II.3.
HEALTH STATUS
MORTALITY FROM RESPIRATORY DISEASES
Mortality from respiratory diseases is the third
main cause of death in EU countries, accounting for
8% of all deaths in 2015. More than 440 000 people
died from respiratory diseases in 2015, an increase of
15% over the previous year. Most of these deaths (90%)
were among people aged 65 and over. The main
causes of death from respiratory diseases are chronic
obstructive pulmonary disease, pneumonia, asthma
and influenza.
In 2015, the United Kingdom and Ireland had the
highest age-standardised death rates from respiratory
diseases among EU countries (Figure 3.15). Finland,
Latvia, Estonia and Lithuania had the lowest rates,
with rates only about half the EU average.
Death rates from respiratory diseases are on
average 85% higher among men than among women
in all EU countries. This is partly due to higher
smoking rates among men. Smoking is an important
risk factor for chronic obstructive pulmonary disease
and other respiratory diseases.
Chronic obstructive pulmonary disease (COPD) (or
chronic lower respiratory diseases), which includes
chronic bronchitis and emphysema, caused over
180 000 deaths in EU countries in 2015 and accounted
for over 40% of all respiratory disease mortality.
Mortality from COPD varies widely across countries.
Hungary, Denmark and the United Kingdom have the
highest rate of mortality from COPD, with age-
standardised rates at least two-thirds higher than the
EU average (Figure 3.16). The main risk factor for COPD
is tobacco smoking (both active and passive smoking),
but other risk factors include occupational exposure to
dusts, fumes and chemicals, and air pollution more
generally. A large number of people with COPD are only
diagnosed at a late stage, contributing to higher
mortality. People with COPD are also more susceptible
to influenza and pneumonia.
Pneumonia was responsible for nearly
140 000 deaths in EU countries in 2015, accounting for
over 30% of all respiratory disease mortality. As with
COPD, there are large variations in mortality rates
across EU countries: Portugal, the Slovak Republic and
the United Kingdom have the highest rates of
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
(Torres et al., 2013).
More than 7 000 people died from asthma in EU
countries in 2015. Mortality rates from asthma are
highest in Estonia, Ireland and the United Kingdom,
b u t r e m a i n m u c h l ow e r t h a n f o r C O P D a n d
pneumonia.
94
Nearly 6 000 deaths were directly attributed to
influenza, with most of these deaths concentrated
among people aged over 65. But influenza also
contributed to many more deaths among frail elderly
people with chronic diseases. The European Monitoring
of Excess Mortality network estimated that up to
217 000 deaths were related to influenza among elderly
people across EU countries during the winter 2015
(EuroMoMo, 2016).
The prevalence and mortality from respiratory
diseases are likely to increase in the coming years as
the population ages and presently unreported cases of
COPD beg in to manifest, whether alone or in
co-morbidity with other chronic diseases.
Many deaths from respiratory diseases could be
prevented by tackling some of the main risk factors,
notably smoking, and by increasing vaccination coverage
for influenza and pneumonia, particularly among elderly
people and other vulnerable groups. Better management
of both asthma and COPD in primary care could also help
reduce health complications.
Definition and comparability
Mortality rates are based on the number of
deaths registered in a country in a year divided
by the population. The rates have been age-
standardised to the revised European standard
population adopted by Eurostat in 2012 to
remove variations arising from differences in
age structures across countries and over time.
Deaths from respiratory diseases relate to
ICD-10 codes J00-J99, with pneumonia relating
to J12-J18, chronic obstructive pulmonary
disease (or chronic lower respiratory diseases)
relating to J40-J47 and asthma to J45-J46. The
international comparability of data on mortality
from respiratory diseases can be affected by
differences in medical training and coding
practices for causes of death. Finland revised
some coding practices in 2005-06, leading
especially to a decrease of recorded deaths
caused by pneumonia.
References
Torres, A. et al. (2013), “Risk Factors for Community-
acquired Pneumonia in Adults in Europe: A Literature
Review”, Thorax, Vol. 68, pp. 1057-1065.
EuroMoMo (2016), “Excess mortality in Europe in the
winter season 2014/15, in particular amongst the
elderly”, Winter season summary 2015.
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
Hungary 72.5 Portugal
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 20 40 60 80 100 0 10 20 30 40 50 60
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

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Health at a Glance: Europe 2018
State of Health in the EU Cycle

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

Please cite this chapter as:

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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