Archive:Causes of death statistics at regional level
- Data from March 2008, most recent data: Further Eurostat information, Main tables and Database.
Mortality patterns differ significantly according to age and sex, but they also vary between countries and between regions. Most of the new Member States of the European Union (EU), for example, are characterised by high death rates due to diseases of the circulatory system. Mortality rates are examined here more closely, both at national and at regional levels, distinguishing between men and women and between different age groups.
Main statistical findings
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Mortality patterns differ significantly according to age and sex, but they also vary between countries and between regions. There are three types of factors that determine mortality patterns: intrinsicfactors, such as age and sex, extrinsic factors, such as biological or social collective factors, living or working conditions, and individual factors, such as lifestyle, smoking, alcohol consumption, driving and sexual behaviour.
As a general rule, mortality is higher among men than among women in all age groups. Although there are signs that the mortality gap is narrowing in some Member States, there are still significant differences between the genders.
Variations in mortality patterns highlight the major difference in causes of death according to the particular age group of the population. Since people tend to live longer nowadays, diseases of the circulatory system are the main cause of death in the European Union (EU). Malignant neoplasms are the second most frequent cause, affecting mainly the middle-aged and the elderly. At the same time, the largest proportion of deaths in the younger age groups is due to external causes (including transport accidents). The distribution of causes of death also varies according to geographical location: most of the new Member States, for example, are characterised by high death rates due to diseases of the circulatory system, with the Baltic Member States also recording excess mortality from external causes.
All the reasons mentioned above make the case for examining mortality rates more closely, both at national and at regional levels, distinguishing between men and women and between different age groups.
Colorectal cancer
Colorectal cancer (also called bowel cancer) includes cancerous growths in the colon, rectum and anus and is the second most frequent cause of deaths from cancer in Europe; it accounts for more than one in 10 of all malignant cancer deaths (11.2 %) and for 3 % of all deaths within the European Union (EU) in the period 2003–05. Colorectalcancer mainly affects older people: seven out of 10 deaths occur after the age of 65 years.
There are considerable differences in the patterns of deaths from colorectal cancer within Europe; these are shown in Map 1 (male death rates) and Map 2 (female death rates). The average death rates range from 26 deaths per 100 000 inhabitants for men and 16 deaths per 100 000 inhabitants for women.
Taking all ages together, in almost all cases the male/female mortality ratios for colorectal cancer show a male excess mortality in virtually every region, except for Martinique (France), where more female deaths were recorded (11.3 compared with 10.6). For other regions within the EU-27 the variation is relatively small, ranging from close to 1.0 in Åland (Finland) and Sterea Ellada (Greece) to around 2.3 in Principado de Asturias (Spain), País Vasco (Spain) and Stredné Slovensko (Slovakia).
The regional pattern of mortality is not very evident, although some regional particularities are apparent. High mortality is observed in the central and east European regions, as well as in Norway and Portugal, for the period 2003–05. Mortality rates were particularly high in Hungary (36.1), the Czech Republic (34.7) and Slovakia (31.4), being on average 77 %, 70 % and 54 % higher than the EU-27 average (20.4). At the other end of the scale are the regions of Finland (13.9), Greece (12.6), and Cyprus (10.1), where mortality from colorectal cancer was the lowest in the EU-27, with rates respectively 32 %, 38 % and 50 % lower than the EU-27 average.
The number of new cases of colorectal cancer and the number of deaths from colorectal cancer aredecreasing slightly each year. However, the survival rate for such cancers is only 54 %. Although it is impossible to influence a number of factors associated with increased risk, such as genetic predisposition or ageing, the incidence of colorectal cancer could be lowered by taking preventive measures and reducing risk factors. There is broad agreement about a correlation between obesity, a diet high in red meat, proteins and fats and high alcohol consumption, and an increased risk of colorectal cancer.
Transport accidents
Regional death rates from transport accidents (which include road, rail and air accidents) mainly reflect the mortality associated with road accidents, which cause by far the greatest number of deaths in the group. Over three quarters of the deaths caused by road accidents affect those under 65 years.
Road traffic accidents from the majority of all transport-related fatalities are the main cause of mortality in the 15–24 age group in most European regions. Map 3 shows the regional distribution of transport accidents for men and Map 4 likewise for women.
Disparities in deaths from transport accidents across Europe are clearly marked: causing more than 20 deaths per 100 000 inhabitants in the period 2003–05 in Cyprus, Lithuania and Latvia, compared with the Netherlands, Malta or Sweden where rates are more than five times lower.
Deaths from transport accidents do not affect the whole population evenly. Premature mortality rates due to transport accidents for males are on average 3.7 times higher than for females. Although the male/female mortality ratio may vary significantly across countries, from less than 3 in Cyprus, Iceland and Luxembourg to more than 5 in the former Yugoslav Republic of Macedonia and Malta, in general the pattern for men and women follows the same trend.
When comparing regional rates, the population size and number of vehicles must be taken into account, together with other factors affecting road safety, such as the quality of the roads and observance of traffic regulations.
Analysed by sub-national areas, mortality rates for transport accidents vary considerably across the EU. The regional distribution of premature mortality expressed in Standardised death rates (SDR) shows a very clear pattern of European risk areas. The highest SDRs for accidents are reported for a more or less coherent area stretching from the Baltic countries via Poland, Slovakia, and regions in the Czech Republic, Austria and Hungary through Romania all the way to Greece.
In the southern part of the EU, almost all regions in Portugal and Greece show high SDRs for the period 2003–05, and indeed the highest rates in the EU; the Portuguese provinces of Algarve and Alantejo rank in second and third place respectively. The lowest mortality rates were found mainly in regions with large urban areas, such as Berlin (3.3), Bremen (3.5) and Hamburg (3.5) in Germany, in Zuid-Holland (with 3.7 for Rotterdam) and Noord-Holland (with 4.3 for Amsterdam) in the Netherlands, Stockholm (3.7) in Sweden, Outer London (4.1) in the United Kingdom, Oslo og Akershus (4.7) in Norway, Zurich (4.9) in Switzerland and Wien (5.3) in Austria.
One possible explanation for these rates is the relatively lower traffic speeds encountered in urban areas, as well as greater efficiency of the emergency care provided to accident victims.
The mortality pattern in many cases follows national borders. In public health terms, transport accidents are arguably the most avoidable cause of loss of productive life — suggesting that there is an important role here for policymakers.
Data sources and availability
Causes of death (COD) statistics are based on information derived from the medical death certificate. COD statistics record the underlying cause of death, i.e. ‘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 has been adopted by the World Health Assembly.
In addition to absolute numbers, crude death rates and standardised death rates for COD are provided at national and regional level. Regional level data are provided in form of three-year averages. The crude death rate describes mortality in relation to the total population. It is expressed per 100 000 inhabitants, being calculated as the number of deaths recorded in the population for a given period divided by the population in the same period and then multiplied by 100 000. Crude death rates are calculated by five-year age groups. At this level of detail, comparisons between countries and regions are meaningful. However, the crude death rate for the total population (all ages) by sex and age 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 ‘young’ population because mortality is higher in higher age groups. For comparisons, the age effect can be taken into account by using a standard population. The standardised death rate (SDR) is a weighted average of age-specific mortality rates. The weighting factor is the age distribution of a standard reference population. The standard reference population used is the ‘standard European population’ as defined by the World Health Organisation (WHO).
Standardised death rates are expressed per 100 000 inhabitants and calculated for the age group 0–64 (‘premature death’) and for all ages. Causes of death are classified by the 65 causes on the ‘European shortlist’ of causes of death. This shortlist is based on the International Statistical Classification of Diseases and Related Health Problems (ICD), a classification developed and maintained by the WHO.
Context
Health is an important priority for Europeans; they expect to be protected against illness and disease — at home, in the workplace and when travelling. Health is a cross-cutting issue involving a range of topics including consumer protection (food safety), safety in the workplace, and environmental and social policies.
The establishment of EU-wide comparable data on public health and its determinants is closely linked to one of the priorities of the community action programme in the field of public health 2008–13, namely the priority to generate and disseminate health information and knowledge.
It is within this priority area that Eurostat contributes to the achievement of other objectives of the action programme, by collecting and disseminating statistical data and health indicators, which will help policymakers to identify health risks and improve citizens’ health security and to promote health, including by the reduction of health inequalities.
The provision of information about healthcare systems and, ultimately, about the health of a population is a prerequisite for monitoring the effective performance of public health policy. The currently available regional indicators for health provide an insight into similarities and specificities, as well as into the contrasts that exist throughout the European regions. As shown above, there can be large differences between the regions of a particular country, while regions of other countries may be very similar. Thorough analysis of the trends in and variation of health indicators at regional level is therefore essential for the planning and monitoring of actions and programmes, the formulation of new policies and the development of new strategies, which together contribute to ‘evidence-based health policy’.
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