Mortality maps in Europe: which diseases are the most deadly in each country?

Every year, more than five million people die in European Union countries. The main cause is diseases of the circulatory system, accounting for 32% of these deaths . Cancer follows, with 22%, according to the latest Eurostat data from 2022. That year, COVID-19 still had a considerable impact on European mortality, constituting the main cause in 6% of cases and up to one in ten in Greece and Slovenia.

But the figures vary significantly by country. Spain is one of the countries with the lowest death rates from circulatory system diseases, accounting for 26% of all deaths. Only France has a lower percentage, at 21%.

On the other hand, these figures are much higher in Bulgaria (61%), Romania (56%), and Lithuania (52%). “Europe is divided into three risk zones , with Eastern and some Northern European countries being high-risk,” explains Dr. Luis Rodríguez Padial, president of the Spanish Society of Cardiology (SEC). The likelihood of developing cardiovascular problems is higher in these areas than in low-risk areas located in the Mediterranean region.

The cardiologist attributes these differences to the risk factors associated with these types of diseases: "People smoke more, have higher cholesterol, and there are probably genetic factors as well," he explains, although he assures that the extent of these factors is less well known.

According to Eurostat, Bulgaria leads several negative health indicators in the EU, leading in the prevalence of daily smoking (29% compared to the EU average of 19%). The country also has a high annual alcohol consumption , and nearly 30% of the population does not engage in any form of physical activity, according to the Bulgarian media outlet Mediapool. Despite national programs, prevention and early detection remain persistent weaknesses.

In an interview with News.ro , Dr. Stefan Busnatu, a cardiologist in Romania, points to a worrying situation, confirming that his country is “unfortunately” in an area where “there is a very high risk of disease.” In his opinion, there is not enough infrastructure to manage ischemic heart disease, which limits treatment. For him, the emphasis on primary prevention , education and cardiac recovery is crucial, as a second acute ischemic event can be fatal .

"It has been seen that far more people die from heart disease in Russia or Eastern European countries than in Spain, Italy, or Greece, the Mediterranean region. Probably due to the famous Mediterranean diet," says Rodríguez. The expert refers to an article published in March in the New England Journal of Medicine, whose main finding is that the presence of the five classic risk factors (hypertension, high cholesterol, abnormal weight, diabetes, and smoking) account for 50% of the global burden of cardiovascular disease. At the same time, the absence of these factors after age 50 is associated with a decade longer life expectancy compared to those who do have them.

The president of the Lithuanian Heart Association, cardiologist Sigita Glaveckaitė, spoke on a television program about the incidence of these pathologies in her country. Beyond the "high" prevalence of risk factors, the doctor alluded to other problems such as beliefs or myths that discourage people from taking appropriate medication, low awareness , low participation in prevention programs, and lack of state funding. In her experience, the healthcare system has an approach inherited from the Soviet system, where professionals are paid by the hour rather than by procedure , which reduces efficiency and interest in work.

"When I ask patients (patients under 60 years old after a heart attack), they almost always smoke, are obese , don't treat their high blood pressure, or don't take cholesterol medication," says Czech cardiologist Josef Kautzner. "We know that approximately 80% of cardiovascular disease can be prevented by adjusting seemingly simple but essential risk factors," Glaveckaitė insists.

Along the same lines, the latest report on health in Europe by the OECD and the European Commission explains the differences between countries due to the variability in the prevalence of risk factors. But it also points to the quality of healthcare. “For example, 30-day mortality after a heart attack (which reflects factors such as timely patient transport and effective medical treatment) was higher than 14% in Latvia, Slovakia, Lithuania, and Estonia in 2021, compared to 7% or less in Sweden, Denmark, and Spain,” the report states.

Meanwhile, men have 43% higher mortality rates from circulatory diseases than women in the EU, according to OECD data, and this gender gap has widened slightly over the last decade. This difference is due to the higher prevalence of key risk factors among men.

The data confirm that the incidence of these diseases directly affects life expectancy in countries. As the graph above shows, life expectancy is shorter in those places where the percentage of deaths from cardiovascular disease is highest.

Poland is among the countries with the largest gap in life expectancy between men and women. "Women in Poland currently live about two years less than the average woman in the European Union. For men, the difference is four years. This is a burden we have been carrying since the beginning of sociodemographic changes," explains Dr. Bogdan Wojtyniak of the National Institute of Public Health.

Malignant cancers are the second leading cause of death in Europe, although in some countries they are the leading cause. In fact, more recent data for Spain, published by the INE for 2024 , place tumors as the leading cause of death (26.6%), followed by circulatory system diseases (26.1%).

The OECD report also mentions differences even within countries . "Large disparities in cancer mortality (over 30%) were found between regions in Romania, Poland, France, Spain, and Germany."

In addition to risk factors and hereditary factors, “a study of educational inequalities in cancer mortality between 2015 and 2019 found that, on average, across 14 EU countries and Norway, men with lower educational attainment had an 84% higher cancer mortality rate than men with higher educational attainment. The gap between women with different educational attainment levels was narrower, but still considerable: 37%,” the OECD cites.

According to the organization, in several countries, cancer survival rates are lower among people with lower socioeconomic status. These inequalities reflect differences in the prevalence of risk factors, participation in screening programs , and access to timely, high-quality health care.

A study published in The Lancet Public Health also analyzed the differences in years of life lost due to premature mortality in 32 European countries. The results indicated that disparities were strongly associated with socioeconomic factors, access to health services, and public policies . Thus, countries with lower investment in public health and greater economic inequality showed higher rates of premature mortality.

More traffic accidents

In addition to natural factors, external causes of mortality also reflect differences between countries. Traffic accidents are the most common cause of mortality in southern Greece , some regions of Portugal, Romania, and Turkey.

In 2024, Greece reached a record 665 traffic deaths . The SOS Traffic Crimes association criticizes the lack of progress toward the government's goal of halving traffic fatalities by 2030. They report that not only has the accident rate not decreased in recent years, but that since 2021 , more and more deaths have been recorded due to this cause.

George Kouvidis, founder of the association, cites the complex case of the Morea Highway , where, despite being a safer route, accidents increased by more than 100% after its completion in 2016. He attributes this to drivers, with more powerful cars , entering provincial networks at an accelerated speed and without the necessary caution on roads with different infrastructure. On the islands, the increase is explained by tourism and alcohol consumption .

However, Kouvidis points out that European accident statistics often exclude countries with worse situations (such as Albania, Serbia, and Kosovo ), distorting the continent's averages . He also finds it "unacceptable" that these death figures do not include those who die more than 30 days after an accident.

Suicide rates in European countries range from around 20 to 2 per 100,000 inhabitants. The countries with the highest incidence are Slovenia, Lithuania, Hungary, Belgium, and Estonia . A study published in 2016 in BioMed Central analyzed the differences between these rates in Europe and concluded that, among other factors, cold weather correlates with a higher suicide rate. "It seems that in Europe, suicidality follows a climatic or temperature gradient that, curiously, does not run from south to north, but from south to northeast," the article states. Despite this, the Association of Professionals in Suicide Prevention and Postvention (Papageno) points out that generally "there is a multi-causality when we talk about suicide": "It never occurs for a single reason, but rather is due to several factors."

Homicides are not a common cause of death on the continent, but in 2022 rates were highest in Latvia, Lithuania and Luxembourg , while Spain is just below the European average , with 0.62 deaths per 100,000 inhabitants.