Statistics Explained

Preventable and treatable mortality statistics


Data from June 2022.

Planned article update: September 2023.

Highlights


In 2019, Sweden had the lowest death rate in the EU for treatable diseases (60.2 per 100 000 inhabitants), followed by the Netherlands, Spain, Luxembourg and Italy; the highest death rates were recorded in Romania, Bulgaria, Latvia and Lithuania.

In the EU, mortality rates for both treatable and preventable diseases were higher for men than for women in 2019.

In the EU, 1.5 million persons aged less than 75 years died in 2017; the total number of avoidable deaths among persons aged less than 75 years was 1.0 million.

Among people aged less than 75 years, the two leading causes of all avoidable deaths in 2017 in the EU were ischaemic heart diseases and lung cancer.

[[File:Preventable and treatable mortality statistics 28-06-2022 dynamic.xlsx]]

Standardised death rates for treatable diseases/conditions, persons aged less than 75 years, by sex, 2019

This article presents statistics for the European Union (EU) on two indicators of avoidable mortality, namely deaths from treatable and preventable diseases/conditions. The concept of treatable and preventable mortality is based on the idea that certain deaths (for specific diseases/conditions defined by the ICD classification — see the Data sources section) could be ‘avoided’ among people aged less than 75 years. In other words, these avoidable deaths would not have occurred at this stage if there had been more effective public health and/or medical interventions in place [1].

A mortality is considered as treatable if the death could have been avoided through optimal quality healthcare.

The concept of preventable deaths covers deaths which could have been avoided by public health interventions focusing on wider determinants of public health, such as behaviour and lifestyle factors, socioeconomic status and environmental factors.

The diseases/conditions that can be both largely prevented and also treated once they have occurred are attributed to the preventable category. In cases when there is no strong evidence of predominance of preventability or treatability diseases/conditions, they are allocated on a 50 %-50 % basis to the two categories.

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

Overview

In the EU, 1.5 million persons aged less than 75 years died in 2017[2]. Certain diseases/conditions are treatable and/or preventable. Collectively, deaths that are the result of these diseases/conditions are referred to as avoidable deaths. The total number of avoidable deaths was 1.0 million in 2017. Among the avoidable deaths, 372 600 could have been avoided with healthcare systems offering timely and effective medical treatments (deaths from treatable diseases/conditions) and 652 000 deaths could have been prevented through better public health interventions (preventable deaths). The leading causes of all avoidable deaths were ischaemic heart diseases and lung cancer.

Number and rate of avoidable deaths

In 2017, deaths from avoidable diseases/conditions among people aged less than 75 years amounted to 1.0 million in the EU

A total of 1.0 million deaths in 2017 among people aged less than 75 years — equivalent to a rate of 255 deaths per 100 000 inhabitants — could have been avoided in the EU, either through better healthcare systems and/or better public health interventions. Around 372 600 of these deaths — equivalent to a standardised rate of 92.1 deaths per 100 000 inhabitants — could have been avoided through better healthcare systems (deaths from diseases/conditions that are treatable). The number of preventable deaths was higher than the number from treatable diseases/conditions due to the broader definition of the former. In 2017, close to two thirds of a million (652 000) deaths in the EU — equivalent to 160 deaths per 100 000 inhabitants — could have been prevented through better public health interventions.

Figure 1 and Figure 2 show data for standardised death rates of avoidable mortality: preventable and treatable respectively. These standardised rates assume the same age distribution of the population for all countries.

Figure 1 shows that in 17 EU Member States, the standardised death rates for treatable diseases/conditions was under 100 (per 100 000 inhabitants). The lowest rates of death from treatable diseases/conditions in 2019 were recorded in Sweden, the Netherlands, Spain, Luxembourg, and Italy (all under 65 per 100 000 inhabitants); France (2017 data) recorded the third lowest rate (62.1 per 100 000 inhabitants). The highest death rate for treatable diseases/conditions was 208.3 per 100 000 inhabitants in Romania, while Bulgaria, Latvia, Lithuania and Hungary recorded rates between 173 and 189 per 100 000 inhabitants.

Figure 1: Standardised death rates for treatable diseases/conditions, persons aged less than 75 years, 2019
(per 100 000 inhabitants)
Source: Eurostat (hlth_cd_apr)

In turn, Figure 2 shows that the standardised death rates for preventable diseases/conditions were higher in all Member States than the standarised death rates for treatable diseases/conditions, with only Cyprus recording the lowest rate of 99.8 per 100 000 inhabitants. Italy, Malta and Spain also recorded the lowest rates (all under 110 per 100 000 inhabitants). The highest rates were recorded in Hungary, Latvia, Romania, and Lithuania, the former recording the highest rate of 315.3 per 100 000 inhabitants.

Figure 2: Standardised death rates for preventable diseases/conditions, persons aged less than 75 years, 2019
(per 100 000 inhabitants)
Source: Eurostat (hlth_cd_apr)

Avoidable death rates by sex

Mortality rates in the EU were higher for males than for females for treatable diseases/conditions

In all EU Member States, except for the Netherlands, mortality rates among people aged less than 75 years for treatable diseases/conditions in 2019 were higher for males than for females — see Figure 3. The smallest gender gaps (compared with the mortality rate for treatable diseases/conditions for both sexes combined) were observed for the Netherlands, France (2017), Belgium, Italy, Sweden, Ireland, and Denmark. The largest gender gaps, in relative terms, were reported for Lithuania, Latvia and Romania. The Netherlands was the only Member State to report higher treatable mortality rates for women (63.3 per 100 000 inhabitants) than men (59.3 per 100 000 inhabitants).

For males, the Netherlands and Sweden reported the lowest rates for treatable diseases/conditions in 2019, while Romania, Lithuania and Latvia reported the highest rates. For females, the lowest rate were reported by Spain and Sweden, and the highest rates by Romania and Bulgaria.

Figure 3: Standardised death rates for treatable diseases/conditions, persons aged less than 75 years, by sex, 2019
(per 100 000 inhabitants)
Source: Eurostat (hlth_cd_apr)

In all of the Member States, preventable mortality rates were higher for males than for females in 2019; the relative gender gap between rates reported for males and females was also bigger for preventable diseases/conditions than treatable diseases/conditions — see Figure 4. In 23 of the Member States, the rate for males was at least double the rate for females and in 10 of these the rate for males was at least three times as high as the rate for females. The smallest relative gender gaps (compared with the preventable mortality rate for both sexes combined) were observed for the Netherlands, Sweden, Ireland and Denmark. The largest relative gender gaps were reported for the three Baltic Member States, as well as for Portugal and Greece.

Sweden, Malta, and Italy reported the lowest preventable mortality rates for males in 2019, while Latvia, Lithuania and Hungary reported the highest rates. For females, the lowest rates were reported by Cyprus, Spain and Italy and the highest rates by Hungary, Romania, Latvia and Lithuania.

Figure 4: Standardised death rates for preventable diseases/conditions, persons aged less than 75 years, by sex, 2019
(per 100 000 inhabitants)
Source: Eurostat (hlth_cd_apr)

Leading causes of avoidable deaths

The total number of EU deaths that could potentially have been avoided through effective public health and medical interventions among people aged less than 75 years was 1.03 million in 2017.

Table 1 (in two parts) lists the avoidable diseases/conditions. In 2017, by far the most common causes of avoidable deaths in the EU were ischaemic heart diseases (152 000 deaths) and lung cancer (147 000 deaths). These were followed by cerebrovascular diseases (79 000 deaths), colorectal cancer (59 000 deaths) and alcohol-specific disorders and poisonings (48 000 deaths).

Table 1a: Number of avoidable deaths, persons aged less than 75 years, EU, 2017
(number)
Source: Eurostat (hlth_cd_apr)


Table 1b: Number of avoidable deaths, persons aged less than 75 years, EU, 2017
(number)
Source: Eurostat (hlth_cd_apr)

The leading cause of deaths for treatable diseases/conditions was ischaemic heart diseases

Figure 5 shows the seven leading causes of death in the EU for treatable diseases/conditions in 2017. The standardised rate from ischaemic heart diseases was 18.8 per 100 000 inhabitants, equivalent to 20 % of the total number of deaths from treatable diseases/conditions. Colorectal cancer (14.7 per 100 000 inhabitants), breast cancer among females only (10.7 per 100 000 inhabitants) and cerebrovascular diseases (9.8 per 100 000 inhabitants) were the next most common causes of death among treatable diseases/conditions. Collectively, the seven diseases/conditions shown in Figure 5 accounted for 72 % of all deaths from treatable diseases/conditions in 2017.

Figure 5: Standardised death rates for treatable diseases/conditions, persons aged less than 75 years, EU, 2017
(per 100 000 inhabitants)
Source: Eurostat (hlth_cd_apr)

The leading causes of preventable deaths were lung cancer, ischaemic heart diseases and alcohol-specific disorders and poisonings

The seven leading causes of preventable deaths are shown in Figure 6. The EU standardised rate of preventable deaths for lung cancer was 36.1 per 100 000 inhabitants in 2017, equivalent to 23 % of the total number of preventable deaths. Ischaemic heart diseases (18.8 per 100 000 inhabitants) and alcohol-specific disorders and poisonings (11.5 per 100 000 inhabitants) were the next most common causes of preventable deaths. The seven diseases/conditions shown in Figure 6 collectively accounted for 65 % of all preventable deaths in 2017.

Figure 6: Standardised death rates for preventable diseases/conditions, persons aged less than 75 years, EU, 2017
(per 100 000 inhabitants)
Source: Eurostat (hlth_cd_apr)

Leading causes of avoidable death — analysis by sex

With the exceptions of some types of cancer that are exclusively or almost exclusively found among women, the leading causes of death from treatable diseases/conditions were broadly similar for men and women

The distribution of diseases/conditions for avoidable deaths in the EU varies somewhat for males and females, reflecting the fact that some of the major causes of death are sex-specific to a large or even exclusive extent. Among females, the leading cause of death from treatable diseases/conditions was breast cancer: this disease alone was responsible for more than one quarter (26.3 %) of all deaths from treatable diseases/conditions among females, reflecting a standardised death rate of 20.6 per 100 000 female inhabitants. Cancer of the uterus (3.9 per 100 000 female inhabitants) was also among the top causes of death shown in Figure 7 and is sex specific as well as cancer of the cervix (1.7 per 100 000 female inhabitants).

Turning to diseases common to males and females, the most frequent cause of death for treatable diseases/conditions in the EU was ischaemic heart diseases (29.5 per 100 000 male inhabitants and 9.0 per 100 000 per female inhabitants) and colorectal cancer (19.2 per 100 000 male inhabitants and 10.7 per 100 000 female inhabitants).

Figure 7: Standardised death rates for treatable diseases/conditions, EU, 2017
(per 100 000 male/female inhabitants)
Source: Eurostat (hlth_cd_apr)

For preventable deaths, the two leading causes of death in the EU were the same for males and for females: lung cancer and ischaemic heart diseases. The standardised death rate was higher among males than females for all of the conditions/diseases presented in Figure 8.

Figure 8: Standardised death rates for preventable diseases/conditions, EU, 2017
(per 100 000 male/female inhabitants)
Source: Eurostat (hlth_cd_apr)

Leading causes of avoidable death — analysis by Member State

In 2017, the five most common causes of death in the EU from treatable diseases/conditions accounted for 64 % of all such deaths. These five causes (as well as a total for all other causes) are presented for 2019 in Figure 9. The share of these five common causes ranged among the EU Member States from 58 % in Estonia to 70 % in Ireland.

In 18 of the 27 EU Member States, ischaemic heart disease had the highest standardised death rate in 2019, among these five leading causes of death from treatable diseases/conditions. In seven others - Portugal, Spain, Denmark, the Netherlands, France (2017 data), Luxembourg, and Belgium - the highest rate was observed for colorectal cancer, while in Bulgaria the highest rate was for cerebrovascular diseases.

Figure 9: Standardised death rates for the top 5 treatable diseases/conditions, 2019
(per 100 000 inhabitants)
Source: Eurostat (hlth_cd_apr)

The five most common causes of preventable death in the EU accounted for 54 % of all such deaths in 2017. These are presented in Figure 10. The share of these five common causes ranged among the EU Member States from 45 % in Portugal to 66 % in Hungary.

Among these five leading causes of preventable deaths, in 18 of the 27 EU Member States lung cancer had the highest standardised death rate in 2019. In five others — Lithuania, Latvia, Romania, Slovakia, and Malta — the highest rate was observed for ischaemic heart disease, while in Estonia and Finland the highest rate was for alcohol-specific disorders and poisonings, and in Bulgaria the highest rate was again for cerebrovascular diseases.

Figure 10: Standardised death rates for the top 5 preventable diseases/conditions, 2019
(per 100 000 inhabitants)
Source: Eurostat (hlth_cd_apr)

Data sources

The definitions of avoidable deaths are based on the following:

  • a disease/condition leading to a death is treatable if, in the light of medical knowledge and technology at the time of death, all or most deaths from that cause could be avoided through optimal quality healthcare;
  • a disease/condition leading to a preventable death is one which, in the light of understanding of the determinants of health at the time of death, all or most deaths from that cause could be avoided by public health interventions in the broadest sense.

To calculate treatable and preventable mortality, the first step is to define which diseases/conditions cause deaths that could have been potentially avoided through optimal quality healthcare (deaths from treatable diseases/conditions) and through public health interventions (preventable deaths). In 2018, the OECD and Eurostat worked together with an expert group to develop new joint lists of treatable and preventable causes of mortality. These lists built on earlier work carried out by researchers (such as Nolte E. and M. McKee (2004 and 2011)), by some OECD countries and by Eurostat. The new OECD-Eurostat lists were approved during the OECD Working Party on Health Statistics meeting in October 2018 and during the Eurostat Working Group on Public Health Statistics in December 2018. The list was slightly revised in November 2019. The complete list of diseases/conditions considered to cause avoidable deaths can be found here. 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, and hence might be subject to change in the future.

The second step in the calculation of treatable and preventable deaths is the summation of all deaths within the age limit where the underlying cause of deaths was included in the list of diseases/conditions for avoidable deaths. The underlying data used to calculate avoidable mortality indicators are the causes of death data, which include detailed information on the underlying cause of death of the deceased. More information on the methodology used for statistics on the causes of death is available in a background article. The data for causes of death are included in an annual data collection with a legal basis requiring all EU Member States to send complete data to Eurostat.

Note that some diseases/conditions are considered to be treatable and preventable. An example is ischaemic heart diseases, from which a death might be successfully avoided through timely and effective healthcare (for example through thrombolytic therapy) and/or through effective public health intervention to reduce the underlying risk factors (for example reduced salt intake).

The causes of death that can be both largely prevented and also treated once they have occurred are attributed to the preventable category on the rationale that if these diseases/conditions are prevented, there would be no need for treatment. The number of deaths for a specific disease/condition are generally not fractioned as being partly preventable and partly treatable given the lack of evidence to do this accurately and systematically. An exception is when there is no strong evidence of predominance, in which case a 50 %-50 % allocation is used. As such any double-counting of the same death between the two lists was avoided, so that the number of deaths according to the two lists can be aggregated to provide a broad assessment of the relative importance of prevention and healthcare interventions in reducing avoidable deaths.

Annual data on the two types of avoidable deaths are provided in absolute numbers and as standardised death rates. Since most causes of death vary significantly by age and according to sex, the use of standardised death rates improves comparability over time and between countries as death rates can be measured independently of a population’s age structure: standardised deaths rates are calculated based on the European Standard Population. Note that the standardised death rates used in this article are calculated per 100 000 inhabitants aged less than 75 years.


Context

Assessing the performance of healthcare systems is of increasing importance in the EU. While avoidable mortality indicators are not meant to be a definite measurement of the quality of the healthcare in EU Member States, they provide some indication of the quality and performance of healthcare and (wider) public health policies. In addition to healthcare and public health policies, other factors related to the likelihood of individuals to contract a disease or to seek medical advice — such as education, social class, health beliefs, levels of concerns, costs of diagnosis and treatment — are likely to influence the number of avoidable deaths [3]. Improvements in health policies should translate into lower numbers for avoidable deaths. However, there is likely to be a long time lag between implementation of health (care) policies and changes in the mortality rates and therefore conclusions need to be drawn with caution.

Notes

  1. See the discussions in Nolte E. and M. McKee (2004): “Does Health Care Save Lives? Avoidable Mortality Revisited”, Nuffield Trust, London; and Gay J. et al. (2011): “Mortality Amenable to Health Care in 31 OECD Countries”. OECD Health Working Papers No. 55, OECD.
  2. 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.
  3. See page 18 of Nolte E. and M. McKee (2004), “Does Health Care Save Lives? Avoidable Mortality Revisited”, Nuffield Trust, London.

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