Premature mortality

1. Key messages

The age-adjusted premature mortality (defined here as mortality before age 75) decreased by 31% between 2000 and 2019. However, in 2020, the age-adjusted premature mortality increased by 10% for men and by 5% for women compared to 2019.

The age-adjusted premature mortality is much higher in men than in women (the sex ratio was 1.7 in 2019).

In 2019, the age-adjusted premature mortality rate was higher in Wallonia (+40%) and Brussels (+21%) than in Flanders. Those regional disparities increased in 2020, the age-adjusted premature mortality rate was 51% higher in Wallonia and 33% higher in Brussels compared to Flanders.

2. Background

Premature mortality refers to deaths occurring too early i.e. at any age lower than the life expectancy. Different thresholds can be used in the operational definition of this indicator. In this report, the premature mortality occurring below 75 years of age is considered. Reducing premature mortality is a key public health objective and actually much of the premature mortality is avoidable by public health actions.

The crude mortality rate – i.e. the number of deaths in a given year divided by the population under study - is not well suited for health monitoring. Mortality is indeed strongly related to age; as a consequence aging populations face rising crude mortality rates, even if the health conditions are improving. Therefore, to compare mortality rates (over time or between populations) the age structure of the compared population groups will be aligned on a common reference. This technique is called “age-adjustment”. In this report, age-adjusted mortality rates are presented using the European standard population 2010 as reference.

The premature mortality can also be described using an indicator called Potential Years of Life Lost (PYLL): each death is weighted in function of the age at death. By doing so, more weight is put on deaths occurring at a younger age, since they represent a higher burden in term of life lost. So, if death is occurring at age 65, the corresponding life lost is 10. In this report, PYLLs are used for the international comparison with also the age of 75 years as reference. Here also the PYLL rates will be age-adjusted.

The data used in this analysis comes, on one hand, from the mortality statistics from 2000 to 2017 that have been computed based on the 2017 national causes of death database owned by Statbel. Additionally, the rates for 2018 to 2020 have been computed based on the open data of Statbel [1].

3. Belgium

The crude premature mortality (0–74 years) rate was 325 per 100,000 inhabitants under 75 years old and the age-adjusted rate was 344/100,000 in Belgium in 2019. The age-adjusted rate was 1.7 times higher in men (415) than in women (249). Those age-adjusted rates are decreasing over time; actually the decrease is more pronounced among men (-37% between the years 2000 and 2019) than among women (-23%).

In 2020, the crude premature mortality rate was 349/100,000 while the age-adjusted rate was 355/100,000 in Belgium. The age-adjusted premature mortality was 1.75 times higher in men than in women. This age-adjusted rate increased by 10% for men and by 5% for women compared to 2019. That increased can be explained by the COVID-19 epidemic.

4. Regions

There are substantial disparities between the three regions in terms of age-adjusted premature mortality. As compared to Flanders, the following relative mortality excesses were observed in the other regions in 2019 :

  • Wallonia: +43% among men and +34% among women
  • Brussels: +23% among men and +10% among women

Until 2019, the premature age-adjusted mortality rates were decreasing in all three regions at the same pace and as consequence the disparities between Flanders and the two other regions were persisting.

The regional disparities have widened in 2020 for both genders. As compared to Flanders, the following excesses were observable in 2020 :

  • Wallonia: +56% among men and +45% among women
  • Brussels: +38% among men and +26% among women

The increase of the regional disparities in premature mortality can probably be explained by the COVID-19 epidemic, as Wallonia and Brussles were more severe hit than Flanders (qua number of deaths)

  • Men
  • Women

Age-adjusted* premature (before 75) mortality rate (per 100,000) among men, by year and region, Belgium, 2000-2020
Source: Own calculations based on Statbel data
(*) with the European standard population 2010 as reference

Age-adjusted* premature (before 75) mortality rate (per 100,000) among women, by year and region, Belgium, 2000-2020
Source: Own calculations based on Statbel data
(*) with the European standard population 2010 as reference

5. Districts

Looking at a smaller geographical level, it becomes clear that most Flemish districts experience, for both sexes (although less pronounced in women), a lower premature mortality rate than the Belgian average. The reverse is observed in Brussels and all Walloon districts (except for Nivelles for both sexes). The highest premature mortality rates for men are observed in three districts of the province of Hainaut (Charleroi, Mons,Tournai). In women the districts with highest rates were found in the provinces of Hainaut, Namur and Liège.

  • Men
  • Women

Age-adjusted (°) premature (before 75) mortality rate (per 100,000) among men, by district, 2010–2017
Source: Own calculations based on Statbel data
(°) with the European standard population 2010 as reference; (*) significantly different from the mean at p<0.05; (***) significantly different from the mean at p<0.05 after Bonferroni correction
prem mort distr men en final

Age-adjusted (°) premature (before 75) mortality rate (per 100,000) among women, by district, 2010–2017
Source: Own calculations based on Statbel data
(°) with the European standard population 2010 as reference; (*) significantly different from the mean at p<0.05; (***) significantly different from the mean at p<0.05 after Bonferroni correction
prem mort distr wom en final

6. International comparison

The Potential Years of Life Lost (PYLL) indicator is used here to perform international comparisons. 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 6% for men and 12% for women in 2016 (or nearest year). These data are the most recent data (2016) currently available from the World Health Organization mortality database.

  • Men
  • Women

Potential years of life lost (before 75) among men, by country, Europe, 2016 or nearest year
Source: Own calculations based on World Health Organization mortality database

Potential years of life lost (before 75) among women, by country, Europe, 2016 or nearest year
Source: Own calculations based on World Health Organization mortality database

7. Read more

View the metadata for this indicator

Statbel: General mortality

Statbel: Open data

Sciensano: Standardized Procedures for Mortality Analysis (SPMA)

WHO: Mortality database

Definitions

Crude Mortality rate
The mortality rate is the number of deaths registered in the country divided by the corresponding population.
Age-standardized mortality rates
The age-standardization is a weighted average of age-specific mortality rates to remove variations arising from differences in age structure between population groups.
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.
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. Statbel. Number of deaths per day, sex, age, region, province, district. https://statbel.fgov.be/en/open-data/number-deaths-day-sex-district-age