Trends in mortality from pneumonia in the Europe union: a temporal analysis of the European detailed mortality database between 2001 and 2014

Abstract

Background: Pneumonia is responsible for approximately 230,000 deaths in Europe, annually. Comprehensive and comparable reports on pneumonia mortality trends across the European Union (EU) are lacking.

Methods: A temporal analysis of national mortality statistics to compare trends in pneumonia age-standardised death rates (ASDR) of EU countries between 2001 and 2014 was performed. International Classification of Diseases version 10 (ICD-10) codes were used to extract data from the World Health Organisation European Detailed Mortality Database and trends were analysed using Joinpoint regression.

Results: Median pneumonia mortality across the EU for the last recorded observation was 19.8 / 100,000 and 6.9 / 100,000 for males and females, respectively. Mortality was higher in males across all EU countries, most notably in Estonia and Lithuania where the ratio of male to female ASDR was 4.0 and 3.7, respectively. Gender mortality differences were lowest in the UK and Demark with ASDR ratios of 1.1 and 1.5, respectively. Pneumonia mortality across all countries decreased by a median of 31.0% over the observation period. Countries that demonstrated an increase in pneumonia mortality were Poland (males + 33.1%, females + 10.2%), and Lithuania (males + 6.0%).

Conclusions: Mortality from pneumonia is improving in most EU countries, however substantial variation in trends remains between countries and between genders.

Fig. 1

Pneumonia mortality trends of male and females in 19 European countries. Lines represent result of Joinpoint analyses: dashed and continuous lines for males and females, respectively. Squares (males) and circles (females) represent raw data; where symbol is absent, data has been imputed for the respective year

Fig. 2

Ranked percentage change data comparing average of European age standardised death rate for 2001–2003 vs 2012–2014, unless otherwise specified. For Austria, 2002–2003 were used for start of period with % change 2002–2003 vs 2012–2014. For Belgium, 2012–2013 were used for end of period with % change 2001–2001 vs 2012–2013. For Cyprus, 2004 was used for start of period, and 2012–2013 were used for end of period with % change 2004 vs 2012–2013. For Denmark, 2012 was used for end of period with % change 2001–2003 vs 2012. For France, 2012–2013 were used for end of period with % change 2001–2003 vs 2012–2013. For Netherlands, 2012–2013 was used with % change 2001–2003 vs 2012–2013. For Portugal, 2002–2003 were used for start of period with % change 2002–2003 vs 2012–2014. For Slovenia, 2010 was used for end of period with % change 2001–2003 vs 2010. For the UK, 2012–2013 were used for end of period with % change 2001–2003 vs 2012–2013

Fig. 3

Ratios of male to female mortality for the period 2012–2014. The pre-2004 joining group was composed of Austria, Belgium, Denmark, Finland, France, Germany, Netherlands, Spain, Sweden and the UK. The post-2004 joining group was composed of Croatia, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania and Slovakia. * p < 0.001