Causes of death

1. Key messages

Neoplasms and cardiovascular diseases are the main broad causes of death, accounting together for more than half of all deaths in both sexes. Their relative importance has changed over time: neoplasm (of which 95% are cancers) mortality has indeed progressively exceeded the one of cardiovascular diseases in men. This is due to an important decrease of the ischemic heart diseases mortality.
Concerning the premature mortality (below 75 years), the specific causes of death with the highest burden (in term of life lost) are suicide, lung cancer, and ischemic heart diseases in men and breast and lung cancers, followed by suicide in women. All main causes of premature death decreased over the last 15 years; particularly, the premature mortality due to ischemic heart diseases decreased by more than 50% in both sexes. An exception to this general tendency is lung cancer among women which steadily increased.

2. Background

In this section, mortality is analyzed according to the underlying cause of death, as indicated on the death certificate. The framework used here is the World Health Organization (WHO) International Classification of Diseases 10th (ICD10) [1].

The causes of overall mortality (all ages) are first described; they have been grouped according to the ICD10 chapters.

The overall mortality by cause is described using age-standardized mortality rates (which eliminate the effect of variations in the age structures of populations).

The next step is the analysis of the causes of premature deaths (before 75 years). We first describe the causes of premature death according to the ICD10 chapters, then further analyze them in detail to allow drawing useful conclusions. Actually most of the causes of premature death are avoidable either through the health system, or by the implementation of public health policies; the reduction of premature mortality rates therefore constitutes a crucial objective in the field of public health. The ranking of the causes of premature deaths is a very important tool to set up priorities.

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

  • Age-standardized premature mortality rates :  compares causes according to their frequency.
  • Potential Years of Life Lost (PYLL), which first weight each death in function of the age when the death occurred (giving more weight for younger ages). PYLL allow to compare causes according to their burden, which takes into account the frequency and the age at death.

Both indicators are adjusted for age using the structure of the Belgian population in 2010 as reference (to eliminate the effect of variations in the age structures between populations or overtime).

3. Causes of overall mortality

Belgium

Distribution of the causes of death grouped in ICD10 chapters

In both sexes, neoplasms (or "tumors") and circulatory system (or "cardiovascular"  diseases ('circulatory system' diseases) were the main causes of death in 2015, accounting together for more than half of the mortality share. The "neoplasms" group includes 95% of malignant neoplasms (or cancers), the other 5% being tumors of benign or borderline behavior.

  • Men
  • Women

Share of the causes of death (ICD10 chapters) among men, ranked by age-adjusted mortality rates, Belgium, 2015
Source: Standardized Procedures for Mortality Analysis [2]

Share of the causes of death (ICD10 chapters) among women, ranked by age-adjusted mortality rates, Belgium, 2015
Source: Standardized Procedures for Mortality Analysis [2]

Trends in the main causes of death, grouped in ICD10 chapters

In men, circulatory (cardiovascular) diseases mortality has decreased faster than mortality from any other cause; mortality due to neoplasms in men went beyond the mortality from circulatory system diseases.

In women, the mortality rate of the circulatory and respiratory systems diseases went down. Most other main causes of deaths have remained stable. Neoplasm mortality is now almost as high as the one of circulatory system diseases in women.

  • Men
  • Women

Age-adjusted* mortality rates of the 5 main causes of death (ICD10 chapter) among men, Belgium, 2001-2015
Source: Standardized Procedures for Mortality Analysis [2]
(*) reference population: Belgium 2010

Age-adjusted* mortality rates of the 5 main causes of death (ICD10 chapter) among women, Belgium, 2001-2015
Source: Standardized Procedures for Mortality Analysis [2]
(*) reference population: Belgium 2010

4. Causes of premature mortality

Belgium

Distribution of the causes of premature death, grouped in ICD10 chapters

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

  • neoplasms as first (among which 98% are cancers in this age group),
  • followed by cardiovascular (or 'circulatory system')  diseases,
  • and external causes (mostly suicide and road accident).

The share of neoplasms is higher in women than in men, while the shares of circulatory system diseases and external causes are higher among men.

  • Men
  • Women

Share of the causes of premature (before 75) deaths (ICD10 chapters) among men, ranked by age-adjusted mortality rates, Belgium, 2015
Source: Own calculation based on death certificates, Statbel

Share of the causes of premature (before 75) deaths (ICD10 chapters) among women, ranked by age-adjusted mortality rates, Belgium, 2015
Source: Own calculation based on death certificates, Statbel

Top 6 of the specific causes of premature death

The importance of the causes of premature deaths can be expressed in rates (which reflects only frequency of the cause) or in PYLL (which reflects the burden of the cause). 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.

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

  • In men: lung cancer followed by ischemic heart disease and suicide
  • In women: lung and breast cancer, followed by ischemic heart disease

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

  • In men: suicide followed by lung cancer and ischemic heart diseases
  • In women: breast cancer followed by lung cancer, suicide, and cerebrovascular diseases and hypertension (replacing ischemic heart diseases)
  • Men
  • Women

Top 6 specific causes of premature death (before 75) ranked by age-adjusted* premature mortality rates among men, Belgium, 2015
Source: Own calculation based on death certificates, Statbel
(*) reference population: Belgium 2010

Top 6 specific causes of premature death (before 75) ranked by age-adjusted* premature mortality rates among women, Belgium, 2015
Source: Own calculation based on death certificates, Statbel
(*) reference population: Belgium 2010

 

  • Men
  • Women

Top 6 specific causes of premature death (before 75) ranked by age-adjusted* Potential Years of Life Lost (PYLLs) among men, Belgium, 2015
Source: Own calculation based on data from Statbel [3]
(*) reference population: Belgium 2010

Top 6 specific causes of premature death (before 75) ranked by age-adjusted* Potential Years of Life Lost (PYLLs) among women, Belgium, 2015
Source: Own calculation based on death certificates, Statbel
(*) reference population: Belgium 2010

Trends in the top 6 of the specific causes of premature death

Except for lung cancer and COPD among women, all causes of premature deaths tend to decrease, or at least stays stable over time.

The premature mortality due to ischemic heart diseases have declined spectacularly over the last 15 years, with more than 50% decrease in the age-adjusted mortality rates in both sexes. The same is observed for cerebrovascular diseases premature mortality.

Premature mortality rates for lung cancer have also substantially declined in men (37.5% of relative decrease) while it dramatically progressed in women (53.3% of relative increase) during the last 15 years (jumping from the fourth to the first cause of death among women, just above breast cancer).

  • Men
  • Women

Age-adjusted* premature (before 75) mortality rates (per 100,000) for the 6 main specific causes of death among men, Belgium, 2000-2015
Source: Own calculation based on data from Statbel [3]
(*) reference population: Belgium 2010

Age-adjusted* premature (before 75) mortality rates (per 100,000) for the 6 main specific causes of death among women, Belgium, 2000-2015
Source: Own calculation based on death certificates, Statbel
(*) reference population: Belgium 2010

Regions

Premature mortality rate ratios between regions

For 5 of the top 6 specific causes of death in men, the premature death rates are higher in Wallonia than in Flanders, the ratio Wallonia versus Flanders being particularly high for premature ischemic heart and COPD mortality (ratio is 1.6 for both causes). Only for colorectal cancer, the rate is higher in Flanders than in Wallonia, but this difference is not significant. The Brussels to Flanders (Bx/F) differences are more moderate with the highest ratio for cerebrovascular diseases (1.4). The lower suicide mortality rate in Brussels is an artefact (due to the delay in confirming suicide cases).

In women also, the premature death rates are higher in Wallonia than in Flanders for all of the 6 main causes, except for breast cancer for which the rates are similar in the three regions. The highest Wallonia to Flanders (W/F) ratios are observed for COPD (1.88) and ischemic heart diseases mortality (1.74). The Brussels to Flanders ratios are more moderate. The highest B/F ratios are observed for COPD (1.55) and cerebrovascular diseases (1.49). As in men, the lower suicide mortality rate in Brussels is probably an artefact (due to the delay in confirming suicide cases).

  • Men
  • Women

Regional rate ratios for the 6 main specific causes of premature death rates (before 75) (using Flanders as reference), among men, 2015
Source: Own calculation based on death certificates, Statbel

Regional rate ratios for the 6 main specific causes of premature death (before 75) (using Flanders as reference), among women, 2015
Source: Own calculation based on death certificates, Statbel

Ranking of the main specific causes of premature death by region

Lung cancer is the most frequent cause of premature death in all the regions, and since 2015 in both genders (measured in rates). The second most frequent causes of death are also common for all regions in each gender: ischemic heart diseases in men and breast cancer in women. In men, COPD and cerebrovascular disease rank higher in Wallonia and Brussels than in Flanders, while inversely colorectal cancer ranks higher in Flanders.

According to the years of life lost (measured in PYLL), lung cancer ranks first in men in Brussels and second in Flanders and Wallonia, where suicide is ranking first. Lung cancer also ranks first (in PYLL) for women in Brussels and Wallonia, second in Flanders after breast cancer.

It is interesting to note that transport accidents are also responsible for many life years lost in men, even if the premature mortality rate is not high.

The apparent lower rate of suicide in Brussels is an artefact (delay of the procedure of suicide confirmation)

Ranking of the main causes of death by premature mortality rates and Potential Years of Life Lost, by sex and regions of residence, Belgium, 2015
Source: Own calculations based on death certificates, Statbel

  Ranking by rates Ranking by PYLL*
Causes of death Flanders Brussels Wallonia Flanders Brussels Wallonia
  Men
 Lung cancer 1 1 1 2 1 2
 Ischaemic heart diseases 2 2 2 3 2 3
 Suicide 3 6 3 1 3 1
 Colorectal cancer 4 11 7 6 14 10
 Cerebrovascular diseases and hypertension 5 3 5 7 5 6
 Chronic Obstructive Pulmonary Diseases (COPD) 6 4 4 10 6 7
 Chronic liver diseases 7 5 6 5 4 5
Transport accident 11 17 9 4 9 4
  Women
Lung cancer 1 1 1 2 1 1
Breast cancer 2 2 2 1 2 3
Cerebrovascular diseases and hypertension 3 3 5 4 4 4
Ischemic heart diseases 4 6 3 6 10 6
Suicide 5 11 6 3 3 2
Colorectal cancer 6 5 8 7 5 9
Chronic Obstructive Pulmonary Diseases (COPD) 7 4 4 10 8 7
Chronic liver diseases 10 8 7 8 6 5
*Potential Years of Life Lost

Trends in specific causes of premature death, by region

Trends in the main causes of premature mortality are quite similar for all the three regions; so we focus here on some regional specificities.

1. The lung cancer premature mortality rate in women was significantly higher in Wallonia than in Flanders over the whole period. It steadily increased in Flanders and Wallonia while remaining stable in Brussels since 2006. Brussels previously experienced the highest lung cancer premature mortality rates but it has been overtaken by Wallonia since 2010.

Lung cancer age-adjusted premature (before 75) mortality rates (per 100,000) among women, by year and region of residence, Belgium, 2000-2015
Source: Own calculation based on death certificates, Statbel

2. In men, the colorectal cancer premature mortality rate was higher in Flanders in the early 2000s, then decreased, leading to similar rates in the Flemish and Walloon Regions since 2006. It decreased substantially in Brussels starting from 2011, resulting in a significantly lower rate in Brussels than in the two other regions since 2013.

Colorectal cancer age-adjusted premature (before 75) mortality rates (per 100,000) among men, by year and region of residence, Belgium, 2000-2015
Source: Own calculation based on death certificates, Statbel

3. Suicide premature mortality rates in men are higher in Wallonia than in Flanders; a decrease was observed in both regions, starting from 2008 in Wallonia, resulting in a decline in the regional difference over time. Among women, the suicide rates are similar and 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 region of residence, Belgium, 2000-2015
Source: Own calculation based on death certificates, Statbel
Note: The lower rates of suicide in Brussels are artefactual and not represented.

Suicide age-adjusted premature (before 75) mortality rates (per 100,000) among women, by region of residence, Belgium, 2000-2015
Source: Own calculation based on death certificates, Statbel
Note: The lower rates of suicide in Brussels are artefactual and not represented.

4. The breast cancer premature mortality rate used to be slightly lower in Wallonia than in the two other regions. Since 2011 rates in Flanders and Wallonia are similar, and since 2014 the rates have equalized in all regions.

Breast cancer age-adjusted* premature (before 75) mortality rates (per 100,000) in women, by year and region of residence, Belgium, 2000-2015
Source: Own calculation based on death certificates, Statbel
(*) reference population: Belgium 2010

5. Read more

View the metadata for this indicator

SPMA: Standardized Procedures for Mortality Analysis

Stabel causes of deaths

Definitions

Age-standardized (or age-adjusted) mortality rate
The crude mortality rate is the number of deaths registered in a population divided by the number of people in this population. The age-specific rates are the number of deaths in a given age-group divided by the population in this age-group. The age-standardization is a weighted average of age-specific mortality rates; the aim of standardization is to remove variations arising from differences in age structure between population groups
International Classification of Diseases (ICD10)
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 a 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-standardised premature mortality rate is calculated as a weighted average of age-specific mortality rates until 75 years.

References

  1. ICD10, International Classification of Diseases (OMS, 1992). http://apps.who.int/classifications/icd10/browse/2016/en
  2. SPMA (Standardized Procedures for Mortality Analysis), Sciensano. https://spma.wiv-isp.be/SitePages/Home.aspx