II.3. HEALTH STATUS

MORTALITY FROM RESPIRATORY DISEASES Mortality from respiratory diseases is the third Nearly 6 000 deaths were directly attributed to main cause of death in EU countries, accounting for influenza, with most of these deaths concentrated 8% of all deaths in 2015. More than 440 000 people among people aged over 65. But influenza also died from respiratory diseases in 2015, an increase of contributed to many more deaths among frail elderly 15% over the previous year. Most of these deaths (90%) people with chronic diseases. The European Monitoring were among people aged 65 and over. The main of Excess Mortality network estimated that up to causes of death from respiratory diseases are chronic 217 000 deaths were related to influenza among elderly obstructive pulmonary disease, pneumonia, asthma people across EU countries during the winter 2015 and influenza. (EuroMoMo, 2016). In 2015, the United Kingdom and Ireland had the The prevalence and mortality from respiratory highest age-standardised death rates from respiratory diseases are likely to increase in the coming years as diseases among EU countries (Figure 3.15). Finland, the population ages and presently unreported cases of Latvia, Estonia and Lithuania had the lowest rates, COPD begin to manifest, whether alone or in with rates only about half the EU average. co-morbidity with other chronic diseases. Death rates from respiratory diseases are on Many deaths from respiratory diseases could be average 85% higher among men than among women prevented by tackling some of the main risk factors, in all EU countries. This is partly due to higher notably smoking, and by increasing vaccination coverage smoking rates among men. Smoking is an important for influenza and pneumonia, particularly among elderly risk factor for chronic obstructive pulmonary disease people and other vulnerable groups. Better management and other respiratory diseases. of both asthma and COPD in primary care could also help Chronic obstructive pulmonary disease (COPD) (or reduce health complications. chronic lower respiratory diseases), which includes chronic bronchitis and emphysema, caused over 180 000 deaths in EU countries in 2015 and accounted Definition and comparability for over 40% of all respiratory disease mortality. Mortality rates are based on the number of Mortality from COPD varies widely across countries. deaths registered in a country in a year divided Hungary, Denmark and the United Kingdom have the by the population. The rates have been age- highest rate of mortality from COPD, with age- standardised to the revised European standard standardised rates at least two-thirds higher than the population adopted by Eurostat in 2012 to EU average (Figure 3.16). The main risk factor for COPD remove variations arising from differences in is tobacco smoking (both active and passive smoking), age structures across countries and over time. but other risk factors include occupational exposure to Deaths from respiratory diseases relate to dusts, fumes and chemicals, and air pollution more ICD-10 codes J00-J99, with pneumonia relating generally. A large number of people with COPD are only to J12-J18, chronic obstructive pulmonary diagnosed at a late stage, contributing to higher disease (or chronic lower respiratory diseases) mortality. People with COPD are also more susceptible relating to J40-J47 and asthma to J45-J46. The to influenza and pneumonia. international comparability of data on mortality Pneumonia was responsible for nearly from respiratory diseases can be affected by 140 000 deaths in EU countries in 2015, accounting for differences in medical training and coding over 30% of all respiratory disease mortality. As with practices for causes of death. Finland revised COPD, there are large variations in mortality rates some coding practices in 2005-06, leading across EU countries: Portugal, the Slovak Republic and especially to a decrease of recorded deaths the United Kingdom have the highest rates of caused by pneumonia. pneumonia mortality, whereas Finland, Greece and Austria have the lowest rates (Figure 3.17). The main risk factors for pneumonia are age, smoking and alcohol abuse, and having COPD or HIV infection References (Torres et al., 2013). Torres, A. et al. (2013), “Risk Factors for Community- More than 7 000 people died from asthma in EU acquired Pneumonia in Adults in Europe: A Literature countries in 2015. Mortality rates from asthma are Review”, Thorax, Vol. 68, pp. 1057-1065. highest in Estonia, Ireland and the United Kingdom, EuroMoMo (2016), “Excess mortality in Europe in the but remain much lower than for COPD and winter season 2014/15, in particular amongst the pneumonia. elderly”, Winter season summary 2015.

94 HEALTH AT A GLANCE: EUROPE 2018 © OECD/EUROPEAN UNION 2018 II.3. HEALTH STATUS

3.15. Respiratory diseases mortality, 2015

Total Women Men Age-standardised rates per 100 000 population 220

200

180

160

140

120

100

80

60

40

20 0

1. Three-year average (2013-15). Source: Eurostat Database. 1 2 http://dx.doi.org/10.1787/888933834547

3.16. COPD mortality, 2015 3.17. Pneumonia mortality, 2015

Latvia 14.4 Finland 2.8 France 16.8 Greece 9.5 Estonia 18.1 Austria 11.8 Bulgaria 21.2 Hungary 13.6 Slovenia 21.8 Cyprus ¹ 13.8 Poland 23.2 Croatia 15.2 Finland 23.7 Italy 16.0 Lithuania 24.7 Latvia 18.1 Malta ¹ 26.0 France 18.5 Cyprus ¹ 26.1 Luxembourg ¹ 19.4 Slovak Rep. 26.4 Bulgaria 19.7 Portugal 27.6 Lithuania 19.8 Greece 28.4 Estonia 20.4 Italy 30.6 Sweden 20.6 Sweden 31.0 Spain 20.6 Spain 34.5 Germany 23.2 Austria 35.7 Netherlands 24.7 EU28 36.3 EU28 28.1 Luxembourg ¹ 36.5 Czech Rep. 33.1 Romania 36.9 Denmark 36.5 Germany 39.3 Slovenia 37.7 Czech Rep. 40.8 Malta ¹ 37.7 Belgium 42.9 Belgium 37.7 Netherlands 47.6 Romania 38.5 Croatia 49.7 Ireland 42.1 Ireland 58.2 Poland 49.8 United Kingdom 60.9 United Kingdom 53.7 Denmark 69.2 Slovak Rep. 57.2 Portugal Hungary 72.5 57.7 Switzerland 27.5 Switzerland 19.2 Iceland ¹ 37.9 Serbia 21.7 Serbia 41.9 Iceland ¹ 28.1 Norway 51.4 Norway 33.7 Turkey 86.8 Turkey 41.5 0 20406080100 0 102030405060 Age-standardised rates per 100 000 population Age-standardised rates per 100 000 population

1. Three-year average (2013-15). 1. Three-year average (2013-15). Source: Eurostat Database. Source: Eurostat Database. 1 2 http://dx.doi.org/10.1787/888933834566 1 2 http://dx.doi.org/10.1787/888933834585

HEALTH AT A GLANCE: EUROPE 2018 © OECD/EUROPEAN UNION 2018 95 From: Health at a Glance: Europe 2018 State of Health in the EU Cycle

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OECD/European Union (2018), “Mortality from respiratory diseases”, in Health at a Glance: Europe 2018: State of Health in the EU Cycle, OECD Publishing, Paris/European Union, Brussels.

DOI: https://doi.org/10.1787/health_glance_eur-2018-12-en

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