Causes of death

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.

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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