Eurostat, the statistical office of the European Union
F5: Education, health and social protection
2920 Luxembourg LUXEMBOURG
Data on causes of death (COD) provide information on mortality patterns and form a major element of public health information.
The COD data refer to the underlying cause which - according to the World Health Organisation (WHO) - is "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".
The data are derived from the medical certificate of death, which is obligatory in the Member States. The information recorded in the death certificate is according to the rules specified by the WHO.
Data published in Eurostat's dissemination database are broken down by sex, 5-year age groups, cause of death and by residency and country of occurrence. For stillbirths and neonatal deaths additional breakdowns might include age of mother and parity.
Data are available for Member States, Iceland, Norway, Liechtenstein, Switzerland, United Kingdom, Serbia, Turkey, North Macedonia and Albania. Regional data (NUTS level 2) are available for all of the countries having NUTS2 regions except Serbia and Albania.
Annual national data are available in Eurostat's dissemination database in absolute number, crude death rates and standardised death rates. At regional level the same is provided in form of 3-years averages (the average of year, year -1 and year -2). Annual crude and standardised death rates are also available at NUTS2 level. Monthly national data are available for 21 EU Member States from reference year 2019 in absolute numbers and standardised death rates.
Eurostat's causes of death statistics build on standards set out by the World Health Organisation (WHO) in the International Statistical Classification of Diseases and Related Health Problems (ICD). Since reference year 2014, all reporting countries follow the ICD classification in its tenth revision (ICD-10).
The regional breakdown is based on the Nomenclature of Territorial Units for Statistics (NUTS 2).
Causes of death are classified by the 86 groups of the 'European shortlist' (please see Annexes) of causes of death established in 2012 (see document in the Annexes concept). This shortlist is based on the ICD classifications and is used for disseminating the data in Eurostat's dissemination database in aggregated form.
Public Health
The concepts and definitions are described in the Commission regulation (EU) No 328/2011, articles 2 and 3.
All the countries use the concepts and definitions as described in the regulation, except for the definitions of stillbirths and usual residence that may differ for a few countries.
There are some additional concepts and definitions which refers to the data published in Eurostat's dissemination database:
The crude death rate describes mortality in relation to the total population. Expressed in deaths per 100 000 inhabitants, it is calculated as the number of deaths recorded in the population for a given period divided by population in the same period and then multiplied by 100 000. Crude death rates are calculated for 5-year age groups. At this level of detail, comparisons between countries and regions are meaningful. The crude death rate for the total population (all ages) however, is a weighted average of the age-specific mortality rates. The weighting factor is the age distribution of the population whose mortality is being observed. Thus, the population structure strongly influences this indicator for broad age classes. In a relatively 'old' population, there will be more deaths than in a 'young' one because mortality is higher for age groups referring to older ages. For comparisons, the age effect can be taken into account by using a standard population.
The (age-) standardised death rate is a weighted average of age-specific mortality rates. The weighting factor is the age distribution of a standard reference population. The standard reference population used is the European standard population. The new European Standard Population (ESP) is the unweighted average of the individual populations of EU Member States plus EFTA countries in each 5-years age band (with the exception of under 5 and the highest age-group of 95+). The ESP is calculated from on the basis of the 2010-based population projections, averaged over the period 2011-30. As method for standardisation, the direct method is applied.
Standardised death rates are calculated for the age group 0-64 ('premature death') and for the total of ages. As most causes of death vary significantly with people's age and sex, the use of standardised death rates improves comparability over time and between countries. For calculating crude and standardised death rates, the annual average population available in Eurostat's demography database is used. In case the data for age groups 85-89 years, 90-94 years and 95+ years was not available for the standardized deaths rate calculation, then the age group 85+ has been used as a proxy. However, the bias is likely to be relatively small. Indicators on fetal, peri- and neonatal mortality are consistent with definitions used in the Eurostat's demography database.
Infant mortality rate per 1000 live births is calculated as the ratio of number of deaths of children under one year of age to the number of live births. The value is expressed per 1000 live births.
Early neonatal mortality rate per 1000 live births is calculated as the ratio of the number of deaths at age day 0 to (and including) day 6 to the number of live births. The value is expressed per 1000 live births.
Late foetal mortality rate per 1000 births is calculated as the ratio of the number of stillbirths to 1000 births. The value is expressed per 1000 births.
Neonatal mortality rate per 1000 live births is calculated as the ratio of the number of deaths at age day 0 to (and including) day 27 to the number of live births. The value is expressed per 1000 live births.
Perinatal mortality rate per 1000 births is calculated as the number of stillbirths plus deaths at age day 0 to (and including) day 6 divided by the number of births. The value is expressed per 1000 births (see concept 3.4.2).
In addition, data is published on Potential Years of Life Lost (PYLL). PYLL is an indicator estimating the potential years lost due to premature death, i.e. death before 70. It is calculated by summing the number of years between the age at death and 70 years for each premature death. PYLL rate is expressed per 100 000 age-standardised population under 70.
For the public health theme tables (hlth_cd_pbt), including treatable and preventable mortality, infant deaths, deaths due to infectious diseases, transport accidents, or dementia including Alzheimer's disease, the specific ICD codes to be used were compiled by Eurostat Task Force on Satellite Lists (final report issued in June 2014). Background information on treatable and preventable mortality, as well as the specific ICD codes used for preventable and treatable deaths and for infectious diseases can be found in the annex (Specifications of public theme tables).
Data in the public health theme tables are disseminated for absolute numbers (NR) and standardized death rates (RT).
Most of the datasets published in Eurostat's disssemination database are broken down by cause of death in accordance with the European shortlist from 2012. Additionally, few new categories have been added recently:
The statistical unit is the deceased person.
The statistical population is the population of a given country, including both residents and non-residents. For the causes of death data collection the following definition of 'resident' is used: 'usual resident' in the place where a person normally spends the daily period of rest, regardless of temporary absences for the purposes of recreation, holidays, visits to friends and relatives, business, medical treatment or religious pilgrimage.
Most of the countries applies the definition as in the regulation ((i) those who have lived in their place of usual residence for a continuous period of at least 12 months before the reference date; or (ii) those who arrived in their place of usual residence during the 12 months before the reference date with the intention of staying there for at least 1 year).
The data are published for two different populations: the first one captures deaths of residents of a country and the second one captures all deaths occurring in a country.
The number for 'All deaths reported in the country (TOT_IN)' includes all deaths occurred in the reporting country, i.e. deaths of residents and non-residents in the reporting country.
The number for 'All deaths of residents in or outside their home country (TOT_RESID)' are calculated by taking data for residents dying in their home country (for example, deaths reported by Latvia for Latvian residents dying in Latvia) and adding the number of deaths that were reported by other countries to have died in their country (for example deaths of Latvian residents dying in Germany and reported by Germany).
The data covers all the deaths of residents and non-residents occurring in the Member States, Iceland, Norway, Liechtenstein, Switzerland, United Kingdom (until 2018), Serbia, Turkey, North Macedonia and Albania.
Time series for most Member States and EFTA are available from 1994 onwards (Belgium, Czechia: 1919, Germany: 1992, Ireland: 1993, Estonia: 1989, Greece: 1956, Luxembourg: 1967 and Slovenia: 1985). For some countries data are only available from 1995 (Bulgaria), 1996 (Latvia and Slovakia), 1998 (Serbia), 1999 (Cyprus, Poland, Romania and Liechtenstein) onwards. Data on CoD for North Macedonia and Albania are available until 2010.
Note that 2011 data are the first data collected under a legal basis and some changes in the requested variables and breakdowns were made. Therefore, the data between 1994-2010 and starting from 2011 are not always comparable (partly due to the different groupings of causes of deaths). Moreover, the time series for data on stillbirths starts in 2011 and no information on previous data is available.
Not applicable
The unit is number.
Data refer to the calendar year (i.e. all deaths occurring during the year) or calendar month.
Countries submitted data to Eurostat on the basis of a gentleman's agreement established in the framework Eurostat's Working Group on "Public Health Statistics" until data with reference year 2010. The first data submitted according to the Regulation (EU) No 328/2011 is data with reference year 2011.
A Regulation on Community statistics on public health and health and safety at work (EC) No 1338/2008 was signed by the European Parliament and the Council on 16 December 2008. This Regulation is the framework of the data collection on the domain.
Within the context of this framework Regulation, the Commission adopted a Regulation on statistics on causes of death (EU) No 328/2011 which specifies the data to be collected.
Eurostat does not share the data with any other Organisation or Institution, however specific extraction can be made on request by users and other organisations.
Regulation (EC) No 223/2009 on European statistics (recital 24 and Article 20(4)) of 11 March 2009 (OJ L 87, p. 164), stipulates the need to establish common principles and guidelines ensuring the confidentiality of data used for the production of European statistics and the access to those confidential data with due account for technical developments and the requirements of users in a democratic society.
Eurostat applies the k-confidentiality with k=4 to the causes of death statistics disseminated in Eurostat's dissemination database. In case the total number of deaths for any given combination of the dimensions GEO, YEAR, SEX and AGE_GROUP is from 1 to 3, then all the ICD categories for that combination are anonymised (value is replaced by ':' and the flag c is added). In addition, special measures for ensuring confidentiality may be taken for small countries.
Eurostat disseminates causes of death by the occurence concept as soon as possible after data have been transmitted by a country and validated by Eurostat. When all countries have sent their data for a certain reference year, Eurostat calculates EU aggregates and releases them and all other indicators. This usually takes place in the first quarter of each year.
The datasets by occurence concept are the following:
Causes of death - deaths by country of residence and occurrence [HLTH_CD_ARO]
Causes of death - infant mortality by country of occurrence [HLTH_CD_AINFO]
Causes of death - death by country of residence and occurence, monthly data [HLTH_CD_MRO]
Peri-neonatal mortality by age of mother, by residence and occurrence [HLTH_CD_APERRO]
Fetal, peri- and neonatal mortality rates by country of occurrence [HLTH_CD_APERRTO]
Deaths related to transport accidents occurring in the country [HLTH_CD_TRO]
Statistics based on the occurence concept are published soon after they have been transmitted by a country, after validation by Eurostat.
For other indicators, Eurostat publishes a release calender on its website:
https://ec.europa.eu/eurostat/web/main/news/release-calendar?start=1710716400000&type=dayGridWeek
In line with the Community legal framework and the European Statistics Code of Practice Eurostat disseminates European statistics on Eurostat's website (see item 10 - 'Accessibility and clarity') respecting professional independence and in an objective, professional and transparent manner in which all users are treated equitably. The detailed arrangements are governed by the Eurostat protocol on impartial access to Eurostat data for users.
Annual.
Eurostat disseminates news releases online on its website.
There is no specific publication for the causes of death statistics, however the "Health in the European Union - facts and figures" has several chapters on Causes of death:
Regional causes of deathstatistics is used in the Eurostat Regional book:
https://ec.europa.eu/eurostat/web/products-flagship-publications/w/KS-HA-23-001
Statistics explained articles are available here:
https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Health
News articles are published on this website:
Causes of death statistics are available on the online database of Eurostat.
Please consult free data on-line: https://ec.europa.eu/eurostat/web/main/data/database or contact User support: https://ec.europa.eu/eurostat/web/main/contact-us/user-support
Eurostat does not provide access to the causes of death microdata.
There is no other dissemination format.
The guidelines for recording and coding the causes of deaths using the ICD-10 classification can be found at:
https://icd.who.int/browse10/Content/statichtml/ICD10Volume2_en_2019.pdf
Countries shall transmit a quality report to Eurostat each five years. There has been two rounds; for reference years 2011 and 2018. All the countries have provided their quality reports and those for reference year 2018 are published in Eurobase together with the national reference metadata in the SIMS structure.
The causes of death data are based on a regulation, which defines scope, definitions of variables and characteristics of the data.
There are clear and delailed guidelines for recording and coding the causes of deaths using the ICD-10 classification published by the WHO. All the countries are following this methodology.
A quality assessment of Eurostat's COD statistics was organised in May and June 2008. In that framework, a questionnaire was sent to Eurostat's partners (data providers) for COD statistics and a user survey was set up on Eurostat's website, for which 25 partners and 34 users answered. A questionnaire was also filled in by the domain manager of COD statistics in Eurostat.
Based on the 34 answers received from the web survey mentioned under concept 11; Quality management, the main users are Research Institutes, Universities, Public Government agencies, Private, Commission services and Business companies. On these 34 answers, Eurostat data on Causes of Death are "essential", "important", or "used for background information" for 25 respondents.
Asking about the availability of needed data in the Eurostat production, users are divided in two equivalent parts: 12 answered that they do not need statistics on the field not currently available from Eurostat and 13 answered that they need, giving information about defects and lacks of the Eurostat data.
Some users as researchers, journalist and professionals working in health institutes or organisations need COD data more disaggregated than published in Eurobase, i.e. deaths for some specific ICD codes and different breakdowns. Eurostat is providing the data anonymised with the same methodology applied to the disseminated data (for more information please see the concept 7.2 related to Confidentiality).
Eurostat publishes annual user satisfaction surveys on its website: https://ec.europa.eu/eurostat/web/main/about-us/policies/evaluation
Eurostat carried out a general User Satisfaction Survey (USS) over the period of April - July 2019 and June-July 2022 on the Health domain statistics with the following result (% of respondants):
| Very good | Good | Adequate | Poor | Very poor | No opinion | |
| 2022 | 32.6 | 39.5 | 18.2 | 7.2 | 0 | 2.4 |
| 2019 | 22.5 | 33.7 | 24.9 | 8.3 | 5.3 | 5.3 |
The Commission Regulation N° 328/2011, of 5 April 2011 implementing Regulation (EC) No 1338/2008 of the European Parliament and of the Council on Community statistics on public health and health and safety at work, as regards statistics on causes of death, describes the data transmission requirements.
Member States shall transmit to the Commission (Eurostat) the list of variables set out in the Annex of this regulation. Member States shall provide aggregated or micro data (finalised and validated) and metadata required by this Regulation. The completeness is described in the annexes.
The overall accuracy of the causes of death statistics is good. It is based on the information recorded in the death certificates, which is compulsory in all the countries.
All the compulsory variables requested in the regulation are collected by the countries. However, in a few cases it could be that some information is missing, such as the residence of the deceased person, the age or the sex, which are finally reported as “unknown”.
Not applicable.
Not applicable.
Commision Regulation (EU) No 328/2011 allows countries to transmit statistics on the causes of death up until 2 years after the end of the reference year. Eurostat and countries make efforts to increase the timeliness by putting in place a voluntary data transmission deadline at 18 months after the reference year. Eurostat also disseminated all statistics that can be calculated as soon as possible after a country has transmitted their data. The time needed by countries to process the deaths certificates and to have the data ready for national publication differs quite a lot but usually it lasts from 6 months to 26 months.
Eurostat usually disseminated all indicators in the first quarter of the year two years after the reference year.
Countries shall provide the data specified in Commission regulation No 328/2011 (Article 4) to Eurostat within 24 months (T+24) after the end of the reference year.
Some countries transmit data to Eurostat within a deadline of 18 months (T+18) after the end of the reference year in accordance with a gentleman's agreement established in the framework Eurostat's Working Group on 'Public Health Statistics'.
See below the timeliness for data and metadata for reference year 2021.
| TIMELINESS | COUNTRIES | |
| DATA | T+18 | BG, CZ, DE, ES, HR, CY, LV, LT, LU, HU, NL, AT, PL, SI, SK, FI, CH, RS |
| T+24 | BE, DK, EE, IE, EL, FR, IT, MT, PT, RO, SE, LI, NO, TR | |
| After T+24 | IS | |
| Not submitted | - |
Comparability is good as countries are using the same standards and definitions. There are no inconsistences in data reporting between regions of a country reported to Eurostat.
There is a break in series in 2011, when Commission regulation No 328/2011 entered into force and some concept were revised (place of occurrence/residence and age groups). Additionally, before 2011 different classification systems for coding the cause of death could be used.
Some countries have reported some other break in series that are described in their national reference metadata files, attached to this report.
The total number of deaths by causes is equal to the number of deaths (stillbirths) in the demographic statistics for most of the countries.
The variables requested for neonatal deaths are transmitted in two datasets. Eurostat is validating the consistency of both datasets and only two countries, Norway and Sweden, have some small inconsistencies because two data sources are used or late registered deaths.
The cost and burden of the data collection is reduced by using validation and dissemination IT tools.
The general Eurostat revision policy applies to this domain.
All reported errors (once validated) result in corrections of the disseminated data.
Reported errors are corrected in the disseminated data as soon as the correct data have been validated.
Data may be published even if they are missing for certain countries or flagged as provisional for certain countries. They are replaced with final data once transmitted and validated.
European aggregates are updated for consistency with new country data if possible and where necessary.
Whenever new data are provided and validated, the already disseminated data are updated as soon as possible.
When there is a change in the NUTS classification at NUTS level 2, the countries must revise their data since 2011 in accordance with the new classification.
The statistics on causes of death are based on the information provided on death certificates (administrative data). All deaths of residents and non-residents happening in the country are counted. In all the Member States, the medical certification of death is an obligation. Most countries already use WHO's international standard model for all but perinatal deaths (0 to 1 week). For perinatal deaths, WHO recommends a specific form, which is less frequently applied. The objective of the medical certificate of cause of death is to allow the certifier to enter as clearly and completely as possible the causes of death, i.e. describing the sequence of diseases and conditions leading to the death, mentioning other contributing conditions etc. In most countries, the medical certificates of cause of death are forwarded to the statistical office or other institution for centralised coding.
Some countries use secondary data sources in order to capture more detailed information or to check the data registered in the death certificates.
Annual.
The data collection is based on the death certificates, which are filled in by the certifiers. In most of the cases, the certifier is a physician.
The information provided on the medical certificates of cause of death is coded into the International Statistical Classification of Diseases and Related Health Problems (ICD). The purpose of coding is to select the underlying cause of death which is defined as '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'.
The coding is done either manually or with specific IT tools. In most countries, the coding is done centrally in the statistical office or in a health institute or organisation.
Countries are submitting two datasets to Eurostat:
There are two transmission formats:
Eurostat compiles and validates all the submitted datasets. The data are stored and treated in a secure confidential environment. The causes of death indicators and the EU aggregates are computed and finally disseminated in Eurostat's dissemination database.
All the datasets transmitted to Eurostat are automatically validated. The validation report must be checked by the sender and any inconsistencies detected must be corrected. Eurostat is also checking the validation reports and only datasets free of errors are treated and published.
The following checks are performed:
- ICD codes that can be used as underlying cause of death
- Countries and regions at NUTS2 level
- Age and sex of the deceased person
- For neonatal deaths and stillbirths: age of the mother and parity
- For stillbirths: birth weight, gestational age and crown-heel length
- Combination of cause of death and sex
- Combination of cause of death and age
- Combination of cause of death and injury codes
The absolute numbers for EU aggregates are the sum of country numbers and are computed only when all the countries have submitted the data. Eurostat is not imputing any missing data.
No adjustments are made.
Metadata collected before 2011 can be found in the Annexes.