Causes of death

1. Key messages

2. Causes of death 

Tumours and cardiovascular diseases are the main groups of causes of death

Tumours and circulatory system diseases (or cardiovascular diseases) were the main causes of death in 2019, accounting together for approximately half of the mortality share (52% for men and 50% for women). In 2020, tumours and cardiovascular diseases were still the main causes of death but they represent a lower share of death (43% for men and 42% for women) due to the presence of COVID-19.

Tumours become the main cause of death in women in 2020

In women, the main cause of death in 2020 is no longer cardiovascular diseases, but tumours. This finding can be explained by a slower decline in the age-adjusted mortality rates for tumours. The age-adjusted mortality rate of cardiovascular diseases decreased by 35% between the years 2010 and 2020, whereas tumour mortality decreased only by 13%, leading to higher tumour mortality than cardiovascular diseases mortality in 2020.

In men, a similar pattern can be found since 2014 with tumour mortality being higher than cardiovascular mortality. The male age-adjusted mortality rate of cardiovascular diseases has also significantly decreased by 35% between the years 2010 and 2020. During the same period, tumour mortality decreased at a slower pace (-22%). The decline in cardiovascular mortality is driven by progress in prevention and treatment, among others the decline in smoking, the improvement in pharmacological treatments of hypertension and cholesterol, and medical procedures [1]. 

In both genders, the mortality of respiratory system diseases (excluding COVID-19) decreased between 2000 and 2019 (by 42% in men, and 24% in women). However, the decrease slowed down and stopped in the last decade. In 2020, due to the impact of COVID-19, the mortality of respiratory system diseases (excluding COVID-19) decreased again.

The main specific causes of death differ by gender

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, COVID-19, ischemic heart diseases (IHD), and lung cancer;
• among women, COVID-19, dementia (including Alzheimer's disease), and cerebrovascular diseases (grouped with HTA).

Rankings are rather similar between regions. However, heart failure in the Flemish Region is ranked as the fourth leading cause of death in men and in women. In contrast, heart failure is ranked as the seventh, ninth or tenth leading cause of death in the Brussels Capital Region and in the Walloon Region. As heart failure is considered to be a common end to several diseases, these disparities could be explained in part by differences in the coding of causes of death among regions. 

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Statbel: Causes of death

Sciensano: Standardized Procedure 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) [2]. 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 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 death are ranked by mortality rates for Belgium and by regions. 

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

For more details on the COVID-19 mortality between 2020 and 2022, consult the dedicated factsheet.

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. Mensah GA, Wei GS, Sorlie PD, Fine LJ, Rosenberg Y, Kaufmann PG, et al. Decline in Cardiovascular Mortality: Possible Causes and Implications. Circ Res. 2017 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5268076/  
2. WHO. ICD-10: International statistical classification of diseases and related health problems: Instruction manual. Geneva: World Health Organization; 2011.

Please cite this page as: Sciensano. Mortality and Causes of Death: Causes of death, Health Status Report, 2 Aug 2023, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/mortality-and-causes-of-death/general-mortality-by-cause