Trends in XXXX mortality in Europe: retrospective analysis of the WHO mortality database.

@entity1 @entity14
OBJECTIVE: To examine changes in @entity14 mortality in 34 European countries between 1970 and 2011. DESIGN: Retrospective trend analysis. DATA SOURCE: World Health Organization mortality database. POPULATION: Deaths from @entity14 between 1970 and 2011. Profound changes in screening and treatment efficiency took place after 1988; therefore, particular attention was paid to the evolution of @entity14 mortality in the subsequent period. MAIN OUTCOMES MEASURES: Time trends in rates of @entity14 mortality, using joinpoint regression analysis. Rates were age adjusted using the standard European population. RESULTS: From 1989 to 2011, @entity14 mortality increased by a median of 6.0% for @entity1 and decreased by a median of 14.7% for @entity1 in the 34 European countries. Reductions in @entity14 mortality of more than 25% in @entity1 and 30% in @entity1 occurred in Austria, Switzerland, Germany, the United Kingdom, Belgium, the Czech Republic, Luxembourg, and Ireland. By contrast, mortality rates fell by less than 17% in the Netherlands and Sweden for both sexes. Over the same period, smaller or no declines occurred in most central European countries. Substantial mortality increases occurred in Croatia, the former Yugoslav republic of Macedonia, and Romania for both sexes and in most eastern European countries for @entity1 . In countries with decreasing mortality, reductions were more important for @entity1 of all ages and @entity1 younger than 65 years. In the 27 European Union member states, @entity14 mortality fell by 13.0% in @entity1 and 27.0% in @entity1 , compared with corresponding reductions of 39.8% and 38.8% in the United States. CONCLUSION: Over the past 40 years, there has been considerable disparity in the level of @entity14 mortality between European countries, as well as between @entity1 and @entity1 and age categories. Countries with the largest reductions in @entity14 mortality are characterised by better accessibility to screening services, especially endoscopic screening, and specialised care.
