Details

Last Updated: 26 August 2024

• cancer
• COVID-19
• cardiovascular diseases
• respiratory diseases
• cerebrovascular diseases
• dementia
• suicide

1. Key messages

2. Causes of death - Belgium

Tumour is the main group of causes of premature deaths

The main groups of causes of premature deaths are tumours, diseases of the circulatory system, and external causes (mostly suicides and road accidents).

The proportion of tumours in premature deaths is higher in women than in men. Conversely, the proportions of diseases of the circulatory system and external causes are higher among men. In 2021, the proportion of deaths due to COVID-19 was higher in men than in women, and the opposite was observed for diseases of the respiratory system. 

Lung cancer and COVID-19 are the main causes of premature deaths in Belgium

Based on age-adjusted premature mortality rates, lung cancer and COVID-19 were the leading causes of death in 2021 for both men and women. In third place for men was ischemic heart disease and for women breast cancer. 

When expressed in the number of potential years of life lost (PYLL), a measure that takes age at death into account, then the ranking is different. In men, suicide then becomes the leading cause of death, followed by COVID-19 and lung cancer. Among women, breast cancer takes first place, followed by lung cancer and suicide. Transport accidents also appear in sixth place among men.

 

Positive trends for the main causes of premature death, but some points of attention remain for women

Most causes of premature deaths tend to decrease (or at least remain stable) over time, but there are some exceptions.

• Premature mortality due to ischemic heart disease fell by 31% in men and 37% in women over the period 2011-2021 ;
• The same trend is observed for cerebrovascular diseases, with a 23% reduction in men and 16% in women;
• Premature lung cancer mortality rates have also fallen considerably in men (38% reduction between 2011 and 2021);
• In contrast, premature lung cancer mortality rose dramatically among women (60% increase) between 2000 and 2015, then stabilized. From the fourth leading cause of death in 2000, it has risen to first place, just above breast cancer;
• An increase in COPD in women was observed in the years preceding COVID-19 (28% increase between 2011 and 2021).

3. Causes of death - Regions

COVID-19, lung cancer, breast cancer, and suicide are the main causes of death in the three regions

In 2021, according to the age-adjusted premature mortality rate:

• Among men, the leading causes were COVID-19, which ranks first in the Walloon and Brussels-Capital Regions and second in the Flemish Region; lung cancer, which ranks first in the Flemish Region and second in the other regions; and ischemic heart disease in the third place. 
• Among women, the leading causes were lung cancer, which ranked first in the Flemish and Walloon Regions and second in the Brussels-Capital Region, COVID-19, which ranked first in the Brussels-Capital Region, and breast cancer. 

In 2021, according to the potential years of life lost (PYLL):

• Among men, the leading causes were suicide, which ranks first in the Flemish and Walloon Regions and third in the Brussels-Capital Region, lung cancer and COVID-19, which ranks first in the Brussels-Capital Region.
• Among women, the leading causes were breast cancer, which ranks first in the Flemish Region and second in the Walloon and Brussels-Capital Regions, and lung cancer, which ranks first in the Walloon Region and third in the other regions. In 2021, COVID-19 was the primary cause of death in the Brussels Capital Region, whereas it ranked fourth in the other regions.

Mortality rates are generally higher in the Walloon Region than in the other regions, except for COVID-19 in the Brussels-Capital Region.

COVID-19 is the main cause of death, leading to regional differences 

As shown on the page ‘Premature mortality’, there are major regional disparities in the age-adjusted premature mortality rate. Here we analyze which causes of death contribute most to the regional difference in age-adjusted mortality rates, by subtracting the cause-specific mortality rates of the Flemish Region from those of the other regions and ranking the differences.

Among men, the causes of death contributing most to the excess premature mortality in the Walloon Region compared to the Flemish Region are COVID-19 (+34 per 100,000), ischemic heart disease (+17), lung cancer (+11), chronic liver disease (+7.7) and COPD (+7.6).

Among women, the causes of death contributing most to the excess premature mortality in the Walloon Region compared to the Flemish Region are COVID-19 (+15 per 100,000), COPD (+7.9), ischemic heart disease (+5), lung cancer (+4.7) and infectious and parasitic diseases (+4.5). As rates are lower for women than for men, regional differences by cause among women are smaller.

Among men, the causes of death contributing most to the excess premature mortality in the Brussels-Capital Region compared to the Flemish Region are COVID-19 (+54 per 100,000), ischemic heart disease (+7.9), lung cancer (+5.4), COPD (+5.2) and diabetes (+4.7). However, lower rates are found for some specific causes in the Brussels-Capital Region than in the Flemish Region, such as suicide (-4.5) and transport accidents (-3.4).

Among women, mortality rates by cause in the Flemish Region and the Brussels-Capital Region are generally relatively similar. However, in 2021, as in 2020, we observed a higher premature mortality in the Brussels-Capital Region for COVID-19 (+21 per 100,000) than in the Flemish Region.

Most causes of premature deaths decline among men

Trends in premature mortality by cause of death are fairly similar for all three regions. Here we highlight five interesting trends for specific causes of death. In addition, you can find information on trends in suicide mortality on the suicidal behaviour page.

1. The premature mortality rate from lung cancer has decreased among men in all three regions over the period 2011-2021 (-34% in the Walloon Region, -41% in the Flemish Region and -31% in the Brussels-Capital Region). These rates have remained higher in the Walloon Region than in the Flemish Region over the whole period.

Among women, the premature mortality rate from lung cancer increased in the Flemish and Walloon Regions until 2015 and 2013 respectively, while remaining stable in the Brussels-Capital Region since 2007. Women in Brussels used to have the highest rates of premature lung cancer mortality, but, since 2010, women in the Walloon Region experience the highest rates. A slow decline in mortality has been observed in recent years; between 2011 and 2021, the decrease is significantly greater in the Brussels-Capital Region (-31%) than in the Flemish Region (-12%) and the Walloon Region (-12%).

2. Premature mortality rates due to ischemic heart disease are decreasing more rapidly among women (-31% in the Walloon Region, -38% in the Flemish Region and -61% in the Brussels-Capital Region) than among men (-26% in the Walloon Region, -35% in the Flemish Region and -34% in the Brussels-Capital Region). The decreasing trend is slowing down for men in recent years. Among men, rates in the Walloon Region have consistently been higher than in the Flemish Region, and this gap is widening, with a faster decline in the Flemish Region than in the Walloon Region. 

3. The premature mortality rate from breast cancer in women has decreased in all three regions over the period 2011-2021 (-35% in the Flemish Region, -32% in the Walloon Region and -44% in the Brussels-Capital Region). Regional differences in breast cancer are small.

The premature mortality rate from breast cancer is very low among men and therefore not presented here.

4. Among men, premature COPD mortality rates decreased in all three regions between 2011 and 2021; the decrease was 33% in the Walloon Region, 26% in the Flemish Region and 27% in the Brussels-Capital Region. The rate is the highest in the Walloon Region, but regional differences diminish over time. In contrast, mortality rates for women increased between 2011 and 2021 in the Walloon Region (+14%) and in the Flemish Region (+12%). The decrease in mortality in the Brussels-Capital Region was 14%. COPD mortality in women was lower in 2020 but increased again in 2021.

5. There is a strong decrease in the premature mortality rate due to colorectal cancer between 2011 and 2021. This decrease is greater in the Flemish Region (-36% in men, -38% in women) than in the Walloon Region (-19% in men, -9% in women) and the Brussels-Capital Region (-25% in men, -19% in women). As a result, the Flemish Region has gone from being the region with the highest premature mortality rates for colorectal cancer in 2000 to the region with the lowest mortality rates for this disease in 2021.

4. Read more

View the metadata for this indicator

Statbel: Causes of death

Sciensano: Standardized Procedures 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) [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 gives more weight to death occurring at younger ages. PYLL’s consequently allow to compare causes according to their burden in terms of years of life lost [2].

The importance of the causes of premature deaths can be expressed in rates which reflect only the frequency of the cause or in PYLL which reflects the burden of the cause in terms 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 between 2020 and 2022 based on the ad-hoc surveillance is analyzed in a factsheet.

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) measure the number of years of life that have been lost due to premature death. The PYLL weights the deaths occurring in 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 95% of malignant neoplasms (or cancers), the other 5% being tumours of benign or borderline behaviour.

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.

Please cite this page as: Sciensano. Mortality and Causes of Death: Causes of premature death, Health Status Report, 15 Apr 2024, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/mortality-and-causes-of-death/causes-of-premature-death 

Details

Last Updated: 29 August 2024

1. Key messages

2. Premature mortality rates

Age-adjusted premature mortality rates decrease below the 2019 level in 2023

In Belgium, the crude premature mortality (0–74 years) rate was 314 per 100,000 inhabitants under 75 years old and the age-adjusted premature mortality rate was 315 per 100,000 inhabitants in 2023. The age-adjusted premature mortality rate was 1.6 times higher in men (392 per 100,000) than in women (240 per 100,000). The age-adjusted premature mortality rates were generally decreasing over time. Between the years 2010 and 2022, the decrease was more pronounced among men (-22%) than among women (-14%).

In 2020, the age-adjusted premature mortality rates increased by 10% for men and by 5% for women compared to 2019. That increase can be explained by the COVID-19 epidemic. In 2023, the age-adjusted premature mortality rates decreased further and were below the 2019 level.

Premature mortality rates are lower in the Flemish Region

There are substantial disparities between the three regions in terms of age-adjusted premature mortality rate. As compared to the Flemish Region, the following relative mortality excesses were observed in the other regions in 2023 :

• Walloon Region: +44% among men and +37% among women
• Brussels Capital Region: +20% among men and +8% among women

After the widening of regional disparities in 2020 and 2021, disparities have reduced in 2022 and 2023.

Disparities by districts are large

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 the highest rates were found in the provinces of Hainaut, Namur, and Liège.

Belgian premature deaths are among the highest in Europe

The Potential Years of Life Lost (PYLL) indicator is used 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 5% for men and 13% for women in 2018 (or the nearest year). These data are the most recent data (2018) currently available from the World Health Organization mortality database.

Insights into these differences can be found in the causes of premature death section. 

3. Read more

View the metadata for this indicator

Statbel: General mortality

Statbel: Open data

Sciensano: Standardized Procedures for Mortality Analysis (SPMA)

WHO: Mortality database

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, premature mortality occurring below 75 years of age is considered. Reducing premature mortality is a key public health objective and 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 their 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. The PYLL rates will also be age-adjusted.

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
2. WHO. Global health estimates: Leading causes of deaths. https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-leading-causes-of-death

Please cite this page as: Sciensano. Mortality and Causes of Death: Premature mortality, Health Status Report, 29 Aug 2024, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/mortality-and-causes-of-death/premature-mortality

Details

Last Updated: 26 August 2024

• cancer
• COVID-19
• cardiovascular diseases
• respiratory diseases
• cerebrovascular diseases
• dementia
• suicide

1. Key messages

2. Causes of death 

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

In 2021, tumours and diseases of the circulatory system (or cardiovascular diseases) remained the main causes of death, accounting for almost half of all deaths (48% for both sexes). The proportion of deaths due to these two groups of diseases has increased compared with 2020 (43% for men and 42% for women) due to the fall in COVID-19.

Respiratory diseases and COVID-19 account for a higher proportion of deaths in men (19%) than in women (15%), while mental and neurological diseases are more prevalent in women (10%) than in men (8%). This latter difference is linked to the fact that women live on average longer than men.

Reduction in mortality from respiratory diseases and mental and neurological diseases in 2020 and 2021

Tumours became the leading cause of death in men in 2014 and in women in 2020, overtaking cardiovascular diseases for the first time since the 1950s. This is due to a significant fall in the age-adjusted mortality rate for cardiovascular diseases, which is greater than that for tumour-related mortality. Between 2011 and 2021, mortality from cardiovascular diseases fell by 30% for men and 32% for women. The fall in cardiovascular mortality is due to progress in prevention and treatment, in particular, the reduction in smoking, improved pharmacological treatments for hypertension and cholesterol, and medical procedures [1].

In general, mortality rates are higher in men and are falling faster in men than in women. Between 2011 and 2021, the mortality rate from tumours fell by 20% for men, compared with 14% for women. For diseases of the respiratory system, the decrease was 32% for men and 25% for women, and for mortality due to external causes, the decrease was 7% for men and 4% for women.

In 2020 and 2021, there was a decrease in mortality due to mental and neurological diseases and respiratory diseases, probably linked to the COVID-19 crisis.

The main specific causes of death differ according to sex

The ten main causes of death have been classified according to 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, cerebrovascular diseases (grouped with hypertension), and dementia (including Alzheimer's disease).

The rankings are fairly similar from one region to another. However, in the Flemish Region, heart failure is ranked as the fourth leading cause of death in men and third in women. On the other hand, heart failure is ranked as the seventh cause of death in the Brussels-Capital Region for both men and women, and as the eighth cause for women and tenth cause for men in the Walloon Region. As heart failure is considered to be the common outcome of several diseases, these disparities could be partly explained by differences in the coding of causes of death between regions.

Breast cancer in women is also a frequent cause of death, ranking fourth in the Brussels Capital Region, fifth in the Flemish Region and sixth in the Walloon Region.

3. Read more

View the metadata for this indicator

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 95% of malignant neoplasms (or cancers), the other 5% being tumours of benign or borderline behaviour.

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, 15 Apr 2024, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/mortality-and-causes-of-death/general-mortality-by-cause 

Details

Last Updated: 29 August 2024

1. Key messages

2. Daily deaths are influenced by epidemics and weather conditions

A heatwave mortality peak was observed in 2019. In 2020, mortality peaks were observed from March to April, and from the end of October to the end of the year. These peaks can be explained by the COVID-19 epidemic. An additional peak was observed during summer in August, caused by higher temperatures.

In 2021, a mortality peak was observed at the end of the year. This can be explained by the COVID-19 epidemic. In 2022, a mortality peak was observed at the end of the year which can be explained by the influenza and bronchiolitis epidemics [1]. The effect of the influenza and bronchiolitis epidemics can still be observed at the beginning of 2023.

More information about excess mortality can be found on the website of the Belgian Mortality Monitoring (Be-MOMO).

3. Mortality rates

In 2023, age-adjusted mortality rates are for the first time lower than in 2019

In 2023, 111,255 deaths were observed in Belgium.

The crude mortality rate decreased in 2023 to 948 per 100,000 inhabitants, comparable to 2019 (949 per 100,000). The crude mortality rate was a bit higher in women (952 per 100,000) than in men (945 per 100,000) in 2023. After adjustment for age, a 39% higher mortality rate was observed in men (1,051 per 100.000) as compared to women (756 per 100,000) in 2023.

Over the last two decades, the age-adjusted mortality rate declined until 2019; a 40% decrease in men and a 28% decrease in women were observed between 2000 and 2019. In 2020, it has raised due mainly to the COVID-19 epidemic and reached 1,051 per 100,000 inhabitants (a 16% increase in men and 15% in women compared to 2019), the highest mortality rate since 2008. In 2023, the age-adjusted mortality rate decreased under the level of 2019 for the first time since the COVID-19 epidemic.

Age-adjusted mortality rates are lower in the Flemish region

Among men in 2023, the age-adjusted mortality rate was 25% and 15% higher respectively in the Walloon Region and in the Brussels Capital Region as compared to the Flemish Region; among women, it was 23% and 11% higher respectively in the Walloon Region and in the Brussels Capital Region as compared to the Flemish Region.

During the year 2020, the regional differentials in mortality increased. Among men, the age-adjusted mortality rate was 35% higher in the Walloon Region and 32% higher in the Brussels Capital Region than in the Flemish Region, and among women, the mortality rate was 29% and 21% higher in the Walloon Region and in the Brussels Capital Region than in the Flemish Region. The COVID-19 mortality rates observed in the epidemiological surveillance [3] have shown the COVID-19 specific mortality rates to be higher in the Walloon Region and in the Brussels Capital Region, which can explain the increase of the regional differentials in all-cause mortality.

4. Read more

View the metadata for this indicator

Statbel: General mortality

Statbel: Open data

Sciensano: Standardized Procedure for Mortality Analysis (SPMA)

Sciensano: Belgian Mortality Monitoring (Be-MOMO)

Background

Mortality is a traditional health indicator, actually better understood as a measure of “non-health”. Although quantifying irreversible events, the mortality analysis provides unique information for public health guidance, like the importance of severe health problems, their evolution over time, and some insights on their determinants (i.e. road security and smoking behavior). It is also a health indicator that has a long tradition and is measured with more validity than any other. Indeed, death is an unambiguous event, that used to be systematically registered in vital registration systems of most countries for more than one century.

The crude mortality rate is the number of deaths in a given year divided by the population under study. This indicator is not well suited for health monitoring; mortality is indeed strongly related to age. As a consequence, aging populations are facing rising crude mortality rates even if the health state is improving.

Therefore, comparisons of mortality indicators between population groups or years should always use estimators that are adjusted for differences in age composition between the groups. In this report, the age-adjusted mortality rates are used, with the European Standard Population 2010 (ESP 2010) [4] as a reference.

In this section, we describe all-cause mortality. The specific causes of death are described in the section on cause of death.

Definitions

Crude mortality rate

The crude mortality rate is the number of deaths registered in the country divided by the corresponding population.

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. Sciensano. Analyse de la surmortalité en 2022. https://www.sciensano.be/fr/coin-presse/analyse-de-la-surmortalite-en-2022
2. Statbel. Nombre de décès par jour, sexe, âge, région, province et arrondissement. https://statbel.fgov.be/fr/open-data/nombre-de-deces-par-jour-sexe-arrondissement-age
3. I. Peeters, M. Vermeulen,N. Bustos Sierra, F. Renard, J. VanderHeyden, A. Scohy, T. Braeye, N. Bossuyt, F. Haarhuis, K. Proesmans, C. Vernemmen, M. Vanhaverbeke. Surveillance of COVID-19 mortality in Belgium, epidemiology and methodology during 1st and 2nd wave (March 2020 - 14 February 2021). Brussels, Belgium : Sciensano. 2021, September. https://covid-19.sciensano.be/fr/covid-19-situation-epidemiologique
4. Pace M, Giampaolo L, Glickman M, Zupanic T. Revision of the European Standard Population Report of Eurostat's Task Force. Luxembourg; 2013.

Please cite this page as: Sciensano. Mortality and Causes of Death: Causes of death, Health Status Report, 29 Aug 2024, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/mortality-and-causes-of-death/general-mortality-by-cause

Details

Last Updated: 03 July 2024

1. Key messages

2. Infant mortality rate

359 deaths of infants observed in Belgium in 2021

In the year 2021, Belgian authorities registered a total of 359 infant deaths.

Among those, 339 deaths occurred in infants born from a mother who is registered in the National Register. There were no infant deaths registered in the Asylum Seeker Register in 2021. For 20 deaths (5.6%), the mother was not officially registered in Belgium or the infant death was only notified via a death certificate.

In the same year, the total number of live births was equal to 120,555, of which 117,914 (98%) were registered in the National Register, 435 (0.36%) were registered in the Asylum Seeker Register, and for 2,206 (1.8%) births the mother was not officially registered in Belgium or the birth was only notified with a birth certificate.

	Number of deaths	Number of live births	Infant mortality rate (/1000)
National Register	339	117,914	2.87
National Register and Asylum Seeker Register	339	118,349	2.86
All	359	120,555	2.98

Decrease in the girl infant mortality rate in 2021

In 2021, the infant mortality rate was 2.9 per thousand live births. Infant mortality rates have decreased by 46% from 1998 (5.3‰) to 2021.

The infant mortality rate in 2021 was 2.5 per thousand live births in girls and 3.2 per thousand live births in boys, corresponding to an absolute gap of 0.7‰ and a sex ratio of 1.3. The fluctuations in these gender mortality gaps over time can be largely explained by the small number of infant deaths. In 2021, the gender difference increased compared to 2020 due to the important decrease in the girl infant mortality rate.

After smoothing, the mortality differences between girls and boys persisted (respectively 3.0‰ and 3.7‰).

There are differences between the Brussels Capital Region and the other regions

Regional differences were observed in infant mortality rates in 2021: the infant mortality rates were highest in the Flemish Region (2.9‰) and the Walloon Region (2.9‰) followed by the Brussels Capital Region (2.7‰). After smoothing, the 2021 infant mortality rates were higher in the Brussels Capital Region (3.6‰) compared to the Flemish Region (3.4‰) and the Walloon Region (3.4‰).

Over time, a decline has been observed in all regions. After a strong decline in the past and a strong rise in the last years, the infant mortality rate in the Brussels-Capital Region declined in 2021. In general, over the last nine years, the infant mortality rate has been stagnating.

Infant mortality in Belgium is slightly higher than the EU-14 average

In 2021, the Belgian infant mortality was slightly higher than the EU-14 average (2.8). 

3. Read more

View the metadata for this indicator

SPMA: Standardized Procedures for Mortality Analysis in Belgium

Background

The infant mortality rate reflects the mortality of children below 1 year. It includes both the consequences of perinatal events and the mortality occurring after the perinatal period, which is often preventable. The infant mortality rate is highly correlated to the country's level of development, the quality of medical care, and the availability of preventive services and health promotion interventions.

Higher infant mortality rates in boys compared to girls have for long been observed in nearly all countries in the world [3]. The explanation is complex, including important biological and genetic factors as well as environmental and behavioral factors resulting in a persistent mortality difference throughout infancy and even later [4,5].

Large fluctuations in yearly rates are observed at regional level, due to the small number of infant deaths. Meaningful comparisons of rates and trends by region are therefore best made using smoothed rates. In this overview, we use a moving average over 5 years period.

Deaths occurring in Belgium may occur in legal residents (registered in the National Register, with a Belgian or foreign nationality), asylum seekers (registered in the register of asylum seekers), or non-residents (travelers, illegal, etc.). Official statistics on infant mortality include legal residents and asylum seekers.

On this page, we first present all infant deaths in Belgium by residence status, and then focus on the deaths of infants whose mothers were legal residents.

Definitions

EU-14

The EU-14 corresponds to all countries that already belonged to the European Union between 1995 and 2004: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, and Sweden. We compare the Belgian health status to that of the EU-14 because these countries have similar socioeconomic conditions. Note: The United Kingdom is not included since they have left the EU.

Infant mortality rate

The infant mortality rate is the number of deaths of children under one year of age per 1000 live births in the same year.

Sex ratio

The sex ratio is the mortality rate of boys under the age of 1 divided by the mortality rate of girls under the age of 1. A sex ratio of 1.2 means that there are 1.2 times more infant deaths in boys than in girls.

References

1. Statbel, 1998-2021. https://statbel.fgov.be/en/themes/population/mortality-life-expectancy-and-causes-death/feto-infant-mortality
2. OECD Health Data, 2020. https://stats.oecd.org/
3. UN IGME. United Nations Interagency Group for Child Mortality Estimation; 2018. https://childmortality.org/data
4. Drevenstedt GL, Crimmins EM, Vasunilashorn S, Finch CE. The rise and fall of excess male infant mortality, 2008. https://pubmed.ncbi.nlm.nih.gov/18362357/
5. Sidebotham P, Fraser J, Covington T, Freemantle J, Petrou S, Pulikottil-Jacob R, et al. Understanding why children die in high-income countries, 2014. https://pubmed.ncbi.nlm.nih.gov/25209491/

Please cite this page as: Sciensano. Mortality and Causes of Death: Infant mortality, Health Status Report, 26 Feb 2024, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/mortality-and-causes-of-death/infant-mortality