Who dies of what in Europe before the age of 65 years?

AN atlas of mortality in the European Union has been published by Eurostat. It highlights important causes of avoidable mortality before the age of 65 between 2002 and 2004:

 

• Heart Disease
• Lung Cancer
• Alcohol-related mortality
• Suicide
• Transport accidents
• Cervical Cancer
• AIDS

The expression ‘avoidable’ is used in the context of important causes of death which could be avoided by changing lifestyles or national health policies.

In the EU,  men lost twice as many life years as women and the loss of life years by men in the Baltic region was more than twice the number of years compared to the EU-27 average. The lowest mortality in women before 65 years was in Italy, Spain, Cyprus and Greece.

Life expectancy in Ireland at birth between 2002 and 2004 when the study was undertaken, was mid range – 78.65 – 78.95 years. The Central and Eastern European new Member States have a high mortality as has the former East Germany and Scotland. Countries with very low mortality below age 65 are Italy, Switzerland, Malta, Norway, Sweden, Iceland, Holland and, to a lesser extent, Spain. The highest 10% of the EU regions have an average life expectancy of 80.6 years, the lowest 10% of 74.2 years. This is a difference of 6.4 years.

Heart Disease

Ischaemic heart disease is responsible for 14% of all years of lost life in Europe and 7% of all potential years of lost life below age 65 years. Munster and south Leinster record lower mortality rates in Ireland than the rest of the island of Ireland. Despite this, ischaemic heart disease mortality has halved in less than 30 years in most of the old Member States. This is attributed to a variety of reasons – increases in wealth, better levels of education and security, decreased levels of smoking and blood pressure, improved cardiovascular risk management, especially in individuals with a family background of cardiovascular disease and improvements in emergency treatment.

 

Lung Cancer

Lung cancer is rare in non-smokers. The average potential years of life lost is around 30 per 100,000 non smokers. Active smoking increases the risk of lung cancer 30-fold. Environmental tobacco smoke is thought to increase lung cancer risk by 15-30% from passive smoking. More than 90% of all lung cancer is caused by tobacco smoke and an estimated 1% is attributable to air pollution.

There have been two distinct smoking epidemics. Smoking by men reached very high levels after World War II before abating. The incidence of lung cancer among men reflected this trend. Women became more active smokers in the 1960’s. The current incidence of smoking is converging among the genders. The risk of men and women under 65 years old dying of lung cancer in Hungary is 131% higher than the EU-27 average. France, the industrial areas of the UK, Germany and Spain have the highest lung cancer mortality among the EU-15 Member States.

Alcohol-related Mortality

This refers to mortality as a consequence of cancer of the mouth, throat, oesophagus, liver, disease and alcohol abuse. Alcohol is also an important risk factor for road traffic injuries, suicide, falls, homicide and circulatory disease mortality. Mortality rates are six-fold higher in Hungary and Romania than in Greece, Norway, Iceland and Sweden. The Republic of Ireland records more favourable rates than Northern Ireland.

Suicide

Men are more likely to take their own lives than women. The highest suicide rates are found in the Estonia, Latvia and Lithuania; Hungary, Slovenia, and many regions of Poland, Finland, Belgium and in some regions of France (Normandy, Brittany, Loire).

Cultural or religious stigmas in certain regions are considered to have a bearing on suicide trends as have the practice that life assurance policies may not be paid after a suicide.

The lowest suicide rates are in Greece, Spain, Italy, Malta, the UK and Holland. The Republic of Ireland has a higher incidence of suicide than Northern Ireland (410 – 570 potential years of life lost in the Republic compared to 220 – 300 in the North).

Fatal Transport Accidents

Road traffic accident mortality is highest among young people. Transport related accidents cause 8% of all loss below 65 years in the EU-27, more than any disease. Men run higher risks than women with a male : female ratio of 3.9. Transport is most dangerous in Portugal, Lithuania, Latvia, Corsica. Greece and Poland. The safest areas are often areas where speed is limited – large German cities, Switzerland, Holland, south of England, Italy, Norway and Sweden.

Donegal, Mayo, Sligo, Leitrim, Cavan, Monaghan, Galway, Westmeath, Roscommon and Longford have a significantly higher fatality record than the rest of the island of Ireland.

Cervical Cancer

If cervical cancer screening successfully targets women most at risk, the mortality rates are lower. Conversely, the adverse effects of over-screening and over-treatment of women less at risk needs to be curtailed. Romania records the highest cervical cancer mortality – 20 times higher than Italy of Greece, which have the lowest mortality. Higher rates prevail in nearly all of the newer Member States. Ireland is mid-to-high ranking.

AIDS

HIV mortality is shifting away from men having sex with men to intravenous drug users and migrants from countries with a high incidence of HIV / AIDS. Spain, Portugal, France, Switzerland, Italy and Estonia have high rates of AIDS deaths. Romania experiences a high incidence of blood-borne HIV in children.

Those counties of Ireland where transport related fatalities are higher experience a lower levels of IADS related fatalities than the rest of the island.