Preventable and treatable mortality statistics


Data from July 2019.

Planned article update: July 2020.

Highlights

In the EU, 1.7 million persons aged less than 75 years died in 2016; the total number of avoidable deaths among persons aged less than 75 years was 1.2 million.

Among people in the EU aged less than 75 years, the leading cause of all avoidable deaths in 2016 was ischaemic heart diseases.

Standardised death rates from treatable diseases/conditions, persons aged less than 75 years, 2016

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 (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 considered 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-28, 1.7 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 1.2 million in 2016. Among the avoidable deaths of people aged less than 75 years, 422 000 could have been avoided with health care systems offering timely and effective medical treatments (deaths from treatable diseases/conditions) and 740 000 deaths could have been prevented through better public health interventions (preventable deaths). The leading cause of all avoidable deaths among people aged less than 75 years was ischaemic heart diseases.

Number and rate of avoidable deaths

In 2016, deaths from avoidable diseases/conditions among people aged less than 75 years amounted to 1.2 million in the EU-28

A total of 1.2 million deaths in 2016 of people aged less than 75 years — equivalent to a rate of 254 deaths per 100 000 — could have been avoided, either through better healthcare systems and/or better public health interventions. Around 422 000 of these deaths — equivalent to a standardised rate of 93 deaths per 100 000 — could have been avoided through better healthcare systems (deaths from diseases/conditions that are treatable). The number of preventable deaths is higher than the number from treatable diseases/conditions due to the broader definition of the former. In 2016, close to three quarters of a million (740 000) deaths of people aged less than 75 years — equivalent to 161 deaths per 100 000 — could have been prevented through better public health interventions.

The avoidable death rate was 2.2 % lower in 2016 than in 2015, while for treatable diseases/conditions the rate was 2.5 % lower and for preventable diseases/conditions it was 2.0 % lower.

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. The highest rate among the western, southern and Nordic Member States was 244 per 100 000, while the lowest rate among the eastern and Baltic Member States was 264 per 100 000 (in Slovenia) and the second lowest rate was 323 per 100 000 (in Czechia). As such, there was a large geographical divide in mortality rates for avoidable diseases/conditions, with Slovenia situated in this gap. The lowest rates of death of people aged less than 75 years from avoidable diseases/conditions in 2016 were in Cyprus and Italy. At the other end of the spectrum, with the highest rates of avoidable mortality, were Lithuania, Latvia, Romania and Hungary.

Table 1: Standardised deaths rates for avoidable mortality, persons aged less than 75 years, 2015 and 2016
(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 2016 were in France, Italy, Spain, Sweden, the Netherlands, Luxembourg, Cyprus and Belgium, while the highest were in Romania, Lithuania, Latvia and Bulgaria.

The EU Member States can be divided into two groups based on their mortality rates for treatable diseases/conditions. The highest rate among the western, southern and Nordic Member States was 95 per 100 000, while — with the exception of Slovenia (which had a rate of 80 per 100 000) — the lowest rate among the eastern and Baltic Member States was 128 per 100 000.

The Member States with the lowest preventable mortality rates in 2016 for people aged less than 75 years were Cyprus, Italy, Malta, Spain and Sweden. The Member States with the highest rates of preventable deaths were Lithuania, Latvia, Hungary and Romania.

Once more there was a geographical divide for preventable mortality, this time with no exceptions. The highest preventable mortality rate among the western, southern and Nordic Member States was 166 per 100 000 (in Finland), while the lowest rate among the eastern and Baltic Member States was 184 per 100 000 (in Slovenia). However, among the eastern and Baltic Member States there was also quite a lot of diversity. As already noted, Lithuania, Latvia, Hungary and Romania had the highest rates, all with rates of at least 310 per 100 000. By contrast, Czechia and Slovenia reported rates of at most 195 per 100 000, with the remaining eastern and Baltic Member States reporting rates between 219 and 262 per 100 000.

Avoidable death rates by sex

Mortality rates in the EU-28 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 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, Malta, Luxembourg, Ireland and France. The largest gender gaps were reported for the three Baltic Member States: Lithuania, Estonia and Latvia.

For males, France and the Netherlands reported the lowest rates for treatable diseases/conditions 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 from treatable diseases/conditions, persons aged less than 75 years, 2016
(per 100 000 inhabitants)
Source: Eurostat (hlth_cd_apr)

In all EU Member States, with no exceptions, preventable mortality rates among people aged less than 75 years were higher for males than for females — see Figure 2. In 23 of the Member States, the rate for males was at least double the rate for females and in 13 of these the rate for males was in fact 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, Denmark, Sweden, the United Kingdom and Ireland. The largest relative gender gaps were again reported for the three Baltic Member States, as well as for Portugal.

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

Figure 2: Standardised death rates for preventable diseases/conditions, persons aged less than 75 years, 2016
(per 100 000 inhabitants)
Source: Eurostat (hlth_cd_apr)

Leading causes of avoidable deaths

The total number of deaths that could potentially have been avoided through effective public health and medical interventions among people aged less than 75 years was roughly 1.16 million in 2016.

Table 2 (in two parts) lists the avoidable diseases/conditions. The five most common causes of avoidable death in 2016 for people aged less than 75 years were ischaemic heart diseases (174 000) lung cancer (168 000 deaths), cerebrovascular diseases (87 000), alcohol related diseases (79 000) and colorectal cancer (67 000).

Table 2a: Number of avoidable deaths, persons aged less than 75 years, EU-28, 2016
(number)
Source: Eurostat (hlth_cd_apreu)


Table 2b: Number of avoidable deaths, persons aged less than 75 years, EU-28, 2016
(number)
Source: Eurostat (hlth_cd_apreu)

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

Figure 3 shows the leading causes of death for treatable diseases/conditions for people aged less than 75 years. Ischaemic heart diseases caused 87 000 deaths in 2016 among people aged less than 75 years, equivalent to 21 % of the total number of deaths from treatable diseases/conditions. Colorectal cancer (16 %), breast cancer among females only (12 %) and cerebrovascular diseases (10 %) 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 number of deaths from five of the major treatable diseases/conditions was lower in 2016 than in 2015, the exceptions being deaths from colorectal cancer and from breast cancer which had slight increases, up 0.7 % and 1.9 % respectively; note that the population in the EU-28 increased by 0.3 % between 2015 and 2016.

Figure 3: Number of deaths from treatable diseases/conditions, persons aged less than 75 years, EU-28, 2015 and 2016
(number)
Source: Eurostat (hlth_cd_apreu)

The leading causes of preventable deaths were lung cancer, ischaemic heart diseases and alcohol related diseases

The leading causes of preventable death among people aged less than 75 years are shown in Figure 4. Lung cancer caused 168 000 deaths in 2016 among people aged less than 75 years, equivalent to 23 % of the total number of preventable deaths. Ischaemic heart diseases (12 %) and alcohol related diseases (11 %) were the next most common causes of preventable deaths. The seven diseases/conditions shown in Figure 4 collectively accounted for 70 % of all preventable deaths among people aged less than 75 years. The number of preventable deaths from five of the major preventable diseases/conditions was lower in 2016 than in 2015, the exceptions being deaths from alcohol related diseases and accidental injuries which had increases of 1.0 % and 3.5 % respectively; as indicated in the previous paragraph, a small part of this increase can be attributed to population growth.

Figure 4: Number of preventable deaths, persons aged less than 75 years, EU-28, 2015 and 2016
(number)
Source: Eurostat (hlth_cd_apreu)

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 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 (26.6 %) of all deaths from treatable diseases/conditions among females. Cancer of the uterus (5.0 %) and cervical cancer (2.0 %) were also among the top causes of death shown in Figure 5 and both are gender specific.

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

Figure 5: Distribution of causes of deaths from treatable diseases/conditions, EU-28, 2016
(% of deaths among males/females aged 0-74 years)
Source: Eurostat (hlth_cd_apreu)

For preventable deaths, the three leading causes of death among people aged less than 75 years were the same for males and for females: lung cancer, ischaemic heart diseases and alcohol related diseases. A greater proportion of preventable deaths were caused by lung cancer among females than among males, as was also the case for deaths from chronic obstructive pulmonary disorder, cerebrovascular diseases and stomach cancer. The reverse was true for the other major causes of preventable deaths shown in Figure 6, most notably for cancer of the lip, oral cavity or pharynx, and for transport accidents.

Figure 6: Distribution of causes of preventable deaths, EU-28, 2016
(% of deaths among males/females aged 0-74 years)
Source: Eurostat (hlth_cd_apreu)

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 and 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 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 persons aged less than 75 years.

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 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 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.
Direct access to
Other articles
Tables
Database
Dedicated section
Publications
Methodology
Legislation
Visualisations
External links






Causes of death (hlth_cdeath)
Public health themes (hlth_cd_pbt)
Treatable and preventable deaths of residents (hlth_cd_apr)
Detailed treatable and preventable deaths of EU residents (hlth_cd_apreu)