In 2021, nearly 5.3 million people died across EU countries (Figure 3.5). This was over 100 000 more deaths than in 2020 and over 600 000 more deaths than in 2019, mainly due to the COVID‑19 pandemic.
Diseases of the circulatory system and cancer remained the two leading causes of mortality in the EU, with circulatory diseases accounting for 32% of all deaths in 2021 (over 1.7 million deaths) and cancer for 22% (1.1 million deaths). Among circulatory diseases, the main causes of mortality relate to ischaemic heart diseases (i.e. diseases that involve reduced blood flow to the heart, including acute myocardial infarctions also commonly called heart attacks) and cerebrovascular diseases (strokes), which together accounted for over half of all deaths from circulatory diseases (see indicator “Mortality from circulatory diseases”). The main causes of cancer-related mortality are lung cancer, colorectal cancer, breast cancer (that affects almost exclusively women) and prostate cancer (that affects only men). About 225 000 people died from lung cancer in 2021 (see indicator “Cancer mortality”). The main risk factor for lung cancer is tobacco smoking (see indicator “Smoking among adults” in Chapter 4).
COVID‑19 was the third leading cause of death in the EU in 2021, accounting for 11% of all deaths (about 580 000 deaths). Death rates from COVID‑19 were particularly high in 2021 in Bulgaria, the Slovak Republic, Poland, Hungary and Czechia, with age‑standardised rates in all these countries exceeding 250 per 100 000 population. By contrast, COVID‑19 deaths fell sharply in 2021 compared to 2020 in other EU countries, notably in Belgium, Spain and Sweden (Eurostat, 2024[1]).
Respiratory diseases (excluding COVID‑19) were the fourth main cause of death in EU countries in 2021, causing 6% of all deaths (approximately 324 000 deaths). Chronic obstructive pulmonary disease (COPD) and pneumonia are the two main causes of death from respiratory diseases. As is the case with lung cancer, tobacco smoking is the main risk factor for COPD.
External causes of death, including accidents, suicides and homicides, were responsible for 5% of all deaths in the EU in 2021. The most important external causes of deaths are accidents (164 000 deaths in 2021, of which 65 000 were falls-related deaths and 22 000 related to transport accidents) and suicides (47 000 deaths). Transport accidents are a particularly important cause of death among young people aged 18‑25, whereas deaths from falls and suicide generally increase with age.
Looking at other specific causes, Alzheimer’s and other dementias accounted for 5% of all deaths in the EU in 2021. The number of deaths from Alzheimer’s and other dementias has increased by over 50% in the decade up to 2021, although some of this increase is due to changes in causes of death coding.
As shown in Figure 3.6, overall mortality rates (age‑standardised to take into account differences in population structure) were 20% lower than the EU average in Spain, France, Sweden and Luxembourg in 2021, while they were at least 50% higher than the EU average in Bulgaria, Romania, Latvia, the Slovak Republic, Hungary and Lithuania. The main reasons for the much higher mortality rates in this latter group of countries were higher mortality rates from circulatory diseases and COVID‑19 in 2021.
