Last Updated: 21 August 2023

1. Key messages

2. Causes of death - Belgium

Tumour is the main group of causes of premature deaths

Traditionally, the main groups of causes of premature deaths (grouped in ICD chapters) in both sexes are tumours, cardiovascular diseases, and external causes, mostly suicide and road accidents. However, in 2020, COVID-19 represented a higher share of premature deaths than the group of external causes of death. 

The proportion of tumours among all premature deaths is higher in women than in men. Inversely, the proportions of circulatory system diseases and external causes are higher among men.

COVID-19 and lung cancers are the most important causes of premature deaths in Belgium

Based on premature mortality rates, COVID-19 was the most important cause of death in 2020. In men, it is followed by lung cancer and ischemic heart disease (IHD); in women, it is followed by lung and breast cancer. 

When expressed in PYLL, a measure taking into account the age at death, COVID-19 was not the main cause of premature death in 2020. In men, suicide was the main cause of premature death followed by COVID-19 and lung cancer. In women, breast and lung cancer were the main causes followed by COVID-19.

 

Stable pattern in main causes of premature death

Most causes of premature deaths tend to decrease (or at least stay stable) over time. For instance:

• The premature mortality due to IHD declined spectacularly (with 38% decrease in the age-adjusted mortality rates) in both sexes during the period 2010-2020.
• The same is observed for cerebrovascular diseases (a decrease of 28%).
• Premature mortality rates for lung cancer have also substantially declined in men (41% of decrease).
• In contrast, premature mortality from lung cancer increased dramatically in women (60% increase) from 2000 to 2015 and then stabilised. From the fourth leading cause of death, it has risen to the first just above breast cancer.
• There was an increase in COPD in women in the years prior to COVID-19.

3. Causes of death - Regions

COVID-19, lung cancer, breast cancer, and suicide are the main causes of death in the 3 regions

In 2020, according to the age-adjusted premature mortality rate:

• COVID-19 was the main cause of premature death in the Walloon Region and the Brussels Capital Region, both among men and women.
• Among men, lung cancer ranks first in the Flemish Region and second in the Walloon and Brussels Capital Regions. The third main cause is IHD in all regions.
• Among women, lung cancer ranks first in the Flemish Region and second in the Walloon and Brussels Capital Regions. The third main cause is breast cancer in the Walloon and Brussels Capital Regions and COVID-19 in the Flemish Region.

In 2020, according to the potential years of life lost (PYLL):

• Among men, COVID-19 was the first cause in the Brussels Capital Region, the second in the Walloon Region, and the third in the Flemish Region. The top 3 was completed by suicide and lung cancer in all regions.
• Among women, in the Walloon and Brussels Capital Regions, COVID-19 was the first cause followed by lung and breast cancer. In the Flemish Region, COVID-19 was the fourth cause of death, the top 3 was breast and lung cancer and suicide.

COVID-19 is the main cause of death leading to regional differences 

As shown on the page ‘Premature mortality’, there are important regional disparities in the age-adjusted premature mortality rate. Here, we analyze which specific conditions contribute the most to the regional difference in age-adjusted mortality rates, by subtracting the cause-specific mortality rates of the Flemish Region from the ones of the other regions and ranking the differences.

In men, the conditions contributing most to the excess premature mortality in the Walloon Region as compared to the Flemish Region are COVID-19 (+44 per 100.000), IHD (+17), lung cancer (+12), infectious and parasitic diseases (+8.5), and COPD (+8.2).

In women, the conditions contributing most to the excess premature mortality in the Walloon Region as compared to the Flemish Region are COVID-19 (+21 per 100.000), COPD (+8.2), IHD (+5.5), lung cancer (+5.2), and infectious and parasitic diseases (+4.5). As rates are lower in women than in men, the regional differences by cause are smaller.

In men, the conditions contributing most to the excess premature mortality in the Brussels Capital Region as compared to the Flemish Region are COVID-19 (+71 per 100.000), IHD (+11), cerebrovascular diseases and HTA (+6.4), COPD (+6.0), and colorectal cancer (+5.2). However, some conditions have lower rates in the Brussels Capital Region compared to the Flemish Region like suicide (-4.8)

In women, the cause-specific mortality rates in the Flemish Region and the Brussels Capital Region are usually relatively similar. However, in 2020, we observed excess premature mortality in the Brussels Capital Region for COVID-19 (+27 per 100.000) compared to the Flemish Region.

Most causes of premature deaths are decreasing among men

The trends in premature mortality are quite similar for the three regions. In the following, we highlight five interesting trends for specific causes of death. 

1. The lung cancer premature mortality rate has been decreasing among men in the three regions during the period 2010–2020 (-42% in the Flemish Region, -39% in the Walloon Region, and -46% in the Brussels Capital Region). Those rates have stayed higher in the Walloon Region than in the Flemish Region over the whole period. For women, the rates steadily increased in the Flemish Region and the Walloon Region until respectively 2015 and 2013, while remaining stable in the Brussels Capital Region since 2007. While previously women in the Brussels Capital Region experienced the highest lung cancer premature mortality rates, since 2010, women in the Walloon Region experience the highest rates for premature lung cancer mortality. A slow mortality decrease is observable in the most recent years except in the Flemish Region.

2. IHD premature mortality rates are decreasing faster in the Flemish Region (-43% in men and -53% in women) than in the Walloon Region (-22% in men and -39% in women) between 2010 and 2020. 

3. Suicide premature mortality rates are decreasing among men in both the Flemish Region and the Walloon Region (starting from 2008). Among women, the suicide mortality rates stayed stable at a much lower level than among men in both the Walloon and the Flemish regions

4. In men, COPD premature mortality rates have decreased by 27% in the Flemish Region and in the Walloon Region, and by 6% in the Brussels Capital Region over the observation period. In contrast, female COPD mortality increased by 9% in the Walloon Region, 8% in the Flemish Region, and 22% in the Brussels Capital Region. COPD mortality in women is lower in 2020.

5. The premature mortality rate for colorectal cancer has decreased in the Flemish Region (-44% for men and -31% for women) between 2010 and 2020 while the decrease has been slower in the Walloon Region in men and nonexistent in women (-23% in men and -2% in women). As a result, the Flemish Region transitioned from being the region with the highest premature mortality rates for colorectal cancer in 2000 to the region with the lowest mortality rates in 2020. 

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Statbel: Causes of death

Sciensano: Standardized Procedures for Mortality Analysis (SPMA)

WHO: ICD-10

Background

The causes of death are classified according to the International Classification of Diseases 10th Revision (ICD-10) [1]. In this report, mortality is analyzed with the underlying cause of death as indicated on the death certificate. The underlying cause of death is by rule preferred to the immediate and the contributing causes of death for mortality statistics because, from a public health perspective, the objective is to break the chain of events leading to death and to prevent the precipitating cause [1].

In a first step, the causes of premature death are presented here according to the ICD-10 main chapters. Those are based on the first digit of the ICD-10 code. In a second step, the 10 most important specific causes of premature death are ranked by mortality rates for Belgium and by regions.

Premature mortality refers to deaths occurring at any age lower than the life expectancy. In the operational definition used here, the threshold was set to the mortality occurring below 75 years of age. Most of the causes of premature death are avoidable either through the health care system or by the implementation of public health policies. Reducing premature mortality is a key public health objective. The ranking of the causes of premature deaths is as a consequence a very important tool to set up public health priorities.

The premature mortality by cause can be evaluated either by using:

• Premature mortality rates, which measure the frequency of deaths due to a specific condition occurring before 75 by 100.000 people under 75 in the population. This indicator is allowing to compare the frequency of different causes of death.
• Potential Years of Life Lost (PYLL), which is taking into account the frequency and the age at death, is weighting each death in function of the age when the death occurred and is thus giving more weight for death occurring at younger ages. PYLL’s consequently allow to compare causes according to their burden in term of years of life lost [2].

The importance of the causes of premature deaths can be expressed in rates which reflects only the frequency of the cause or in PYLL which reflects the burden of the cause in term of years of life lost. The PYLL-based ranking ranks external causes higher than the rates-based one because external causes usually occur at a younger age than deaths due to chronic diseases.

Both indicators are adjusted for age using the structure of the European standard population 2010 as reference in order to take into account the effect of variations in the age structures between populations.

The COVID-19 mortality between 2020 and 2022 based on the ad-hoc surveillance is analyzed in a factsheet.

Definitions

Crude mortality rate

The crude mortality rate is the number of deaths registered in a population divided by the number of people in this population.

Age-standardized (or age-adjusted) mortality rate

The age-standardization is a weighted average of age-specific mortality rates to remove variations arising from differences in age structure between population groups.

International Classification of Diseases (ICD-10)

The International Classification of Diseases is an international codification for diseases and for a very wide variety of signs, symptoms, traumatic injuries, poisonings, social circumstances and external causes of injury or illness.

Potential Years of Life Lost (PYLL)

The potential years of life lost (PYLL) measures the number of years of life that have been lost due to premature death. The PYLL weights the deaths occurring at younger age groups more heavily than the ones occurring in older people. The calculation of PYLL involves summing up deaths occurring at each age and multiplying this with the number of remaining years to live up to a selected age limit (here, 75 years). Age-specific PYLL rates are calculated by dividing the number of PYLL in a given age-group by the number of people in this age group. An age-adjusted PYLL rate is then calculated as a weighted average of age-specific PYLL rates until 75 years.

Premature mortality rate

The premature mortality is defined here as deaths occurring before the age of 75; the age-standardized premature mortality rate is calculated as a weighted average of age-specific mortality rates until 75 years.

Underlying cause of death

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.

Tumours

Also known as neoplasms in ICD-10. The neoplasms group includes actually 95% of malignant neoplasms (or cancers), the other 5% being tumors of benign or borderline behavior.

References

1. World Health Organization. International statistical classification of diseases and related health problems 10th. 2016.
2. Gardner JW, Sanborn JS. Years of Potential Life Lost (YPLL). What Does it Measure? Epidemiol 1990;1:322-9.

Please cite this page as: Sciensano. Mortality and Causes of Death: Causes of premature death, Health Status Report, 2 Aug 2022, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/mortality-and-causes-of-death/causes-of-premature-death 

Last Updated: 25 August 2023

1. Key messages

2. Premature mortality rates

Age-adjusted premature mortality rates decrease between 2020 and 2022

In Belgium, the crude premature mortality (0–74 years) rate was 334 per 100,000 inhabitants under 75 years old and the age-adjusted premature mortality rate was 335 per 100,000 inhabitants in 2022. The age-adjusted premature mortality rate was 1.7 times higher in men (421 per 100,000) than in women (253 per 100,000). The age-adjusted premature mortality rates were generally decreasing over time. Between the years 2010 and 2022, the decrease was more pronounced among men (-17%) than among women (-9%).

In 2020, the age-adjusted premature mortality rates increased by 10% for men and by 5% for women compared to 2019. That increase can be explained by the COVID-19 epidemic. In 2022, the age-adjusted premature mortality rates decreased further compared to 2020 and 2021 and were close to 2019 level.

Decrease of regional disparities in 2022

There are substantial disparities between the three regions in terms of age-adjusted premature mortality rate. As compared to the Flemish Region, the following relative mortality excesses were observed in the other regions in 2022 :

• Walloon Region: +42% among men and +39% among women
• Brussels Capital Region: +21% among men and +8% among women

After the widening of regional disparities in 2020 and 2021, disparities have reduced in 2022.

Disparities by districts are large

Looking at a smaller geographical level, it becomes clear that most Flemish districts experience, for both sexes (although less pronounced in women), a lower premature mortality rate than the Belgian average. The reverse is observed in Brussels and all Walloon districts (except for Nivelles for both sexes). The highest premature mortality rates for men are observed in three districts of the province of Hainaut (Charleroi, Mons, Tournai). In women, the districts with highest rates were found in the provinces of Hainaut, Namur, and Liège.

Belgian premature deaths are among the highest in Europe

The Potential Years of Life Lost (PYLL) indicator is used to perform international comparisons. Belgium ranks poor in this domain in both males and in females. The excess of PYLL in Belgium as compared to the EU-15 mean was respectively 5% for men and 13% for women in 2018 (or nearest year). These data are the most recent data (2018) currently available from the World Health Organization mortality database.

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Statbel: General mortality

Statbel: Open data

Sciensano: Standardized Procedures for Mortality Analysis (SPMA)

WHO: Mortality database

Background

Premature mortality refers to deaths occurring too early i.e. at any age lower than the life expectancy. Different thresholds can be used in the operational definition of this indicator. In this report, premature mortality occurring below 75 years of age is considered. Reducing premature mortality is a key public health objective and much of the premature mortality is avoidable by public health actions.

The crude mortality rate – i.e. the number of deaths in a given year divided by the population under study - is not well suited for health monitoring. Mortality is indeed strongly related to age; as a consequence aging populations face rising crude mortality rates, even if their health conditions are improving. Therefore, to compare mortality rates (over time or between populations) the age structure of the compared population groups will be aligned on a common reference. This technique is called “age-adjustment”. In this report, age-adjusted mortality rates are presented using the European standard population 2010 as reference.

The premature mortality can also be described using an indicator called Potential Years of Life Lost (PYLL): each death is weighted in function of the age at death. By doing so, more weight is put on deaths occurring at a younger age, since they represent a higher burden in term of life lost. So, if death is occurring at age 65, the corresponding life lost is 10. In this report, PYLLs are used for the international comparison with also the age of 75 years as reference. The PYLL rates will also be age-adjusted.

Definitions

Crude Mortality rate

The mortality rate is the number of deaths registered in the country divided by the corresponding population.

Age-standardized mortality rates

The age-standardization is a weighted average of age-specific mortality rates to remove variations arising from differences in age structure between population groups.

Premature mortality rate

The premature mortality rate is defined here as the number of deaths occurring before the age of 75 registered in the country divided by the corresponding population.

Potential Years of Life Lost

The potential years of life lost (PYLL) measure the number of years of life that have been lost due to a premature death. PYLL weights the deaths occurring at younger age groups more heavily than the ones occurring in older people. The calculation of PYLL involves summing up deaths occurring at each age and multiplying this with the number of remaining years to live up to a selected age limit (here, 75 years).

References

1. Statbel. Number of deaths per day, sex, age, region, province, district. https://statbel.fgov.be/en/open-data/number-deaths-day-sex-district-age
2. WHO. Global health estimates: Leading causes of deaths. https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-leading-causes-of-death 

Please cite this page as: Sciensano. Mortality and Causes of Death: Premature mortality, Health Status Report, 25 Aug 2023, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/mortality-and-causes-of-death/premature-mortality 

Last Updated: 21 August 2023

1. Key messages

2. Causes of death 

Tumours and cardiovascular diseases are the main groups of causes of death

Tumours and circulatory system diseases (or cardiovascular diseases) were the main causes of death in 2019, accounting together for approximately half of the mortality share (52% for men and 50% for women). In 2020, tumours and cardiovascular diseases were still the main causes of death but they represent a lower share of death (43% for men and 42% for women) due to the presence of COVID-19.

Tumours become the main cause of death in women in 2020

In women, the main cause of death in 2020 is no longer cardiovascular diseases, but tumours. This finding can be explained by a slower decline in the age-adjusted mortality rates for tumours. The age-adjusted mortality rate of cardiovascular diseases decreased by 35% between the years 2010 and 2020, whereas tumour mortality decreased only by 13%, leading to higher tumour mortality than cardiovascular diseases mortality in 2020.

In men, a similar pattern can be found since 2014 with tumour mortality being higher than cardiovascular mortality. The male age-adjusted mortality rate of cardiovascular diseases has also significantly decreased by 35% between the years 2010 and 2020. During the same period, tumour mortality decreased at a slower pace (-22%). The decline in cardiovascular mortality is driven by progress in prevention and treatment, among others the decline in smoking, the improvement in pharmacological treatments of hypertension and cholesterol, and medical procedures [1]. 

In both genders, the mortality of respiratory system diseases (excluding COVID-19) decreased between 2000 and 2019 (by 42% in men, and 24% in women). However, the decrease slowed down and stopped in the last decade. In 2020, due to the impact of COVID-19, the mortality of respiratory system diseases (excluding COVID-19) decreased again.

The main specific causes of death differ by gender

The ten main causes of death have been ranked in function of their age-adjusted mortality rates, separately for men and women. The three main causes of death are:

• among men, COVID-19, ischemic heart diseases (IHD), and lung cancer;
• among women, COVID-19, dementia (including Alzheimer's disease), and cerebrovascular diseases (grouped with HTA).

Rankings are rather similar between regions. However, heart failure in the Flemish Region is ranked as the fourth leading cause of death in men and in women. In contrast, heart failure is ranked as the seventh, ninth or tenth leading cause of death in the Brussels Capital Region and in the Walloon Region. As heart failure is considered to be a common end to several diseases, these disparities could be explained in part by differences in the coding of causes of death among regions. 

3. Read more

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Statbel: Causes of death

Sciensano: Standardized Procedure for Mortality Analysis (SPMA)

WHO: ICD-10

Background

The causes of death are classified according to the International Classification of Diseases 10th Revision (ICD-10) [2]. In this report, mortality is analyzed with the underlying cause of death as indicated on the death certificate. The underlying cause of death is by rule preferred to the immediate and the contributing causes of death for mortality statistics because, from a public health perspective, the objective is to break the chain of events leading to death and to prevent the precipitating cause [1].

In a first step, the causes of death are presented here according to the ICD-10 main chapters. Those are based on the first digit of the ICD-10 code. In a second step, the 10 most important specific causes of death are ranked by mortality rates for Belgium and by regions. 

To take into account the variations in the age structure of the Belgian population overtime and allow comparisons between periods, the rates are age-standardized (using the European standard population 2010 as reference).

For more details on the COVID-19 mortality between 2020 and 2022, consult the dedicated factsheet.

Definitions

International Classification of Diseases (ICD-10)

The International Classification of Diseases is an international codification for diseases and for a very wide variety of signs, symptoms, traumatic injuries, poisonings, social circumstances and external causes of injury or illness.

Underlying cause of death

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.

Immediate cause of death

The final disease, injury, or complication directly causing death.

Contributing cause of death

All other significant diseases, conditions, or injuries that contributed to death but which did not result in the underlying cause of death.

Tumours

Also known as neoplasms in ICD-10. The neoplasms group includes actually 95% of malignant neoplasms (or cancers), the other 5% being tumors of benign or borderline behavior.

Age-standardized mortality rate

The age-standardization is a weighted average of age-specific mortality rates to remove variations arising from differences in age structure between population groups.

References

1. Mensah GA, Wei GS, Sorlie PD, Fine LJ, Rosenberg Y, Kaufmann PG, et al. Decline in Cardiovascular Mortality: Possible Causes and Implications. Circ Res. 2017 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5268076/  
2. WHO. ICD-10: International statistical classification of diseases and related health problems: Instruction manual. Geneva: World Health Organization; 2011.

Please cite this page as: Sciensano. Mortality and Causes of Death: Causes of death, Health Status Report, 2 Aug 2023, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/mortality-and-causes-of-death/general-mortality-by-cause 

Last Updated: 25 August 2023

1. Key messages

2. A mortality peak is observed end of 2022

A heatwave mortality peak was observed in 2019. In 2020, mortality peaks were observed from March to April, and from the end of October to the end of the year. These peaks can be explained by the COVID-19 epidemic. An additional peak was observed during summer in August, caused by higher temperatures. 

In 2021, a mortality peak was observed at the end of the year. This can be explained by the COVID-19 epidemic. In 2022, a mortality peak was observed at the end of the year which can be explained by the influenza and bronchiolitis epidemics [1]. 

More information about excess mortality can be found on the website of the Belgian Mortality Monitoring (Be-MOMO).

3. Mortality rates

Age-adjusted mortality rates are higher in 2022 than in 2021

In 2022, 116,380 deaths were observed in Belgium.

The crude mortality rate increased in 2022 to 1000 per 100,000 inhabitants compared to 2021 (972 per 100,000); it is however lower than the jump in 2020 due to the COVID-19 epidemic (1,102 per 100,000). The crude mortality rate was a bit higher in women (1,008 per 100,000) than in men (991 per 100,000) in 2022. After adjustment for age, a 39% higher mortality rate was observed in men (1,120 per 100.000) as compared to women (805 per 100,000) in 2022.

Over the last two decades, the age-adjusted mortality rate declined until 2019; a 40% decrease in men and a 28% decrease in women were observed between 2000 and 2019. In 2020, it has raised due mainly to the COVID-19 epidemic and reached 1,058 per 100,000 inhabitants (a 16% increase in men and 15% in women compared to 2019), the highest mortality rate since 2008. In 2022, the age-adjusted mortality rate was still higher than in 2019 (945 in 2022 vs 916 in 2019). Compared to 2021, it decreased in men (-2%) and increased in women (+4%).

Age-adjusted mortality rates are lower in the Flemish region

Among men in 2022, the age-adjusted mortality rate was 26% and 13% higher respectively in the Walloon Region and in the Brussels Capital Region as compared to the Flemish Region; among women, it was 23% and 8% higher respectively in the Walloon Region and in the Brussels Capital Region as compared to the Flemish Region.

During the year 2020, the regional differentials in mortality increased. Among men, the age-adjusted mortality rate was 35% higher in the Walloon Region and 32% higher in the Brussels Capital Region than in the Flemish Region, and among women, the mortality rate was 29% and 21% higher in the Walloon Region and in the Brussels Capital Region than in the Flemish Region. The COVID-19 mortality rates observed in the epidemiological surveillance [3] have shown the COVID-19 specific mortality rates to be higher in the Walloon Region and in the Brussels Capital Region, which can explain the increase of the regional differentials in all-cause mortality.

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Statbel: General mortality

Statbel: Open data

Sciensano: Standardized Procedure for Mortality Analysis (SPMA)

Sciensano: Belgian Mortality Monitoring (Be-MOMO)

Background

Mortality is a traditional health indicator, actually better understood as a measure of “non-health”. Although quantifying irreversible events, the mortality analysis provides unique information for public health guidance, like the importance of severe health problems, their evolution over time, and some insights on their determinants (i.e. road security and smoking behavior). It is also a health indicator that has a long tradition and is measured with more validity than any other. Indeed, death is an unambiguous event, that used to be systematically registered in vital registration systems of most countries for more than one century.

The crude mortality rate is the number of deaths in a given year divided by the population under study. This indicator is not well suited for health monitoring; mortality is indeed strongly related to age. As a consequence, aging populations are facing rising crude mortality rates even if the health state is improving.

Therefore, comparisons of mortality indicators between population groups or years should always use estimators that are adjusted for differences in age composition between the groups. In this report, the age-adjusted mortality rates are used, with the European Standard Population 2010 (ESP 2010) [4] as a reference.

In this section, we describe all-cause mortality. The specific causes of death are described in the section on cause of death.

Definitions

Crude mortality rate

The crude mortality rate is the number of deaths registered in the country divided by the corresponding population.

Age-standardized mortality rate

The age-standardization is a weighted average of age-specific mortality rates to remove variations arising from differences in age structure between population groups.

References

1.  Sciensano. Analyse de la surmortalité en 2022.  https://www.sciensano.be/fr/coin-presse/analyse-de-la-surmortalite-en-2022  
2. Statbel. Nombre de décès par jour, sexe, âge, région, province et arrondissement. https://statbel.fgov.be/fr/open-data/nombre-de-deces-par-jour-sexe-arrondissement-age
3. I. Peeters, M. Vermeulen,N. Bustos Sierra, F. Renard, J. VanderHeyden, A. Scohy, T. Braeye, N. Bossuyt, F. Haarhuis, K. Proesmans, C. Vernemmen, M. Vanhaverbeke. Surveillance of COVID-19 mortality in Belgium, epidemiology and methodology during 1st and 2nd wave (March 2020 - 14 February 2021). Brussels, Belgium : Sciensano. 2021, September. https://covid-19.sciensano.be/fr/covid-19-situation-epidemiologique 
4. Pace M, Giampaolo L, Glickman M, Zupanic T. Revision of the European Standard Population Report of Eurostat's Task Force. Luxembourg; 2013.

Please cite this page as: Sciensano. Mortality and Causes of Death: Causes of death, Health Status Report, 25 Aug 2023, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/mortality-and-causes-of-death/general-mortality-by-cause 

Last Updated: 21 August 2023

1. Key messages

2. Infant mortality rate

395 deaths of infants observed in Belgium in 2020

In the year 2020, Belgian authorities registered a total of 395 infant deaths.

Among those, 368 deaths occurred in infants born from a mother who is registered in the National Registry. There were no infant deaths registered in the Asylum Seeker Register in 2020. For 27 deaths (6.8%), the mother was not officially registered in Belgium or the infant death was only notified via a death certificate.

In the same year, the total number of live births was equal to 116 543, of which 113 739 (97.6%) were registered in the National Registry, 611 (0.5%) were registered in the Asylum Seeker Register, and for 2193 (1.8%) births the mother was not officially registered in Belgium or the birth was only notified with a birth certificate.

	Number of deaths	Number of live births	Infant mortality rate (/1000)
National Registry	368	113,739	3.24
National Registry and Asylum Seeker Register	368	114,350	3.22
All	395	116,543	3.39

Decrease in the male infant mortality rate in 2020

In 2020, the infant mortality rate was 3.2 per thousand live births. Infant mortality rates have decreased by 40% from 1998 (5.3‰) to 2020.

The infant mortality rate in 2020 was 3.1 per thousand live births in girls and 3.4 per thousand live births in boys, corresponding to an absolute gap of 0.3‰ and a sex ratio of 1.1. The fluctuations in these gender mortality gaps over time can be largely explained by the small number of infant deaths. In 2020, the gender difference was minimal due to the important decrease in the male infant mortality rate.

After smoothing, the mortality differences between girls and boys persisted (respectively 3.0‰ and 3.9‰).

In 2020, there are differences in the regional infant mortality rates

Stark regional differences were observed in infant mortality rates in 2020: the infant mortality rates were highest in the Brussels Capital Region (4.5‰) followed by the Flemish Region (3.2‰) and the Walloon Region (2.7‰). After smoothing, the 2020 infant mortality rates were still higher in the Brussels Capital Region (3.7‰) compared to the Flemish Region (3.5‰) and the Walloon Region (3.3‰).

Over time, a strong decline has been observed in all regions. However, despite a strong decline in the past, the infant mortality rate in the Brussels Capital Region is rising again. In general, over the last eight years, the infant mortality rate has been stagnating.

Infant mortality in Belgium is higher than the EU-14 average

In 2020, the Belgian infant mortality was higher than the EU-14 average (3.0). Belgium had the 4th highest infant mortality rate in 2020 among the EU-14, after its neighboring countries (Luxembourg, Netherlands, and France).

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SPMA: Standardized Procedures for Mortality Analysis in Belgium

Background

The infant mortality rate reflects the mortality of children below 1 year. It includes both the consequences of perinatal events and the mortality occurring after the perinatal period, which is often preventable. The infant mortality rate is highly correlated to the country's level of development, the quality of medical care, and the availability of preventive services and health promotion interventions.

Higher infant mortality rates in boys compared to girls have for long been observed in nearly all countries in the world [3]. The explanation is complex, including important biological and genetic factors as well as environmental and behavioral factors resulting in a persistent mortality difference throughout infancy and even later [4,5].

Large fluctuations in yearly rates are observed at regional level, due to the small number of infant deaths. Meaningful comparisons of rates and trends by region are therefore best made using smoothed rates. In this overview, we use a moving average over 5 years period.

Deaths occurring in Belgium may occur in legal residents (registered in the National Register, with a Belgian or foreign nationality), asylum seekers (registered in the register of asylum seekers), or non-residents (travelers, illegal, etc.). Official statistics on infant mortality include legal residents and asylum seekers.

On this page, we first present all infant deaths in Belgium by residence status, and then focus on the deaths of infants whose mothers were legal residents.

Definitions

EU-14

The EU-14 corresponds to all countries that already belonged to the European Union between 1995 and 2004: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, and Sweden. We compare the Belgian health status to that of the EU-14 because these countries have similar socioeconomic conditions. Note: The United Kingdom is not included since they have left the EU.

Infant mortality rate

The infant mortality rate is the number of deaths of children under one year of age per 1000 live births in the same year.

Sex ratio

The sex ratio is the mortality rate of boys under the age of 1 divided by the mortality rate of girls under the age of 1. A sex ratio of 1.2 means that there are 1.2 times more infant deaths in boys than in girls.

References

1. Statbel, 1998-2020. https://statbel.fgov.be/en/themes/population/mortality-life-expectancy-and-causes-death/feto-infant-mortality
2. OECD Health Data, 2020. https://stats.oecd.org/
3. UN IGME. United Nations Interagency Group for Child Mortality Estimation; 2018. https://childmortality.org/data
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Please cite this page as: Sciensano. Mortality and Causes of Death: Infant mortality, Health Status Report, 7 Apr 2023, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/mortality-and-causes-of-death/infant-mortality