shortlist since it was first published:

[B180-B182] Chronic viral hepatitis B and C
[K72-K75] Chronic liver disease (excluding alcoholic and toxic liver disease)
[U071] COVID-19, virus identified
[U072] COVID-19, virus not identified
[U_COV19_OTH] COVID-19, other

Further methodological information

Methodological notes for individual countries are available in the annexes to the metadata file for causes of death statistics.

Data quality

The validity and reliability of statistics on the causes of death rely, to some degree, on the quality of the data provided by certifying physicians. Inaccuracies may result for several reasons, including:

errors when issuing the death certificate
problems associated with the medical diagnosis
the selection of the main cause of death
the coding of the cause of death.

Sometimes there is ambiguity in the main condition, especially when manual coding is performed: besides the condition leading directly to death, the medical data on the death certificate should also contain a causal chain of diseases, injuries or poisoning leading to death, according to the ICD-10 provisions. Other substantial health conditions may be indicated, which did not have a link to the illness leading directly to death but may have unfavourably affected the course of a disease and thus contributed to the fatal outcome.

Due to the fact that the data collection in 2011 was the first undertaken with a legal basis (which also introduced changes in the requested variables and breakdowns), the data starting from 2011 are not always comparable with the data for the period 1994 to 2010. This is in part due to the potentially different underlying populations as well as different groupings of causes of deaths.

Overall quality is also ensured by the widespread use of the IRIS automated coding system across EU countries.

Data dissemination

Published data

Statistical data are available in various formats. Statistics Explained articles and publications provide data and analysis, while Eurobase provides a set of multi-dimensional databases and information in a simpler format as selected datasets.

For general mortality, these statistics are analysed by cause of death, age, sex and country/region of residency or occurrence. For stillbirths and neonatal deaths, additional analyses include age of mother and parity (the number of previous births (including live births and stillbirths) of the mother); optional variables for stillbirths include birth weight or gestational age or crown–heel length.

Causes of death are classified according to the 86 causes of death as found in the European shortlist which is based on ICD-10.

Concerning age, data are generally presented for 5-year age groups for the number of deaths and for crude death rates. Whenever data are considered as confidential, the data for such age groups are grouped with other age groups. In practice, this issue mainly occurs for age groups covering younger people, for example in the age groups within the range of 0 to 14 years. For standardised death rates, a distinction is made between i) persons aged less than 65 years and ii) those aged 65 years and over. For potential years of life lost, a distinction is made between years lost before 70 years of age and years lost before 75 years of age.

Concerning residency/occurrence, most data are provided for two different populations:

deaths among residents of a reporting country/region (an EU country/region or a non-EU country/region);
all deaths which occurred in the reporting country, regardless of the residency status of the deceased.

The absolute number of deaths is published for i) deaths among residents and ii) all deaths reported in a reporting country/region (in an EU country or a non-EU country). Crude deaths rates and standardised deaths rates are calculated using data on deaths among residents.

A selection of information on causes of death is also published under the heading of public health themes. With the exception of information on the health impacts of air pollution (not collected by Eurostat), these indicators concern relevant public health themes such as: treatable and preventable mortality, infant deaths, deaths related to transport accidents, deaths related to dementias (including Alzheimer’s disease), deaths related to infectious diseases and potential years of life lost. Health statistics are used to support the monitoring and evaluation of health-related, evidence-based policies, both nationally and in the EU, for example on social inclusion and protection, healthy lifestyles, healthy ageing and well-being, health inequalities, health outcomes, healthcare access, quality of healthcare services, and health and safety at work.

Time coverage

All data on causes of death are annual. Starting from reference year 2019 monthly national data are available for 21 EU Member States, and for 22 Member States from reference year 2023 in absolute numbers and standardised death rates. For regional data, 3-year averages are also calculated from the annual data in order to reduce the impact of outliers.

The time series disseminated on Eurobase start in 2011, coinciding with the introduction of a legal basis for causes of death statistics. Data starting in 2011 are available for all EU and EFTA countries, as well as Serbia and Türkiye. Data before 2011 are available for most EU and EFTA countries starting from 1994. Shorter series are available for Bulgaria (from 1995), Latvia and Slovakia (1996), Cyprus, Poland and Romania (1999) and Liechtenstein (2010). Due to the fact that the data collection in 2011 was the first with a legal basis, the data starting from 2011 are not always comparable with the data for the period 1994 to 2010.

The time series for data concerning stillbirths start in 2011.

Geographical coverage and detail

As well as data for EU and EFTA countries, Eurostat also publishes data for some candidate countries.

Alongside the national data, regional data are also available for all EU and EFTA countries as well as Serbia and Türkiye. Data are normally available at levels 1 and 2 of the classification of territorial units for statistics (NUTS).

Regional data for general mortality are presented as crude and standardised death rates, with information by region of residence and of occurrence. Regional data are also available for the potential years of life lost.
Regional infant causes of death and peri-neonatal mortality are presented as 3-year averages with information by region of residence and of occurrence. In addition, regional peri-neonatal mortality data are analysed by the mother’s age and the parity.

Timing of data transmission to Eurostat and dissemination

The legal requirement is for mandatory data of causes of death to be submitted as final data for year T within 2 years of the end of the reference year (T+24 months). For example, data for the reference year 2024 should be provided by the end of December 2026. Under a voluntary agreement, countries provide data for year T within 18 months of the end of the reference year (T+18 months) if possible. Note that monthly data are transmitted with an annual frequency (all months together) at the same time as annual data.

Data analysed by occurrence are disseminated as and when they are received. Data analysed by residence are usually disseminated by March of year T+3. For example, data for the reference year 2023 would be released in March 2026.

Footnotes

The coverage is that at the time of the revision in 2010, in other words including the United Kingdom and excluding Croatia. ↑

Explore further

Database

Health (hlth), see:

Causes of death] (hlth_cdeath)

Health (t_hlth), see:

Causes of death (t_hlth_cdeath)

External links

[1] The coverage is that at the time of the revision in 2010, in other words including the United Kingdom and excluding Croatia. ↑

[1]

Causes of death statistics - methodology

Main features

Development and legal bases

Methodology

Data quality

Data dissemination

Footnotes

Explore further

Other articles

Database

Thematic section

Publications

Methodology

External links