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1. Key messages

  • In 2020, the conditions with the highest burden in term of years of life lost before 75 years are suicide, COVID-19, and lung cancer in men, and breast cancer, lung cancer, and COVID-19 in women.
  • For most conditions, the premature mortality rates decreased between the years 2010 and 2020, except for lung cancer and chronic obstructive pulmonary disease (COPD) among women.
  • The causes contributing most to the higher premature mortality rates in the Walloon Region and in the Brussel Capital Region compared to the Flemish Region are COVID-19 and ischemic heart disease in men and COVID-19 and COPD in women.

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.

  • Men
  • Women

Distribution of the causes of premature (before 75) deaths (ICD-10 chapters) among men, ranked by age-adjusted* mortality rates, Belgium, 2020
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, 2020
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

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.

  • Men
  • Women

Ranking of specific causes of premature death (before 75) ranked by age-adjusted* premature mortality rates among men, Belgium, 2020
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

Ranking of specific causes of premature death (before 75) ranked by age-adjusted* premature mortality rates among women, Belgium, 2020
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

 

  • Men
  • Women

Ranking of specific causes of premature death (before 75) ranked by age-adjusted* Potential Years of Life Lost (PYLLs) among men, Belgium, 2020
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

Ranking of specific causes of premature death (before 75) ranked by age-adjusted* Potential Years of Life Lost (PYLLs) among men, Belgium, 2020
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

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.
  • Men
  • Women

Age-adjusted* premature (before 75) mortality rates (per 100,000) for the 6 main specific causes of death (excluded COVID-19) among men, Belgium, 2000-2020
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010
Note: In the past, suicide rates in Brussels were underestimated for some years due to the delay of the justice department in transmitting files.

Age-adjusted* premature (before 75) mortality rates (per 100,000) for the 6 main specific causes of death (excluded COVID-19) among women, Belgium, 2000-2020
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010
Note: In the past, suicide rates in Brussels were underestimated for some years due to the delay of the justice department in transmitting files.

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.
  • Men
  • Women

Ranking of the main causes of death by age-adjusted* mortality rates among men, by region of residence, Belgium, 2020
Source: Own calculation based on death certificates, Statbel



Ranking of the main causes of death by age-adjusted* mortality rates among women, by region of residence, Belgium, 2020
Source: Own calculation based on death certificates, Statbel



  • Men
  • Women

Ranking of the main causes of death by age-adjusted* Potential Years of Life Lost (PYLL) among men, by region of residence, Belgium, 2020
Source: Own calculation based on death certificates, Statbel



Ranking of the main causes of death by age-adjusted* Potential Years of Life Lost (PYLL) among women, by region of residence, Belgium, 2020
Source: Own calculation based on death certificates, Statbel



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.

  • Men
  • Women

Ranking of differences in age-adjusted* mortality rates of specific causes of death among men, the Flemish Region versus the Walloon Region, 2018-2020 average**
Source: Own calculation based on death certificates, Statbel
**For COVID-19, only 2020

Ranking of differences in age-adjusted* mortality rates of specific causes of death among women, the Flemish Region versus the Walloon Region, 2018-2020 average**
Source: Own calculation based on death certificates, Statbel
**For COVID-19, only 2020

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.

  • Men
  • Women

Ranking of differences in age-adjusted* mortality rates of specific causes of death among men, the Flemish Region versus the Brussels Capital Region, 2018-2020 average**
Source: Own calculation based on death certificates, Statbel
**For COVID-19, only 2020

Ranking of differences in age-adjusted* mortality rates of specific causes of death among women, the Flemish Region versus the Brussels Capital Region, 2018-2020 average**
Source: Own calculation based on death certificates, Statbel
**For COVID-19, only 2020

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.

  • Men
  • Women

Lung cancer age-adjusted* premature (before 75) mortality rates (per 100,000) among men, by year and region of residence, Belgium, 2000-2020
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, 2000-2020
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

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. 

  • Men
  • Women

Ischemic heart disease age-adjusted* premature (before 75) mortality rates (per 100,000) among men, by year and region of residence, Belgium, 2000-2020
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

Ischemic heart disease age-adjusted* premature (before 75) mortality rates (per 100,000) among women, by year and region of residence, Belgium, 2000-2020
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 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

  • Men
  • Women

Suicide age-adjusted* premature (before 75) mortality rates (per 100,000) among men, by year and region of residence, Belgium, 2000-2020
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010
Note: In the past, suicide rates in the Brussels Capital Region were underestimated for some years due to the delay of the justice department in transmitting files.


Suicide age-adjusted* premature (before 75) mortality rates (per 100,000) among women, by year and region of residence, Belgium, 2000-2020
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010
Note: In the past, suicide rates in the Brussels Capital Region were underestimated for some years due to the delay of the justice department in transmitting files.


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.

  • Men
  • Women

COPD age-adjusted* premature (before 75) mortality rates (per 100,000) among men, by year and region of residence, Belgium, 2000-2020
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, 2000-2020
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

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. 

  • Men
  • Women

Colorectal cancer age-adjusted* premature (before 75) mortality rates (per 100,000) among men, by year and region of residence, Belgium, 2000-2020
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, 2000-2020
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

4. Read more

View the metadata for this indicator

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