Causes and extent of avoidable mortality across the european union: insights for advancing healthy aging

Although population aging is a global worldwide phenomenon, it is most pronounced in European Union countries. An unhealthy ageing population not only places a heavy burden on healthcare, but also hinders sustainable socio-economic development. Supporting healthy aging can be achieved through evidence-based strategies aimed at reducing avoidable mortality and interventions that promote these strategies. Our study is based on a secondary analysis of Eurostat data for 2022 to describe the extent and structure of avoidable (divided to preventable and treatable) mortality stratified by sex for each EU country. Cluster analyses based on avoidable mortality indicators (preventable mortality rate, treatable mortality rate, preventable-to-treatable mortality ratio, and male-to-female avoidable mortality rate ratio) and the cause-specific composition of avoidable mortality were used to highlight similarities and differences between countries. Classification based on the available mortality indicators revealed regional patterns. Western and Northern EU countries were predominantly in Cluster 1 which had the lowest preventable and treatable mortality rates, as well as relatively balanced sex ratios. However, these countries had a higher preventable-to-treatable mortality ratio indicating potential delays or gaps in preventive services. Mediterranean EU countries were in Cluster 2 showing moderate values for the avoidable mortality indicators and relatively low preventable-to-treatable mortality ratios. However, the male-to-female mortality ratio was high, indicating significant sex disparities. Central and Eastern-European EU countries were in Cluster 3 which had the highest burden of both preventable and treatable mortality. The preventable-to-treatable mortality ratio was lower than in Cluster 1, and the male-to-female mortality ratio was the highest in this cluster. Cluster analysis based on the cause-specific composition of avoidable mortality also identified three clusters with leading mortality causes as (1) cardiovascular diseases mainly in Clusters 2 and 3 countries; (2) cancer dominantly for Cluster 1 countries; and (3) high proportions of cardiovascular and alcohol-related mortality in mainly Cluster 3 countries. The clusters do not align perfectly (Adjusted Rand Index = 0.240, Normalized Mutual Information = 0.337), the two approaches complement each other. The first approach identified countries with similar levels and patterns in terms of preventable and treatable types of avoidable mortality, while the second approach highlighted similarities in the composition of health threats. Combining the two approaches offers a more detailed understanding of regional health profiles within the European Union, and enables the development of targeted interventions to reduce avoidable mortality and promote healthy aging.