KS 08 02 008 en

U N I O N
COPYRIGHT
2002 EDITION
Luxembourg: Office for Official Publications of the
European Communities, 2003
E U R O P E A N
ISBN 92-894-3727-8
Cat. No. KS-08-02-001-EN-N
© European Communities, 2003
Health
T H E
statistics
O F
Atlas on
P A N O R A M A
mortality in the
European Union
Chapter 8
Cardiovascular diseases
Data 1994–96
E U R O P E A N
COMMISSION
CépiDC — Centre d’épidémiologie
sur les causes médicales de décès
3 THEME 3
Population and
social conditions
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Luxembourg: Office for Official Publications of the European Communities, 2002
ISBN 92-894-3727-8
© European Communities, 2002

Atlas — Contents
ATLAS — Contents
Health statistics — Atlas on mortality in the European Union

1. Introduction.............................................................................................................................. 9
2. Methodology ............................................................................................................................ 11
3. General mortality ...................................................................................................................... 15
4. ‘Premature’ mortality ................................................................................................................ 23
5. Mortality by age group ............................................................................................................. 27
6. Typologies of mortality by age................................................................................................... 43
7. Typologies of mortality by cause................................................................................................ 49
8. Cardiovascular diseases............................................................................................................. 53
9. Respiratory diseases .................................................................................................................. 59
10. Respiratory cancers ................................................................................................................... 65
11. Intestinal cancers (colon, rectum and anus) ............................................................................... 71
12. Stomach cancers....................................................................................................................... 75
13. Breast cancers........................................................................................................................... 79
14. Cancers of the uterus................................................................................................................ 81
15. Prostate cancer ......................................................................................................................... 83
16. Cancer of the pancreas ............................................................................................................. 85
17. Cancer of the bladder ............................................................................................................... 89 7
18. Malignant melanoma of the skin............................................................................................... 93

eurostat
19. Mortality associated with alcoholism ......................................................................................... 97
20. Violent deaths........................................................................................................................... 101
21. AIDS ......................................................................................................................................... 111
Annex 1 — Standard European population ...................................................................................... 115
Annex 2 — Causes of death (European shortlist).............................................................................. 116
Annex 3 — List of NUTS 2 regions ................................................................................................... 118
8. Cardiovascular diseases

8.1. DISEASES OF THE CIRCULATORY SYSTEM
AGE STANDARDISED MORTALITY IN MALES ALL AGES
(1994–96) — NUTS 2
634.8 National data
P
Standardised death Percentage of total
rate (rates per 100 000) mortality
510.0
Minimum 256.4 (France) 28.6 (France)
European
rate 365.9 38.8
417.1
Açores
Maximum 480.2 (Ireland) 49.0 (Sweden)
P
373.0 Madeira
DE, UKL, UKM: NUTS 1
FI16 and FI17 data are merged
E
IE01 and IE02 data are merged
318.7 SE09 and SE0A data are merged
UKI1 and UKI2 data are merged Canaries
UKK3 and UKK4 data are merged
F
249.8
Guadeloupe
F
216.3
Martinique
Data not available
F
(rates per 100 000)
La Réunion
F
National boundaries
Guyane
NUTS 2 limits
N
0 100 500 km
= 44 400 deaths
53
Discretisation method: Q6 eurostat

Statistical data: Eurostat. Database: NewCronos.
© EuroGeographics Association for the administrative boundaries.
Cartography: Inserm-CépiDc/Espace, health and territory, 2002.
8. Cardiovascular diseases rates for men and women reveals a clear-cut gra-
dient dividing the north and the south of the EU.
Cardiovascular diseases are the main cause of mor-
tality in the European Union. They account for ap- In the north of the EU, the UK, the Scandinavian
proximately 40 % of deaths in both the male and countries, Germany, Austria and Luxembourg
female populations. These pathologies affect the have the highest rates, with particularly marked
population at advanced ages: over nine out of 10 excess mortality in certain regions (the eastern
deaths occur after 65 years. German Länder and Scotland). There are clear-cut
contrasts: a north/south divide in Great Britain
Although excess male mortality remains high for
and Finland and an east/west divide in Germany
these pathologies, the differences in mortality be-
and Austria.
tween the sexes are less pronounced than for oth-
er causes of death. The highest regional ratio of ex-
There is a clear dividing line between this group
cess male mortality does not exceed 1.8, whereas it
of countries and the south of the EU, which has
is, for example, over 20 in some European regions
below-average mortality, particularly France, Bel-
for mortality from respiratory cancers.
gium, Italy and Spain. However, the southern-
Disparities within Europe are considerable for all most regions — Portugal and Greece and, for
deaths from cardiovascular diseases, with rates women, southern Spain and southern Italy —
varying at a ratio of 1 to 3 depending on the re- have rates similar to those of the northern
gion. The relatively similar distribution of death countries.
8.2. DISEASES OF THE CIRCULATORY SYSTEM

AGE STANDARDISED MORTALITY IN FEMALES ALL AGES
(1994–96) — NUTS 2
401.9 National data
P
342.2
European
rate 231.6 46.5
276.7
Açores
Maximum 310.5 (Austria) 58.8 (Austria)
P
229.2 Madeira
E
F
146.8
Guadeloupe
F
123.6
Martinique
Data not available
F
(rates per 100 000)
La Réunion
F
National boundaries
Guyane
NUTS 2 limits
N
0 100 500 km
= 58 700 deaths
54
eurostat Discretisation method: Q6

The pattern of these maps should be compared Cerebrovascular diseases (deaths from cerebrovas-
with the two most common types of disease cular accident of ischaemic, haemorrhagic etc. ori-
among pathologies of the circulatory system. gin) account for 9 % of male deaths and 13 % of
female deaths.
Ischaemic heart diseases (sudden death, death af-
ter myocardial infarction, etc.) account for almost These two groups of pathologies form very differ-
20 % of all deaths in the male population and ent geographical patterns within the EU.
15 % in the female population.

8.3. ISCHAEMIC HEART DISEASES
(1994–96) — NUTS 2
335.7 National data
P
308.0
Minimum 85.4 (France) 9.3 (Portugal)
European
rate 167.6 17.8
233.7
Açores
Maximum 300.0 (Finland) 28.5 (Finland)
P
154.1 Madeira
E
F
80.3
Guadeloupe
F
67.5
Martinique
Data not available
F
(rates per 100 000)
La Réunion
F
National boundaries
Guyane
NUTS 2 limits
N
0 100 500 km
= 12 800 deaths
55
Discretisation method : Q6 eurostat

A clear-cut geographical pattern rates vary at a ratio of 1 to 5 for men and 1 to 7

for ischaemic heart diseases and for women.
a more diffuse geographical pattern In the south, France, northern Spain and northern
for cerebrovascular diseases Portugal have the most favourable rates in Europe.
In the north, the northernmost regions, the Länder
The north/south divide in the European Union, par-
of eastern Germany, Saarland and Wien are partic-
ticularly in terms of mortality associated with circu-
ularly affected.
latory diseases as a whole, is largely determined by
the geographical pattern of ischaemic heart dis- The contrasts in mortality from cerebrovascular dis-
eases, which is similar for both sexes and at the eases are similar in scale, but the geographical pat-
same time very specific. tern is very different. At sub-national level, there
are much greater discontinuities and differences.
There are two groups of countries with different
patterns, one with marked excess mortality com- The Mediterranean countries (except France) have
prising the UK, the Scandinavian countries, the below-average mortality for ischaemic heart dis-
Netherlands, Germany and Austria, and the oth- eases but excess mortality for cerebrovascular dis-
er with below-average mortality comprising Lux- eases. Portugal in particular has the highest male
embourg, Belgium and the Mediterranean coun- and female rates in the EU. In Spain, there is a clear-
tries, including France. There are very great cut north/south divide, since the situation in the
contrasts between these two groups, since the northern provinces is closer to that in the neigh-
8.4. ISCHAEMIC HEART DISEASES

(1994–96) — NUTS 2
184.2 National data
P
153.9
European
rate 80.4 15.7
109.7
Açores
Maximum 141.6 (Ireland) 26.1 (Finland)
P
70.9 Madeira
E
F
33.4
Guadeloupe
F
27.3
Martinique
Data not available
F
(rates per 100 000)
La Réunion
F
National boundaries
Guyane
NUTS 2 limits
N
0 100 500 km
= 13 300 deaths
56
eurostat Discretisation method: Q6

bouring French regions. In contrast, in the other Some regions have high rates for both types of
Member States, a number of regions have below- pathologies: Scotland, southern Finland, Saarland
average mortality for cerebrovascular diseases and and the Länder of eastern Germany. Their situation
high rates for ischaemic heart diseases: Denmark, contrasts with the overall favourable situation of
north-west Germany, Ireland, southern Sweden, France, Belgium and northern Spain.
and northern Finland for men.

8.5. CEREBROVASCULAR DISEASES
(1994–96) — NUTS 2
242.1 National data
P
162.3
European
rate 83.8 8.9
95.8
Açores
Maximum 216.0 (Portugal) 18.7 (Portugal)
P
79.0 Madeira
E
F
56.9
Guadeloupe
F
46.2
Martinique
Data not available
F
(rates per 100 000)
La Réunion
F
National boundaries
Guyane
NUTS 2 limits
N
0 100 500 km
= 19 600 deaths
57
Discretisation method: Q6 eurostat

The disparities in Europe can be foods in the northern Member States. Similarly, in
explained by eating habits the countries of southern Europe, the excess mor-
tality from cerebrovascular diseases can be linked
Before interpreting these disparities in terms of risk to high salt consumption. France’s favourable posi-
factors or the features of the healthcare systems, tion in terms of mortality from ischaemic heart dis-
we need to look at the comparability of certifica- eases is in stark contrast to its poor situation in
tion practices. For example, a proportion of sudden terms of premature mortality. This brings us to a
deaths of cardiac origin may be recorded, depend- consideration of the potential effect of ‘competi-
ing on the certification practices, as ill-defined tion’ among causes of death. For example, a com-
causes of death or as infarctions. However, a com- parison between the premature mortality levels in
parative study recently carried out between France France and the United Kingdom reveals substitu-
and the United Kingdom showed that, if the data tion between the causes of death directly associat-
were adjusted on the basis of strong hypotheses, ed with alcohol (very common in France) and
the death rates remained considerably lower in deaths from infraction (very common in the United
France. Kingdom). One explanation could be that those
who are most likely to indulge in risk behaviour (al-
In addition to these potential methodological bias- cohol consumption in France) die prematurely and
es, disparities between Member States regarding the remaining ‘healthy’ population is less likely to
mortality from ischaemic heart diseases can be ex- suffer from ischaemic heart diseases. Although this
plained by eating habits, for example rich or fatty hypothesis can be put forward, it is not, however,
8.6. CEREBROVASCULAR DISEASES

(1994–96) — NUTS 2
188.7 National data
P
146.1
European
rate 67.6 13.8
80.2
Açores
Maximum 167.6 (Portugal) 26.7 (Portugal)
P
67.0 Madeira
E
F
41.1
Guadeloupe
F
32.2
Martinique
Data not available
F
(rates per 100 000)
La Réunion
F
National boundaries
Guyane
NUTS 2 limits
N
0 100 500 km
= 31 300 deaths
58
eurostat Discretisation method : Q6

valid for Germany and Austria, where there is ex- fore hospitalisation. The density of healthcare facil-
cess early mortality from pathologies associated ities and the quality and speed of treatment both at
with alcoholism and excess mortality from is- the time of the attack (emergency services) and up-
chaemic heart diseases. stream (hospital cardiology departments) should
Lastly, with regard to ischaemic heart diseases, par- therefore be taken into account as explanatory fac-
ticularly infarctions, deaths occur rapidly, often be- tors, but this would need specific studies.

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U N I O N

© European Communities, 2003

Luxembourg: Office for Official Publications of the European Communities, 2002

© European Communities, 2002

Health statistics — Atlas on mortality in the European Union

18. Malignant melanoma of the skin............................................................................................... 93

Health statistics — Atlas on mortality in the European Union

Discretisation method: Q6 eurostat

8.2. DISEASES OF THE CIRCULATORY SYSTEM

eurostat Discretisation method: Q6

Health statistics — Atlas on mortality in the European Union

Discretisation method : Q6 eurostat

A clear-cut geographical pattern rates vary at a ratio of 1 to 5 for men and 1 to 7

8.4. ISCHAEMIC HEART DISEASES

eurostat Discretisation method: Q6

Health statistics — Atlas on mortality in the European Union

Discretisation method: Q6 eurostat

8.6. CEREBROVASCULAR DISEASES

eurostat Discretisation method : Q6

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