Indicators of avoidable mortality provide a starting point for assessing the effectiveness of public health and healthcare systems in reducing premature deaths from causes considered to be avoidable. In 2021, nearly a quarter of deaths (24% or 1.26 million deaths) across the EU were considered avoidable. Of these, more than 860 000 deaths could have been prevented through effective primary prevention or other public health measures (i.e. measures taken before the onset of disease or injury to reduce its occurrence), while nearly 400 000 could have been avoided through more effective and timely healthcare treatment (i.e. measures taken after the onset of diseases, to reduce case‑fatality).
In 2021, COVID‑19 was the largest cause of preventable mortality, accounting for 24% of preventable deaths in people under age 75. The four leading causes of preventable mortality – COVID‑19, lung cancer, ischaemic heart diseases and alcohol-related deaths – accounted for more than half (56%) of all preventable deaths in the EU (Figure 6.1). Other major causes of preventable mortality include stroke, accidents, chronic obstructive pulmonary disease (COPD) and suicide. The four most common treatable causes of mortality – ischaemic heart disease, breast cancer, colorectal cancer and stroke –accounted for more than half of all treatable causes of mortality.
The rate of preventable mortality in 2021 was lowest in Iceland, Norway, Switzerland and Sweden at less than 120 per 100 000 population under age 75. Italy, Luxembourg, Malta and Spain also had low preventable mortality rates, more than 30% lower than the EU average. In contrast, preventable mortality was more than two times higher than the EU average in Bulgaria, Hungary, Romania and Latvia, all above 400 premature preventable deaths per 100 000 population under age 75 (Figure 6.2). Major differences across countries emerged in 2021 due to variations in mortality from COVID‑19, ranging from 16 deaths per 100 000 population under age 75 in Sweden to 213 deaths in Bulgaria. Other sources of cross-country differences come from differing mortality rates due to lung cancer, ischaemic heart disease and alcohol-specific disorders and poisonings, which are substantially higher in Central and Eastern European countries. Much of this can be attributed to differences in the prevalence of preventable risk factors, such as smoking and alcohol consumption (see indicators on smoking and alcohol consumption among adults in Chapter 4).
Preventable mortality in the EU decreased by 13% between 2011 and 2019, largely due to reductions in mortality from lung cancer, ischaemic heart disease and stroke. However, following the emergence of the COVID‑19, the EU average rates in 2020 and 2021 surpassed the 2011 levels – increasing by 50% or more between 2019 and 2021 in countries such as Bulgaria, Czechia, Latvia, Poland, the Slovak Republic and Romania.
Switzerland, Luxembourg, Norway and France had the lowest rates of treatable causes of mortality in 2021, with less than 60 deaths per 100 000 population under age 75. Romania, Bulgaria, the Slovak Republic and Latvia had treatable mortality rates more than two times above the EU average. The higher rates in this latter group of countries were mainly driven by higher mortality rates from ischaemic heart disease, stroke and pneumonia.
Compared to 2011, the EU average rate of treatable causes of mortality in 2021 has improved by 10%. However, compared to 2019, some countries (Slovak Republic, Türkiye, Romania and Bulgaria) saw increases in 2021 of more than 20% in treatable causes of mortality, possibly owing to increases in deaths from pneumonia related to COVID‑19 infection and disruptions in healthcare due to the pandemic.
