Statbel, the Belgian statistical office, publishes today the causes of death for 2019.

In 2019, neoplasms^[1] (malignant, benign or of uncertain behaviour) were, with 25.5% of cases, the first cause of death in Belgium, ahead of diseases of the circulatory system (25.1%). Diseases of the respiratory system are the 3rd cause of death (11.2%).

However, there are regional disparities. While the Flemish Region follows the national ranking, the same is not true of the other two regions. In the Brussels-Capital Region, the first two places are the same, but the third place goes to the large group of ‘other natural deaths’ (including, among others, diseases of the blood, of the eye, of the ear, of the musculoskeletal system, of the skin, cases related to pregnancy and those not elsewhere classified). In Wallonia, the situation is unchanged compared to 2018: diseases of the circulatory system still rank first ahead of neoplasms and diseases of the respiratory system.

Men follow the national ranking in a more evident way: the main cause of death is due to a neoplasm in 28.6% of cases and to a disease of the circulatory system in 23.4% of cases. Among women, the order is reversed. The main cause of death is attributed to a disease of the circulatory system (26.7%); neoplasms are the second cause (22.6%). We observe the same trends by gender in the three regions of the country.

Significant changes in the initial causes of death

While the relative share of certain diseases as an initial cause of death is becoming increasingly marked - such as ‘other natural deaths’ or, to a lesser extent, mental and behavioural disorders^[2] - that of diseases of the circulatory system has been declining for several years. They accounted for 36.3% of deaths in 2000 compared to 25.1% in 2019.

Deaths due to neoplasms show a decreasing trend, especially among men

Following the World Health Organization (WHO), both benign and malignant neoplasms are grouped together in one category of cause of death, which we will refer to below as neoplasms (ICD-10; Chapter 2; codes C00-D48: Neoplasms).

In 2019, the highest proportion of deaths was due to neoplasms (27,739 established deaths, or 25.5%), in contrast to previous years where most deaths were due to cardiovascular diseases (in 2019: 27,297 deaths, or 25.1%).

In order to make a meaningful comparison with previous years, the mortality ratio is shown below as the number of deaths per 100,000 inhabitants. If we look at the number of deaths per 100,000 inhabitants due to neoplasms over time, we see that it remains relatively stable, but that a slight decrease has started in recent years. It remains to be seen whether this trend will continue in the coming years.

When the figures are broken down by gender, we see that this decrease is particularly noticeable in the male population; in contrast, we see a slight increase in the female population compared to 2018. The difference in deaths between both genders per 100,000 inhabitants therefore shows a decreasing trend. However, men still die more often as a result of a neoplasm than women.

Figure 1: deaths due to neoplasms per 100,000 inhabitants, by gender (2000-2019).

Broken down by region of death, it is striking that the mortality rate per 100,000 inhabitants due to neoplasms seems to have fallen sharply between 2000 and 2019, especially in Brussels. However, this is probably more a consequence of the change in population structure that the Brussels-Capital Region is experiencing. Compared to the other two regions, there are relatively fewer elderly people living in Brussels, which means that neoplasms could play a relatively smaller role in the mortality observed. The differences between the Flemish and Walloon Regions are less pronounced: in 2019, we can see that there were approximately 4 more deaths per 100,000 inhabitants in Flanders than in Wallonia (251.3 and 247.5 deaths respectively).

Figure 2: number of deaths per 100,000 inhabitants due to neoplasms, by region (2000-2019)

Evolution in types of neoplasms by gender

Men

Half of the deaths due to neoplasms among men in 2019 were attributable to five categories. The largest share is for malignant neoplasms of trachea, bronchus and lung (68.3 deaths per 100,000 male inhabitants). As many as one in four deaths among men caused by neoplasms is due to this type of cancer. However, a slight decrease can be observed compared to previous years (70.6 in 2018, and 71.3 in 2017). Malignant neoplasm of prostate remains relatively stable in second place (28 deaths per 100,000 male inhabitants), followed by malignant neoplasm of colon, which is again experiencing a decline (from 19.6 in 2017, to 17.5 in 2018 to 17.2 in 2019). Among men, the fourth place goes to malignant neoplasm of pancreas with 15.0 deaths/100,000, again a decrease compared to 2018 (16.9); there was then a slight increase compared to 2017 (16.1). In fifth place is a broad collection that includes all benign neoplasms, but also neoplasms of uncertain or unknown behaviour (i.e. it is not possible to unequivocally demonstrate that it is a benign or malignant neoplasm). In 2019, there were 12.2 deaths per 100,000 inhabitants identified in this category. Again, this is a decrease compared to previous years (2018: 14.1; 2017: 15.1). This category consists mainly of deaths due to myelodysplasia, malignant neoplasms of trachea, bronchus and lung and malignant neoplasms of brain.

Women

As in the male population, more than half of deaths due to neoplasms are the result of five categories, four of which are the same, although not in the same order.

For women, malignant neoplasm of breast remains the leading cause of death among neoplasms in 2019 (35.8 deaths per 100,000 women) despite a decrease compared to 2018, when there was a slight increase (38.4) compared to 2017 (38.1). Second place goes to malignant neoplasms of trachea, bronchus and lung (34.7 deaths per 100,000 male inhabitants). In contrast to the male population, this number is on the rise (from 31.9 in 2017 to 33.3 in 2018). The third to fifth places are assigned to the same groups for both women and men. In 2019, 17.1 deaths per 100,000 women were recorded due to a malignant neoplasm of colon, which is a slight increase compared to 2018 (16.7) after a decrease compared to 2017 (17.8). Malignant neoplasm of pancreas also registers a slight increase (16.3 deaths per 100,000 inhabitants), after a decrease was already observed in 2018 (2018: 15.6; 2017: 16.5). Fifth place goes to benign neoplasms and neoplasms of uncertain or unknown behaviour (2019: 16.6). Here we do see a decrease compared to 2018 (12.0) and 2017 (13.5). For deaths among women, this mostly concerns myelodysplasia, neoplasms of the brain and neoplasms of some digestive organs such as the pancreas or oesophagus.

Based on statistical death bulletins, which are managed by the federated entities, the statistic on causes of death has now a homogeneous series for the period 1998-2019. This homogeneity of the series is achieved because the three federated institutions concerned use the tenth revision of the World Health Organization's International Classification of Diseases and Related Health Problems (ICD-10) to code the causes of death and to identify, among them, the initial cause on the basis of which the main tables of the statistic are produced.

^[1] Within the meaning of Chapter 2 of the International Statistical Classification of Diseases and Related Health Problems of the World Health Organization (ICD-10).

^[2] The ‘other natural deaths’ accounted for 4.3% of cases in 2000 and have now more than doubled in relative importance to 9.5% of cases in 2019. Mental and behavioural disorders accounted for 2.8% of deaths in 2000 and 5.3% of cases in 2019.