Preventable and treatable mortality statistics


Data from June 2020.

Planned article update: June 2021.

Highlights

In the EU-27, 1.5 million persons aged less than 75 years died in 2016; 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 2016 in the EU-27 were ischaemic heart diseases and lung cancer.

Standardised death rates from treatable diseases/conditions, persons aged less than 75 years, 2017

This article presents statistics for the European Union (EU) on two indicators of avoidable mortality, 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 (before the age of 75 years) 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 health care.

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.

Some diseases/conditions are considered to be treatable and preventable. These diseases/conditions that can be both largely prevented and treated once they have occurred are classified as preventable. The number of deaths for a specific disease/condition are generally not fractioned as being partly preventable and partly treatable. An exception is when there is no strong evidence of predominance, in which case a 50 %-50 % allocation is used.

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-27, 1.5 million persons aged less than 75 years died in 2016. 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 among persons aged less than 75 years was 1.0 million in 2016. Among the avoidable deaths of people aged less than 75 years, 371 000 could have been avoided with health care systems offering timely and effective medical treatments (deaths from treatable diseases/conditions) and 645 000 deaths could have been prevented through better public health interventions (preventable deaths). The leading causes of all avoidable deaths among people aged less than 75 years were ischaemic heart diseases and lung cancer.

Number and rate of avoidable deaths

In 2016, deaths from avoidable diseases/conditions among people aged less than 75 years amounted to 1.0 million in the EU-27

A total of 1.0 million deaths in 2016 of people aged less than 75 years — equivalent to a rate of 254 deaths per 100 000 inhabitants — could have been avoided in the EU-27, either through better healthcare systems and/or better public health interventions. Around 371 000 of these deaths — equivalent to a standardised rate of 93 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 2016, close to two thirds of a million (645 000) deaths in the EU-27 of people aged less than 75 years — equivalent to 160 deaths per 100 000 inhabitants — could have been prevented through better public health interventions.

Table 1 shows data for standardised death rates of avoidable mortality. These standardised rates assume the same age distribution of the population for all countries.

The EU Member States can be divided into two groups based on their mortality rates for avoidable diseases/conditions. In 2017, the highest standardised death rate for avoidable diseases/conditions among the western, southern and Nordic Member States was 241 per 100 000 inhabitants recorded for Germany. The lowest rate among the eastern and Baltic Member States was 267 per 100 000 inhabitants in Slovenia, while the second lowest rate was 323 per 100 000 inhabitants in Czechia. As such, there was a large geographical divide in mortality rates for avoidable diseases/conditions, with Slovenia situated between the two groups. The lowest death rate for people aged less than 75 years from avoidable diseases/conditions in 2017 was 174 per 100 000 inhabitants in Italy. At the other end of the spectrum, with the highest rates of avoidable mortality, were Latvia, Romania and Hungary, all with rates above 500 per 100 000 inhabitants; the highest rate of all was 521 per 100 000 inhabitants in Latvia.

Table 1: Standardised deaths rates for avoidable mortality, persons aged less than 75 years, 2016 and 2017
(per 100 000 inhabitants)
Source: Eurostat (hlth_cd_apr)

Among EU Member States, the lowest rates of death of people aged less than 75 years from treatable diseases/conditions in 2017 were recorded in Italy, Sweden, Spain and the Netherlands (all under 70 per 100 000 inhabitants); France (2016 data) recorded the lowest rate (62.5 per 100 000 inhabitants). The highest death rate for treatable diseases/conditions was 208 per 100 000 inhabitants in Romania, while Latvia, Bulgaria, Lithuania, Hungary and Slovakia recorded rates between 176 and 198 per 100 000 inhabitants.

The EU Member States can be divided into two groups based on their mortality rates for treatable diseases/conditions in 2017. The highest rate among the western, southern and Nordic Member States was 95 per 100 000 inhabitants in Greece, while — with the exception of Slovenia (which had a rate of 79 per 100 000 inhabitants) — the lowest rate among the eastern and Baltic Member States was 128 per 100 000 inhabitants in Czechia.

The EU Member States with the lowest preventable mortality rates in 2017 for people aged less than 75 years were Malta, Sweden, Spain, Cyprus and Italy, the latter recording the lowest rate of 107 per 100 000 inhabitants. The Member States with the highest rates of preventable deaths were Lithuania, Romania, Latvia and Hungary, the latter recording the highest rate of 327 per 100 000 inhabitants.

There was also a geographical divide for preventable mortality. In 2017, the highest preventable mortality rate among the western, southern and Nordic Member States was 162 per 100 000 inhabitants in Finland, while the lowest rate among the eastern and Baltic Member States was 188 per 100 000 inhabitants in Slovenia. However, among the eastern and Baltic Member States there was also quite a lot of diversity. As already noted, Lithuania, Romania, Latvia and Hungary had the highest rates, all with rates of at least 303 per 100 000 inhabitants. By contrast, Czechia and Slovenia reported rates of 194 and 188 per 100 000 inhabitants respectively, with the remaining eastern and Baltic Member States reporting rates between 221 and 247 per 100 000 inhabitants.

Avoidable death rates by sex

Mortality rates in the EU-27 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 2017 were higher for males than for females — see Figure 1. The smallest gender gaps (compared with the mortality rate for treatable diseases/conditions for both sexes combined) were observed for the Netherlands, France (2016 data), Italy, Belgium, Ireland, Sweden and Malta. The largest gender gaps in relative terms were reported for the three Baltic Member States: Lithuania, Latvia and Estonia.

For males, the Netherlands and France (2016 data) reported the lowest rates for treatable diseases/conditions in 2017, while Latvia and Lithuania reported the highest rates. For females, the lowest rate was reported by Spain and the highest rate by Romania.

Figure 1: Standardised death rates for treatable diseases/conditions, persons aged less than 75 years, 2017
(per 100 000 inhabitants)
Source: Eurostat (hlth_cd_apr)

In all of the EU Member States, preventable mortality rates among people aged less than 75 years were higher for males than for females in 2017 — see Figure 2. 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, Denmark and Ireland. The largest relative gender gaps were again reported for the three Baltic Member States, as well as for Cyprus.

Sweden, Italy and the Netherlands reported the lowest preventable mortality rates for males in 2017, while Latvia and Lithuania 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 2: Standardised death rates for preventable diseases/conditions, persons aged less than 75 years, 2017
(per 100 000 inhabitants)
Source: Eurostat (hlth_cd_apr)

Leading causes of avoidable deaths

The total number of EU-27 deaths that could potentially have been avoided through effective public health and medical interventions among people aged less than 75 years was 1.02 million in 2016.

Table 2 (in two parts) lists the avoidable diseases/conditions. In 2016, by far the most common causes of avoidable death in the EU-27 for people aged less than 75 years were ischaemic heart diseases (151 000) and lung cancer (149 000 deaths). These were followed by cerebrovascular diseases (79 000), colorectal cancer (60 000) and alcohol-specific disorders and poisonings (48 000).

Table 2a: Number of avoidable deaths, persons aged less than 75 years, EU-27, 2016
(number)
Source: Eurostat (hlth_cd_apr)


Table 2b: Number of avoidable deaths, persons aged less than 75 years, EU-27, 2016
(number)
Source: Eurostat (hlth_cd_apr)

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

Figure 3 shows the leading causes of death in the EU-27 for treatable diseases/conditions among people aged less than 75 years in 2016. The standardised rate for treatable deaths from ischaemic heart diseases was 18.9 per 100 000 inhabitants, equivalent to 20 % of the total number of deaths from treatable diseases/conditions. Colorectal cancer (15.1 per 100 000 inhabitants), breast cancer among females only (10.9 per 100 000 inhabitants) and cerebrovascular diseases (10.0 per 100 000 inhabitants) were the next most common causes of death among treatable diseases/conditions. Collectively, the seven diseases/conditions shown in Figure 3 accounted for 72 % of all deaths from treatable diseases/conditions among people aged less than 75 years. As can be seen in Figure 3, the standardised death rate for six of the major treatable diseases/conditions was lower in 2016 than in 2015, albeit only slightly lower in several cases; the exception was deaths from breast cancer for which a slight increase in the rate was observed.

Figure 3: Standardised death rates for treatable diseases/conditions, persons aged less than 75 years, EU-27, 2015 and 2016
(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 leading causes of preventable death among people aged less than 75 years are shown in Figure 4. The EU-27 standardised rate of preventable deaths for lung cancer was 37.1 per 100 000 inhabitants in 2016 among people aged less than 75 years, equivalent to 23 % of the total number of preventable deaths. Ischaemic heart diseases (18.9 per 100 000 inhabitants) and alcohol-specific disorders and poisonings (11.7 per 100 000 inhabitants) were the next most common causes of preventable deaths. The seven diseases/conditions shown in Figure 4 collectively accounted for 66 % of all preventable deaths among people aged less than 75 years. The standardised death rate for six of the major preventable diseases/conditions was lower in 2016 than in 2015, the exception being deaths from accidental injuries for which the rate was practically unchanged.

Figure 4: Standardised death rates for preventable diseases/conditions, persons aged less than 75 years, EU-27, 2015 and 2016
(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-27 varies somewhat for males and females aged less than 75 years, reflecting the fact that some of the major causes of death are gender-specific to a large or even exclusive extent. Among females aged less than 75 years, the leading cause of death from treatable diseases/conditions was breast cancer: this disease alone was responsible for more than one quarter (26.5 %) of all deaths from treatable diseases/conditions among females, reflecting a standardised death rate of 21.0 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 5 and is gender specific.

Turning to diseases common to males and females, the most frequent cause of death for treatable diseases/conditions in the EU-27 was colorectal cancer among females aged less than 75 years and ischaemic heart diseases among males aged less than 75 years.

Figure 5: Standardised death rates for treatable diseases/conditions, EU-27, 2016
(per 100 000 male/female inhabitants)
Source: Eurostat (hlth_cd_apr)

For preventable deaths, the two leading causes of death in the EU-27 among people aged less than 75 years 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 6.

Figure 6: Standardised death rates for preventable diseases/conditions, EU-27, 2016
(per 100 000 male/female inhabitants)
Source: Eurostat (hlth_cd_apr)

Leading causes of avoidable death — analysis by Member State

In 2016, the five most common causes of death in the EU-27 among people aged less than 75 years from treatable diseases/conditions accounted for 65 % of all such deaths. These five causes (as well as a total for all other causes) are presented in Figure 7. The share of these five common causes ranged among the EU Member States from 58 % in Luxembourg and Estonia to 71 % in Ireland.

In 19 of the 27 EU Member States, ischaemic heart disease had the highest standardised death rate in 2017 for people aged less than 75 years among these five leading causes of death from treatable diseases/conditions. In seven others — Belgium, Denmark, Spain, France (2016 data), Italy, the Netherlands and Portugal — the highest rate was observed for colorectal cancer, while in Bulgaria the highest rate was for cerebrovascular diseases.

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

The five most common causes of preventable death in the EU-27 among people aged less than 75 years accounted for 55 % of all such deaths in 2016. These are presented in Figure 8. The share of these five common causes ranged among the EU Member States from 44 % in Portugal to 66 % in Hungary.

Among these five leading causes of preventable deaths, in 20 of the 27 EU Member States lung cancer had the highest standardised death rate in 2017 for people aged less than 75 years. In four others — Latvia, Lithuania, Romania and Slovakia — 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 8: Standardised death rates for preventable diseases/conditions, 2017
(per 100 000 inhabitants)
Source: Eurostat (hlth_cd_apr)

Data sources

The definitions of avoidable deaths are based on the following (for more information, see the definition from the Office for National Statistics):

  • 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 health care;
  • 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 health care (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 health care (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 health care 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.

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.

Context

Assessing the performance of health care 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 health care in EU Member States, they provide some indication of the quality and performance of health care and (wider) public health policies. In addition to health care 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 [2]. 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. 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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