Pooling European all-cause mortality: methodology and findings for the seasons 2008/2009 to 2010/2011

Abstract

Several European countries have timely all-cause mortality monitoring. However, small changes in mortality may not give rise to signals at the national level. Pooling data across countries may overcome this, particularly if changes in mortality occur simultaneously. Additionally, pooling may increase the power of monitoring populations with small numbers of expected deaths, e.g. younger age groups or fertile women. Finally, pooled analyses may reveal patterns of diseases across Europe. We describe a pooled analysis of all-cause mortality across 16 European countries. Two approaches were explored. In the ‘summarized’ approach, data across countries were summarized and analysed as one overall country. In the ‘stratified’ approach, heterogeneities between countries were taken into account. Pooling using the ‘stratified’ approach was the most appropriate as it reflects variations in mortality. Excess mortality was observed in all winter seasons albeit slightly higher in 2008/09 than 2009/10 and 2010/11. In the 2008/09 season, excess mortality was mainly in elderly adults. In 2009/10, when pandemic influenza A(H1N1) dominated, excess mortality was mainly in children. The 2010/11 season reflected a similar pattern, although increased mortality in children came later. These patterns were less clear in analyses based on data from individual countries. We have demonstrated that with stratified pooling we can combine local mortality monitoring systems and enhance monitoring of mortality across Europe.

Fig. 1.

Weekly procedures at national and European level.

Fig. 2.

Comparing the two approaches: summarized (black lines) and stratified (red lines). Green lines = registered; dashed lines = 2 z-score deviation.

Fig. 3.

Pooled analyses for all ages using the stratified approach. Top panel: - - -, daily adjusted; –––, expected (baseline). Bottom panel: –––, Pooled;, countries.

Fig. 4.

Pooled delay-adjusted (- - -) and expected (–––) number of deaths by age group using the stratified approach.

Fig. 5.

Pooled (–––) and country-specific () z scores by age group using the stratified approach.

Fig. 6.

Cumulated deviation from the expected number of deaths. – – – , 2008/09; –––, 2009/10 (pandemic); - - -, 2010/11.