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Mortality and Causes of Death

Ischemic heart disease is the main cause of death, while suicide is the main cause of potential years of life lost.

Premature mortality by cause

1. Key messages

The causes of premature death before 75 years with the highest burden in term of years of life lost are:
  • suicide, lung cancer, and ischemic heart diseases in men
  • breast and lung cancer and suicide in women.
Most causes of premature death decreased between the years 2000 and 2016. It is particularly the case for ischemic heart diseases and transport accidents who decreased by more than 50% in both sexes. Exceptions to this general tendency are lung cancer and Chronic Obstructive Pulmonary Disease (COPD) among women which steadily increased.

2. Background

The framework used to classify cause of deaths is the International Classification of Diseases 10th Revision (ICD-10). In this report, mortality is analyzed according to 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 first described according to the ICD-10 chapters i.e. the main groups of diseases. This is based on the ICD-10 using the first character. In a second step, more detailed analyzes are performed to allow drawing operational conclusions.

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.

3. Belgium

Most deaths are caused by tumors, cardiovascular diseases, and external causes

In both sexes, nearly 70% of the premature deaths are caused by the same 3 groups of causes:

  • Tumours, mainly cancers
  • Cardiovascular diseases
  • External causes, mostly suicide and road accident.

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

  • Men
  • Women

Distribution of the causes of premature (before 75) deaths (ICD-10 chapters) among men, ranked by age-adjusted* mortality rates, Belgium, 2016
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

Distribution of the causes of premature (before 75) deaths (ICD-10 chapters) among women, ranked by age-adjusted* mortality rates, Belgium, 2016
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

Top 10 of the specific causes of premature death

Expressed in premature mortality rates, the most frequent specific causes of premature death are:

  • In men: lung cancer followed by Ischemic Heart Disease (IHD) and suicide
  • In women: lung and breast cancer followed by cerebrovascular diseases

While expressed in PYLL, the highest burden causes of premature death are:

  • In men: suicide followed by lung cancer, IHD, and transport accidents
  • In women: breast cancer followed by lung cancer, suicide, and cerebrovascular diseases
  • Men
  • Women

Top 10 specific causes of premature death (before 75) ranked by age-adjusted* premature mortality rates among men, Belgium, 2016
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

Top 10 specific causes of premature death (before 75) ranked by age-adjusted* premature mortality rates among women, Belgium, 2016
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

 

  • Men
  • Women

Top 10 specific causes of premature death (before 75) ranked by age-adjusted* Potential Years of Life Lost (PYLLs) among men, Belgium, 2016
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

Top 10 specific causes of premature death (before 75) ranked by age-adjusted* Potential Years of Life Lost (PYLLs) among women, Belgium, 2016
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

Trends: Improvements in most causes of deaths, worsening for lung cancer in women

All 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 more than 50% decrease in the age-adjusted mortality rates) in both sexes during the period 2000-2016
  • the same is observed for cerebrovascular diseases
  • premature mortality rates for lung cancer have also substantially declined in men (39% of relative decrease).

However, lung cancer premature mortality dramatically progressed in women (55% of relative increase) since 2000. From the fourth cause of death, it jumped to the first just above breast cancer. A slight increase is also observed for Chronic Obstructive Pulmonary Diseases (COPD) among women.

  • Men
  • Women

Age-adjusted* premature (before 75) mortality rates (per 100,000) for the 6 main specific causes of death among men, Belgium, 2000-2016
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

Age-adjusted* premature (before 75) mortality rates (per 100,000) for the 6 main specific causes of death among women, Belgium, 2000-2016
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

4. Regions

Disparities within regions, lower premature mortality rates for most causes in Flanders

Among men, the premature mortality rates are higher in Wallonia than in Flanders for the 6 main causes of death. The ratio Wallonia versus Flanders (W/F) is particularly high for chronic liver diseases (ratio is 1.7), IHD (1.6) and COPD (1.5). The differences between Brussels and Flanders (B/F ratio) are less pronounced with the highest ratio observed for COPD (1.5) and chronic liver diseases (1.4). The B/F ratio is however higher than the W/F ratio for cerebrovascular diseases + arterial hypertension (HTA) (1.4). The suicide mortality rate in Brussels is underestimated due to the delay of the Brussels administration in confirming suicide cases.

Among women, as observed for men, the premature mortality rates are higher in Wallonia than in Flanders for the 6 main causes of death, except for breast cancer. The highest W/F ratios are observed for IHD mortality (1.9) and COPD (1.5). The B/F ratios are less pronounced with the highest ratios observed for IHD (1.5) and cerebrovascular diseases (1.2). As in men, the suicide mortality rate in Brussels is underestimated.

  • Men
  • Women

Regional rate ratios for the 6 main specific causes of premature death rates (before 75) (using Flanders as reference), among men, 2016
Source: Own calculation based on death certificates, Statbel
Note: The rates of suicide in Brussels are underestimated and not represented

Regional rate ratios for the 6 main specific causes of premature death rates (before 75) (using Flanders as reference), among women, 2016
Source: Own calculation based on death certificates, Statbel
Note: The rates of suicide in Brussels are underestimated and not represented

Ranking

The highest premature mortality rate is observed for lung cancer; this is the case in the three regions and, since 2015, in both genders. The second causes of death are common for all regions as well: IHD in men and breast cancer in women. The third cause of death is :

  • among men, suicide in Wallonia and Flanders and COPD in Brussels
  • among women, cerebrovascular diseases in Flanders and Brussels and IHD in Wallonia.

According to the potential years of life lost (PYLL):

  • among men, suicide ranks first in Flanders and Wallonia, followed by lung cancer and IHD. In Brussels, the lung cancer ranks before suicide. The 3rd cause is IHD in all the regions
  • among women, lung cancer ranks first in Wallonia, second in Flanders and Brussels after breast cancer. Suicide ranks 3rd in all regions.

It is interesting to note that transport accidents are ranking quite high in men, even if the premature mortality rate is rather low. The suicide mortality rate in Brussels is underestimated due to the delay of the Brussels administration in confirming suicide cases.

Ranking of the main causes of death by premature mortality rates and Potential Years of Life Lost (PYLL), by sex and regions of residence, Belgium, 2016
Source: Own calculation based on death certificates, Statbel
Men Ranking by rates Ranking by PYLL
Causes of death Flanders Brussels Wallonia Flanders Brussels Wallonia
Lung cancer 1 1 1 2 1 2
Ischemic Heart Diseases 2 2 2 3 3 3
Suicide 3 5 3 1 2 1
Cerebrovascular Diseases + HTA 4 4 6 5 5 7
COPD 5 3 4 10 6 6
Colorectal cancer 6 8 7 8 8 8
Chronic Liver Diseases 7 6 5 6 4 5
Transport Accident 13 23 11 4 12 4
             
Women Ranking by rates Ranking by PYLL
Causes of death Flanders Brussels Wallonia Flanders Brussels Wallonia
Lung cancer 1 1 1 2 2 1
Breast cancer 2 2 2 1 1 2
Cerebrovascular Disease + HTA 3 3 4 4 4 4
COPD 4 5 5 8 7 6
Suicide 5 10 6 3 3 3
Colorectal cancer 6 6 7 5 11 10
Ischemic Heart Diseases 7 4 3 11 5 5
Chronic Liver Diseases 10 9 11 6 6 9

Trends

For most causes of death, the premature death rates are higher in Wallonia than in Flanders. The evolutions of premature mortality are quite similar for the three regions. The focus has been put here on specific causes of death with remarkable regional differences and/or specific trends.


1. The lung cancer premature mortality rate has been decreasing among men in the three regions during the period 2000–2016 (-40% in Brussels and Flanders and -33% in Wallonia). Those rates have stayed higher in Wallonia than in Flanders over the whole period. For women, the rates steadily increased in Flanders and Wallonia while remaining stable in Brussels since 2006. Women in Brussels previously experienced the highest lung cancer premature mortality rates but it has been overtaken by Wallonia since 2010.

  • Men
  • Women

Lung cancer age-adjusted* premature (before 75) mortality rates (per 100,000) among men, by year and region of residence, Belgium, 2000-2016
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

Lung cancer age-adjusted* premature (before 75) mortality rates (per 100,000) among women, by year and region of residence, Belgium, 2000-2016
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

2. IHD premature mortality rates are decreasing faster in Flanders (-65% in men and -71% in women) than in Wallonia (-52% in both sexes). This is leading to an increasing gap between the regions.

  • Men
  • Women

Coronary heart disease age-adjusted* premature (before 75) mortality rates (per 100,000) among men, by year and region of residence, Belgium, 2000-2016
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

Coronary heart disease age-adjusted* premature (before 75) mortality rates (per 100,000) among women, by year and region of residence, Belgium, 2000-2016
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

3. Suicide premature mortality rates are decreasing among men in both Flanders and Wallonia (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.

  • Men
  • Women

Suicide age-adjusted* premature (before 75) mortality rates (per 100,000) among men, by year and region of residence, Belgium, 2000-2016
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010
Note: The rates of suicide in Brussels are underestimated and not represented.


Suicide age-adjusted* premature (before 75) mortality rates (per 100,000) among women, by year and region of residence, Belgium, 2000-2016
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010
Note: The rates of suicide in Brussels are underestimated and not represented.


4. In men, COPD mortality rates have decreased by 42% in Flanders and Wallonia and by 30% in Brussels over the period. On the contrary, COPD mortality rates in women have increased in Flanders and Wallonia over the period.

  • Men
  • Women

COPD age-adjusted* premature (before 75) mortality rates (per 100,000) among men, by year and region of residence, Belgium, 2000-2016
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

COPD age-adjusted* premature (before 75) mortality rates (per 100,000) among women, by year and region of residence, Belgium, 2000-2016
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

5. Colorectal cancer premature mortality rates used to be higher in Flanders than in the other regions. The premature mortality rate for colorectal cancer have decreased faster in Flanders (-46% for men and -37% for women) than in Wallonia (-10% in men and -7% in women). In 2016, Wallonia was experiencing the highest premature mortality rate.

  • Men
  • Women

Colorectal cancer age-adjusted* premature (before 75) mortality rates (per 100,000) among men, by year and region of residence, Belgium, 2000-2016
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

Colorectal cancer age-adjusted* premature (before 75) mortality rates (per 100,000) among women, by year and region of residence, Belgium, 2000-2016
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

5. Read more

View the metadata for this indicator

Statbel: Causes of death

Sciensano: Standardized Procedures for Mortality Analysis (SPMA)

WHO: ICD-10

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.

Premature mortality

1. Key messages

The premature (below 75 years of age) mortality rate was 350 per 100,000 in 2016 in Belgium.
This rate decreased by 27% between 2000 and 2016 but despite that, Belgium is ranking poor among EU-15 countries, with an excess in potential years of life lost (PYLL) reaching 8% in men and 13% in women as compared to the EU-15 means. Premature mortality is 1.8 times higher in men than in women.
Lower mortality rates are observed in the Flemish region when compared with the two other regions with respective excesses of 40% and 20% in Wallonia and Brussels as compared to Flanders. Mortality is declining in all three regions, but the regional disparities persist.

2. 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, the premature mortality occurring below 75 years of age is considered. Reducing premature mortality is a key public health objective and actually 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 the 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. Here also the PYLL rates will be age-adjusted.

3. Belgium

The crude premature mortality (0–75 years) rate was 331/100,000 and the age-adjusted rate was 350/100,000 in Belgium in 2016. The age-adjusted rate was 1.8 times higher in men (452) than in women (254). Those rates are decreasing over time; actually the decrease is more pronounced among men (-31% between the years 2000 and 2016) than among women (-22%).

4. Regions

There are substantial disparities between the three regions in terms of premature mortality. As compared to Flanders, relative mortality excesses are observed :

  • 44% among men and 36% among women in Wallonia
  • 27% among men and 14% among women in Brussels.

The premature mortality rates are decreasing in all three regions at the same pace and as consequence the disparities between Flanders and the two other regions persist. All those differences are statistically significant.

  • Men
  • Women

Age-adjusted* premature (before 75) mortality rate (per 100,000) among men, by year and region, Belgium, 2000–2016
Source: Own calculations based on Statbel data
(*) with the European standard population 2010 as reference

Age-adjusted* premature (before 75) mortality rate (per 100,000) among women, by year and region, Belgium, 2000–2016
Source: Own calculations based on Statbel data
(*) with the European standard population 2010 as reference

5. Districts

Looking at a lower geographical (district) level, it is quite obvious 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 rates of premature mortality for men are observed in three districts of the province of Hainaut.

  • Men
  • Women

Age-adjusted (°) premature (before 75) mortality rate (per 100,000) among men, by district, 2010–2016
Source: Own calculations based on Statbel data
(°) with the European standard population 2010 as reference; (*) significantly different from the mean at p<0.05; (***) significantly different from the mean at p<0.05 after Bonferroni correction
Premature mortality in men BE 2010 2016

Age-adjusted (°) premature (before 75) mortality rate (per 100,000) among women, by district, 2010–2016
Source: Own calculations based on Statbel data
(°) with the European standard population 2010 as reference; (*) significantly different from the mean at p<0.05; (***) significantly different from the mean at p<0.05 after Bonferroni correction
Preamture mortality women BE 2010 2016

6. International comparison

The Potential Years of Life Lost (PYLL) indicator is used here 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 8% for men and 13% for women in 2015 (or nearest year).

  • Men
  • Women

Potential years of life lost (before 75) among men, by country, Europe, 2015 or nearest year
Source: Own estimations based on World Health Organization mortality database

Potential years of life lost (before 75) among women, by country, Europe, 2015 or nearest year
Source: Own estimations based on World Health Organization mortality database

7. Read more

View the metadata for this indicator

Statbel: General mortality

Sciensano: Standardized Procedures for Mortality Analysis (SPMA)

WHO: Mortality database

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).

Overall mortality by cause

1. Key messages

Tumours and cardiovascular diseases are the main causes of death observed in Belgium, accounting together for more than half of all deaths in both sexes.
The relative importance of those two broad categories has changed over time: tumours mortality has indeed progressively exceeded the mortality of cardiovascular diseases in men because of a rapid decrease in ischemic heart diseases mortality.
Still, cerebrovascular and ischemic heart diseases are in the top 3 of the specific causes of deaths, completed by dementia (including Alzheimer disease) for women and lung cancer for men.

2. Background

The framework used to analyze the causes of death is the World Health Organization (WHO) International Classification of Diseases 10th Revision (ICD-10). In this report, mortality is analyzed according to 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. This is based on the ICD-10 using the first character. In a second step, the 10 most important specific causes of death are ranked and presented for Belgium as for the regions in function of their mortality rates.

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

3. Causes of death grouped by ICD-10 chapter

Distribution

Tumours and circulatory system diseases (or cardiovascular diseases) were the main causes of death in 2016, accounting together for more than half of the mortality share.

  • Men
  • Women

Distribution of the causes of death (ICD-10 chapters) among men, by age-adjusted mortality rates, Belgium, 2016
Source: Own calculation based on data provided by Statbel

Distribution of the causes of death (ICD-10 chapters) among women, by age-adjusted mortality rates, Belgium, 2016
Source: Own calculation based on data provided by Statbel

Trends

In men, the cardiovascular diseases and the respiratory diseases mortality have significantly decreased between the years 2000 and 2016 (respectively by 45% and 42%). As a consequence, the tumour mortality, decreasing at a slower pace (25%), is nowadays higher than the mortality from cardiovascular diseases.

In women, the mortality rate of the diseases of the cardiovascular and respiratory systems decreased overtime as well. The mortality rates related to most of the other diseases have remained stable. That is the reason why tumour mortality is now almost as high as the one due to cardiovascular diseases.

It is worth mentioning the specific evolution regarding the mental and neurological diseases: the corresponding mortality rates have increased both among women (by 23%) as among men (24%) since the year 2000.

All the trends mentioned are statistically significant.

  • Men
  • Women

Age-adjusted* mortality rates of the 5 main causes of death (ICD10 chapter) among men, Belgium, 2000-2016
Source: Own calculation based on data provided by Statbel
(*) reference population: European standard population 2010

Age-adjusted* mortality rates of the 5 main causes of death (ICD10 chapter) among women, Belgium, 2000-2016
Source: Own calculation based on data provided by Statbel
(*) reference population: European standard population 2010

4. Specific causes of deaths

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, ischemic heart diseases, lung cancer and cerebrovascular diseases (grouped with arterial hypertension (HTA))
  • among women the cerebrovascular diseases (grouped with HTA), dementia (including the Alzheimer disease) and ischemic heart diseases.

Rankings are rather similar when comparing the regions. However, heart failure in Flanders is the fourth cause of death in men and the third in women, which is much higher than in the other regions. A part of these disparities could be due to differences in the coding of causes of deaths among regions.

  • Men
  • Women

Ranking by age-adjusted* mortality rates of the main causes of death (all ages) among men, Belgium and regions, 2016
Source: Own calculation based on data provided by Statbel
(*) reference population: European standard population 2010

Ranking by age-adjusted* mortality rates of the main causes of death (all ages) among women, Belgium and regions, 2016
Source: Own calculation based on data provided by Statbel
(*) reference population: European standard population 2010

5. Read more

View the metadata for this indicator

Statbel: Causes of death

Sciensano: Standardized Procedure for Mortality Analysis (SPMA)

WHO: ICD-10

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. WHO. ICD-10: International statistical classification of diseases and related health problems: Instruction manual. Geneva: World Health Organization; 2011.

Overall mortality

1. Key messages

The number of deaths in Belgium remains quite stable over time, around 105,000 a year.
When considering the crude mortality rate, it hardly declines since the year 2000 (6%). After standardization for age, the overall mortality rate is declining slowly (by 23% since 2000). This is reflecting the fact that the age distribution of the population is varying over time and that the age at death is increasing.
The overall mortality is 1.5 higher in men than in women and this gap is decreasing.
Geographical disparities are observed, with lower overall mortality rates in the Flemish region. Mortality is declining over time in all three regions, but the regional disparities persist.

2. 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. the road security and the 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 registrations 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) [1] as a reference. Mortality statistics have been computed here based on the 2016 data of the National Death Registry owned by Statistics Belgium.

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

3. Belgium

The crude mortality rate was 955 per 100,000 in 2016.

During the period 2000 - 2016, the crude mortality rates were very close in both men and women. However, after adjustment for age, a 50% higher mortality rate is observed in men (1202 per 100.000) as compared to women (794 per 100,000) in 2016.

The crude mortality rate hardly declined over time between 2000 and 2016. When considering age-adjusted rates, a 28% decrease in men and a 22% decrease in women are observed between 2000 and 2016.

Age-adjusted* mortality rates (per 100,000) among men and women, by year, Belgium, 2000–2016
Source: Own calculations based on data provided by Statbel
(*) with the European standard population 2010 as reference

4. Regions

The mortality rate was 18% higher in Wallonia and 8% higher in Brussels in 2016 as compared to Flanders. The mortality decreased the same way during the period 2000 – 2016 in the three regions as it was observed in Belgium as a whole.

  • Men
  • Women

Age-adjusted* mortality rates (per 100,000) among men, by year and region, Belgium, 2000–2016
Source: Own calculations based on data provided by Statbel

(*) with the European standard population 2010 as reference

Age-adjusted* mortality rates (per 100,000) among women, by year and region, Belgium, 2000–2016
Source: Own calculations based on data provided by Statbel
(*) with the European standard population 2010 as reference

5. Read more

View the metadata for this indicator

Statbel: General mortality

Sciensano: Standardized Procedure for Mortality Analysis (SPMA)

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. Pace M, Giampaolo L, Glickman M, Zupanic T. Revision of the European Standard Population Report of Eurostat's Task Force. Luxembourg; 2013.

Infant mortality

1. Key messages

In 2015, the infant mortality rate was 3.3 per thousand live births; this is close to the average EU-15 rate.
Infant mortality has sharply declined over the last decennia in Belgium. Current rates and trends are similar in the 3 regions.

2. Background

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

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 on smoothed rates. In this report we used a moving average over the last 5 years.

Infant mortality rates are sometimes published earlier by international organisations than at national level, as they only publish the national rates and therefore do not need the regional distribution of births and deaths.

3. Infant mortality rate

In 2015, the infant mortality rate was 3.3 per thousand live births. There are no differences between genders.

After smoothing, the 2015 infant mortality rates were quite similar in Flanders and Wallonia (around 3.5‰), and slightly lower in Brussels (even after smoothing); this should be confirmed on a longer period since the numbers in Brussels are very small.

At country level, the infant mortality decreased by almost 40% between 1998 and 2015 (respective rates were 5.3‰ and 3.3‰). A strong decline was observed in all regions, but seemed to be slightly slower in Flanders.

Between 2002 and 2013, infant mortality rates used to be slightly lower in Wallonia than in Flanders, afterwards they become similar. In Brussels, the rate used to be higher than in the other regions until 2009, then declined more sharply.

  • Raw
  • Smoothed

Raw infant mortality rate (‰) by region, 1998-2015
Source: Statistics Belgium, 1998-2015 [1]

Smoothed infant mortality rate (‰) (5-years moving average) by region, 2002-2015
Source: Own calculation from Statistics Belgium data, 2002-2015 [1]

International comparison

In 2016, the infant mortality rate in Belgium was at the average EU-15 rate (3.2).

Infant mortality rate by country of birth, Europe, 2016
Source: OECD Health Data, 2016 [2]

4. Read more

View the metadata for this indicator

Definitions

EU-15
The EU-15 corresponds to all countries that belonged to the European Union between 1995 and 2004: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden and the United Kingdom. We compare the Belgian health status to that of the EU-15 because these countries have similar socioeconomic conditions.
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.

References

  1. Statistics Belgium, 1998-2015. https://statbel.fgov.be/fr/themes/population/mortalite/mortalite-foeto-infantile#figures
  2. OECD Health Data, 2016. http://stats.oecd.org/index.aspx?queryid=30116#

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