Causes of premature death

1. Key messages

The conditions with the highest burden in term of years of life lost before 75 years are :

  • Suicide, lung cancer, and ischemic heart diseases in men
  • Breast cancer, lung cancer, and cerebrovascular diseases in women

For most conditions, the premature mortality rates decreased between the years 2000 and 2018. It is particularly the case for ischemic heart diseases and transport accidents who decreased by more than 50% in both genders. Exceptions to this general tendency are lung cancer and chronic obstructive pulmonary disease (COPD) among women which steadily increased then stabilized.

Regional differences are observed with higher premature mortality rates in Wallonia and Brussels than in Flanders. The causes contributing most to the difference between Wallonia and Flanders are ischemic heart diseases (IHD), lung cancer and COPD in men, and lung cancer, COPD, IHD in women. The causes contributing most to the difference between Brussels and Flanders are IHD, cerebrovascular diseases and chronic liver diseases for men and COPD, IHD, and chronic liver diseases in women.

The evolution of premature mortality over time is quite similar for the three regions.

2. 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. 

3. Belgium

Categories of main causes of premature deaths

In both sexes, nearly 70% of the 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.

  • Men
  • Women

Distribution of the causes of premature (before 75) deaths (ICD-10 chapters) among men, ranked by age-adjusted* mortality rates, Belgium, 2018
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, 2018
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

Ranking of the specific causes of deaths

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

For more information concerning the morbidity of specific conditions, please consult the related page: Overview non-communicable diseases, Cancer, Ischemic heart disease, Diabetes, and Suicidal behaviour.

  • Men
  • Women

Ranking of specific causes of premature death (before 75) ranked by age-adjusted* premature mortality rates among men, Belgium, 2018
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, 2018
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, 2018
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, 2018
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

Trends

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 more than 60% decrease in the age-adjusted mortality rates) in both sexes during the period 2000-2018.
  • The same is observed for cerebrovascular diseases (a decrease of more than 50%).
  • Premature mortality rates for lung cancer have also substantially declined in men (47% of decrease).
  • In contrast, premature mortality from lung cancer increased dramatically in women (41% 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.
  • A slight increase is also observed for COPD in women.
  • Men
  • Women

Age-adjusted* premature (before 75) mortality rates (per 100,000) for the 6 main specific causes of death among men, Belgium, 2000-2018
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 among women, Belgium, 2000-2018
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.

4. Regions

Categories of main causes of premature deaths, by region 

As for Belgium, in all regions, most of the premature deaths are caused by tumors, cardiovascular diseases, and external causes.

Ranking of the specific causes of deaths, by region

In 2018, according to the age-adjusted premature mortality rate:

  • among men, lung cancer ranks first in the 3 regions. The second cause of death is IHD and is also common in all regions. The third main cause is suicide in Flanders and cerebrovascular diseases + HTA in Wallonia and Brussels.
  • among women, in Wallonia lung cancer ranks first followed by breast cancer, while in Flanders and Brussels, breast cancer takes over first place and lung cancer steps down to second place. The 3rd place is occupied by cerebrovascular diseases in Flanders and COPD in Wallonia and Brussels.

In 2018, according to the potential years of life lost (PYLL):

  • among men, suicide ranks first in Flanders and Wallonia, followed by lung cancer and IHD. In Brussels, lung cancer ranks first followed by IHD and suicide.
  • among women, lung cancer ranks first in Wallonia, second in Flanders and Brussels after breast cancer. Suicide ranks third in Wallonia and Flanders, cerebrovascular diseases + HTA took over the third place in Brussels.

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

For more information concerning the morbidity of specific conditions, please consult the related page: Overview non-communicable diseases, Cancer, Ischemic heart disease, Diabetes, and Suicidal behaviour.

  • Men
  • Women

Ranking of the main causes of death by age-adjusted* mortality rates among men, by region of residence, Belgium, 2018
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, 2018
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, 2018
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, 2018
Source: Own calculation based on death certificates, Statbel



Main conditions contributing to regional disparities in mortality

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 Flanders to the ones of the other regions and ranking the differences.

In men, the conditions contributing most to the excess premature mortality in Wallonia as compared to Flanders are IHD (+18.2 per 100.000), lung cancer (+14.2), chronic liver disease (+9.4), COPD (+8.5), and infectious and parasitic diseases (+8.5).

In women, the conditions contributing most to the excess premature mortality in Wallonia as compared to Flanders are lung cancer (+7.0) followed by COPD (+6.9), IHD (+5.7), infectious and parasitic diseases (+5.2), and chronic liver diseases (+3.4). 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, Flanders versus Wallonia, 2016-2018 average
Source: Own calculation based on death certificates, Statbel

Ranking of differences in age-adjusted* mortality rates of specific causes of death among women, Flanders versus Wallonia, 2016-2018 average
Source: Own calculation based on death certificates, Statbel

In men, the conditions contributing most to the excess premature mortality in Brussels as compared to Flanders are IHD (+9.3), cerebrovascular diseases and HTA (+7.9), COPD (+5.9), chronic liver disease (+5.4) and infectious and parasitic diseases (+4.9). However, some conditions have lower rates in Brussels compared to Flanders like suicide (-6.2), transport accidents and heart failure (-3.3 for both conditions).

In women, the cause-specific mortality in Flanders and Brussels are quite similar.

  • Men
  • Women

Ranking of differences in age-adjusted* mortality rates of specific causes of death among men, Flanders versus Brussels, 2016-2018 average
Source: Own calculation based on death certificates, Statbel

Ranking of differences in age-adjusted* mortality rates of specific causes of death among women, Flanders versus Brussels, 2016-2018 average
Source: Own calculation based on death certificates, Statbel

Trends by region 

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 2000–2018 (-55% in Brussels, -51% in Flanders, and -40% in Wallonia). Those rates have stayed higher in Wallonia than in Flanders over the whole period. For women, the rates steadily increased in Flanders and Wallonia until respectively 2015 and 2013, while remaining stable in Brussels since 2007. Women in Brussels previously experienced the highest lung cancer premature mortality rates but it has been overtaken by Wallonia since 2010. A slow decrease is observable in all regions in the most recent years.

  • Men
  • Women

Lung cancer age-adjusted* premature (before 75) mortality rates (per 100,000) among men, by year and region of residence, Belgium, 2000-2018
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, 2000-2018
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

2. IHD premature mortality rates are decreasing faster in Flanders (-67% in men and -72% in women) than in Wallonia (-55% in men and -58% in women) between 2000 and 2018.

  • Men
  • Women

Ischemic heart disease age-adjusted* premature (before 75) mortality rates (per 100,000) among men, by year and region of residence, Belgium, 2000-2018
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, 2000-2018
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 Flanders and Wallonia (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, 2000-2018
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.


Suicide age-adjusted* premature (before 75) mortality rates (per 100,000) among women, by year and region of residence, Belgium, 2000-2018
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.


4. In men, COPD premature mortality rates have decreased by 47% in Flanders, by 45% in Wallonia, and by 36% in Brussels over the period. On the contrary, COPD mortality rates in women have increased in all regions.

  • Men
  • Women

COPD age-adjusted* premature (before 75) mortality rates (per 100,000) among men, by year and region of residence, Belgium, 2000-2018
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, 2000-2018
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 Flanders (-57% for men and -43% for women) between 2000 (where it was slightly higher than in the other regions) and 2018 while remaining more stable in Wallonia (-25% in men and -11% in women). In 2018, Wallonia and Brussels were experiencing higher rates than Flanders. Brussels also is experiencing an increase in men and women.

  • Men
  • Women

Colorectal cancer age-adjusted* premature (before 75) mortality rates (per 100,000) among men, by year and region of residence, Belgium, 2000-2018
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, 2000-2018
Source: Own calculation based on death certificates, Statbel
(*) reference population: European standard population 2010

5. Read more

View the metadata for this indicator

Statbel: Causes of death

Sciensano: Standardized Procedures for Mortality Analysis (SPMA)

WHO: ICD-10

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.