The rise of mortality from mental and neurological diseases in Europe, 1979-2009: observational study

Abstract

Background: We studied recent trends in mortality from seven mental and neurological conditions and their determinants in 41 European countries.

Methods: Age-standardized mortality rates were analysed using standard methods of descriptive epidemiology, and were related to cultural, economic and health care indicators using regression analysis.

Results: Rising mortality from mental and neurological conditions is seen in most European countries, and is mainly due to rising mortality from dementias. Mortality from psychoactive substance use and Parkinson's disease has also risen in several countries. Mortality from dementias has risen particularly strongly in Finland, Iceland, Malta, Netherlands, Spain, Sweden and the United Kingdom, and is positively associated with self-expression values, average income, health care expenditure and life expectancy, but only the first has an independent effect.

Conclusions: Although trends in mortality from dementias have probably been affected by changes in cause-of-death classification, the high level of mortality from these conditions in a number of vanguard countries suggests that it is now among the most frequent causes of death in high-income countries. Recognition of dementias as a cause of death, and/or refraining from life-saving treatment for patients with dementia, appear to be strongly dependent on cultural values.

Figure 1

Correlation between trends in all-cause mortality and trends in cause-specific mortality, European countries, 1970-2009. a. Men. b. Women. Notes: We regressed age-adjusted cause-specific mortality rates and all-cause mortality rates, using ordinary least squares regression, according to a method originally developed by Preston [Preston SH: Mortality patterns in national populations, with special reference to recorded causes of death. New York: Academic Press; 1976.] but modified by us by including country dummies to allow for between-country differences in levels of mortality. The graphs present partial correlation coefficients between cause-specific mortality rates on all-cause mortality rates, controlling for country. Full regression results are given in web Additional file 1: Table S1.

Figure 2

The rising share of mental and neurological diseases in all-cause mortality, European countries with available data, 1970–2006. Notes: Average of shares in each European country as calculated on the basis of age-standardized mortality rates. Irregularities around 1979 may be related to the introduction of ICD-9, and irregularities in the early 1980s may be related to the fact that countries in the Soviet Union submitted data for some years, and not for others.

Figure 3

The rise of age-standardized mortality from (a) all dementias, (b) psychoactive substance use, and (c) Parkinson’s disease, countries in upper quartile of mortality change, men. Note: Countries in upper quartile of change in age-standardized mortality between 1991 and 2009. Age-standardized mortality rates all ages (in deaths per 100,000 person-years).

Figure 4

Age-standardized rates of mortality from all dementias in Europe, 2009, persons aged 65 and over. a. Men. b. Women. Note: No deaths from dementia among men reported from Portugal and TFYR Macedonia.

Figure 5

Age-specific mortality rates from all dementias, countries in upper quartile of mortality, 2009. a. Men. b. Women.