Causes of premature death

1. Key messages

2. Causes of death - Belgium

Tumour is the main group of causes of premature deaths

In both sexes, 66% of premature deaths are caused by the same 3 groups of causes (grouped in ICD chapters):

• 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.

Lung and breast cancers are the most important causes of premature deaths in Belgium

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 chronic obstructive pulmonary disease (COPD)

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

• In men: suicide followed by lung cancer, IHD, and transport accidents
• In women: breast cancer followed by lung cancer, suicide, and cerebrovascular diseases + high blood pressure (HTA)

Lung cancer and COPD in women are increasing

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 a more than 65% decrease in the age-adjusted mortality rates) in both sexes during the period 2000-2019.
• The same is observed for cerebrovascular diseases (a decrease of around 55%).
• Premature mortality rates for lung cancer have also substantially declined in men (49% 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.
• An increase is also observed for COPD in women.

3. Causes of death - Regions

Lung cancer, breast cancer and suicide are the main causes of death in the 3 regions

In 2019, according to the age-adjusted premature mortality rate:

• among men, lung cancer ranks first and IHD second in the three regions. The third main cause is suicide in the Flemish Region and in the Walloon Region, and cerebrovascular diseases + HTA in the Brussels Capital Region.
• among women, the top three is similar in the regions: lung cancer, breast cancer, and COPD.

In 2019, according to the potential years of life lost (PYLL):

• among men, suicide ranks first in the Flemish Region and in the Walloon Region, followed by lung cancer and IHD. In the Brussels Capital Region, lung cancer ranks first followed by suicide and IHD.
• among women, lung cancer ranks first in the Walloon Region, second in the Flemish Region and the Brussels Capital Region after breast cancer. Suicide ranks third in the three regions.

It is interesting to note that transport accidents are ranking quite high in Flemish and Walloon men, even if the premature mortality rate is rather low. 

Ischemic heart disease is the main cause of death leading to regional differences among men

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 IHD (+17.0 per 100.000), lung cancer (+13.4), infectious and parasitic diseases (+8.9), chronic liver disease (+8.8), and COPD (+8.4).

In women, the conditions contributing most to the excess premature mortality in the Walloon Region as compared to the Flemish Region are COPD (+8.0), lung cancer (+6.4), infectious and parasitic diseases (+5.7), IHD (+5.2), and chronic liver diseases (+4.1). 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 IHD (+11.1), cerebrovascular diseases and HTA (+8.5), infectious and parasitic diseases (+5.0), chronic liver disease (+4.5), and COPD (+4.3). However, some conditions have lower rates in the Brussels Capital Region compared to the Flemish Region like suicide (-5.7) and transport accidents (-3.3).

In women, the cause-specific mortality rates in the Flemish Region and the Brussels Capital Region are quite similar.

Most causes of premature deaths are decreasing among men

The trends in premature mortality are quite similar for the three regions. The focus has been put here on specific causes of death with particular trends.

1. The lung cancer premature mortality rate has been decreasing among men in the three regions during the period 2000–2019 (-53% in the Flemish Region, -46% in the Walloon Region, and -44% 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. Women in the Brussels Capital Region previously experienced the highest lung cancer premature mortality rates but it has been overtaken by the Walloon Region since 2010. A slow decrease is observable in all regions in the most recent years.

2. IHD premature mortality rates are decreasing faster in the Flemish Region (-69% in men and -73% in women) than in the Walloon Region (-60% in men and -58% in women) between 2000 and 2019.

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 47% in the Flemish Region and in the Walloon Region, and by 48% in the Brussels Capital Region over the period. On the contrary, female COPD mortality increased by 35% in the Walloon Region, 28% in the Flemish Region and 13% in the Brussels Capital Region.

5. The premature mortality rate for colorectal cancer has decreased in the Flemish Region (-57% for men and -37% for women) between 2000 and 2019 while remaining more stable in the Walloon Region (-22% in men and -5% 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 2019. The Walloon Region and the Brussels Capital Region were experiencing higher rates than the Flemish Region in 2019.

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 is analyzed on another page. 

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.