All-cause mortality

1. Key messages

The number of deaths in Belgium remained quite stable over the last 15 years around 105,000 a year. The crude overall mortality rate is declining slowly, but since the people die at older ages, after correction for age, the age-adjusted overall mortality rate has declined by 19% in 15 years.
Premature mortality (before 75 years) is decreasing overall in Europe. In Belgium, the premature mortality rate decreased by 22% between 2001 and 2015. However, Belgium ranks poor among EU-15 countries, with an excess in potential years of life lost (PYLL) reaching 8% and 13% respectively in men and women as compared to the EU-15 means in 2015.
Mortality is higher in men than in women (overall mortality is 1.5 times higher and premature mortality is 1.7 times higher).
Geographical disparities are observed, with lower overall mortality rates in the Flemish region than in the two other regions. The regional differences are still more pronounced for premature mortality, with respective excesses of 40% and 19% in Wallonia and Brussels as compared to Flanders. Mortality is declining in all three regions, but the regional disparities persist.

2. Background

The mortality level is a traditional health indicator, actually better understood as an indicator of “non-health”. Although measuring 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. It is also a health indicator that has a longer tradition and is measured with more validity than any other.

In this report, we describe the overall mortality (including all ages) and the premature mortality (before 75 years). Premature mortality refers to deaths occurring too early (at any age lower than the life expectancy, and different thresholds can be used in the operational definition). In this report, we describe the premature mortality occurring below 75 years of age. Reducing premature mortality is a key public health objective: in terms of societal and human loss, it is important to prevent citizens from dying too early. Moreover, much of the premature mortality is avoidable by public health policies.

The crude mortality rate (the number of deaths in a given year divided by the population under study) is not well suited for health monitoring: as mortality is strongly related to age, aging populations face rising crude mortality rates, even as the health conditions are improving. Therefore, comparisons of mortality indicators should always use estimators that are adjusted for differences in age composition between the population groups. In this report, we are using the age-adjusted mortality rates, with the Belgian 2010 population as reference. Beside the age-adjusted mortality rates, the premature mortality can be described by using the estimator called Potential Years of Life Lost (PYLL), which weights each death in function of the age, giving more weight for younger ages (weight being calculated as 75 minus age at death). In this report, we are using PYLLs for the international comparison. This indicator is also age-adjusted, but with the OECD 2010 population as reference.

3. Overall mortality

Over the last 15 years, the crude mortality rate was very close in both sexes and hardly declined over time, reaching 980 per 100,000 in 2015. After adjustment for age, a 50% higher mortality rate is observed in men than in women (1118 and 748 per 100,000 respectively, in 2015). It decreased by 24% in men and 16% in women between 2001 and 2015.

In 2015, the mortality rate was 22% higher in Wallonia and 8% higher in Brussels when compared to Flanders. For both sexes, mortality rate is decreasing the same way in Belgium and the three regions.

  • Men
  • Women

Age-adjusted* mortality rates (per 100,000) among men, by year and region, Belgium, 2001–2015
Source: SPMA [1]
(*) with the Belgian population 2010 as reference

Age-adjusted* mortality rates (per 100,000) among women, by year and region, Belgium, 2001–2015
Source: SPMA [1]
(*) with the Belgian population 2010 as reference

4. Premature mortality

Belgium

In 2015, the age-adjusted premature mortality (0–75 years) rate was 325.1/100,000 in Belgium. It was 1.7 times higher in men (414.8) than in women (240.7). It is decreasing faster over time for men than for women with decreases of respectively 26% and 16% between 2001 and 2015.

Geographical variations

The disparities in premature mortality between the three regions are substantial: Flanders has the lowest premature mortality rates, while we observe excesses of 41% and 23% among men and 41% and 18% among women in Wallonia and Brussels respectively. The premature mortality rates are decreasing in all the three regions but the disparities between Flanders and the two other regions persist.

  • Men
  • Women

Age-adjusted* premature (before 75) mortality rate (per 100,000) among men, by year and region, Belgium, 2001–2015
Source: Own calculations based on Statbel data [2]
(*) with the Belgian population 2010 as reference


Age-adjusted* premature (before 75) mortality rate (per 100,000) among women, by year and region, Belgium, 2001–2015
Source: Own calculations based on Statbel data [2]
(*) with the Belgian population 2010 as reference
 

 

Looking at a smaller geographical level, we observe that most Flemish districts experience, for both sexes (although less pronounced in women), a lower premature mortality rate than the Belgian average while the reverse is observed in Brussels and all Walloon districts (except Nivelles for both sexes). The highest rates of premature mortality for men are observed in the province of Hainaut, which is also one of the most deprived provinces of Belgium (according to the unemployment rates and income levels).

  • Men
  • Women

Age-adjusted* premature (before 75) mortality rate (per 100,000) among men, by district, 2010–2014
Source: Own calculations based on Statbel data [2]
(*) with the Belgian population 2010 as reference

 premature mortality district men

Age-adjusted* premature (before 75) mortality rate (per 100,000) among women, by district, 2010–2014
Source: Own calculations based on Statbel data [2]
(*) with the Belgian population 2010 as reference

premature mortality district women

International comparison

International comparisons of premature mortality are done using the Potential Years of Life Lost (PYLL) indicator. The premature mortality has been decreasing continuously since a few decades in the EU-15 countries. 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 [3]

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 [3]

5. Read more

View the metadata for this indicator

Definitions

Age-standardized mortality rate
The mortality rate is the number of deaths registered in the country divided by the corresponding population. The age-standardization is a weighted average of age-specific mortality rates to remove variations arising from differences in age structure.
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. The premature mortality rate is also age-adjusted.
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. Standardized Procedures for Mortality Analysis. https://spma.wiv-isp.be/SitePages/Home.aspx
  2. Statbel. https://statbel.fgov.be/en/themes/population/mortality
  3. World Health Organization, mortality database http://www.who.int/healthinfo/statistics/mortality_rawdata/en/