Life expectancy

In 2019, LE in Belgium was 79 years [95% UI 78.7–79.2] for men and 84 years [95% UI 83.6–84] for women. Between 1990 and 2019, LE at birth increased significantly for both men (+ 6.2 years) and women (+ 4.3 years). In 2019, life expectancy in Belgium was slightly below the EU-15 average for both men (-0.7) and women (-0.5) (EU-15 LE in men: 79.7 years [95% UI 79.4–80]; EU-15 LE in women 84.3 years [95% UI 84–84.5] – these differences were significant. Across the EU-15 countries, LE in Belgian men and women ranked 12th and 10th, respectively (Fig. 1). This is worse compared to the LE among men and women in 1990, where Belgium ranked 8th for LE in men and women.

Fig. 1

Life expectancy (LE) at birth in the EU-15, in 1990 and 2019, for men and women

Mortality rates

In men, age-standardised mortality rates for the top five causes of death observed in 2019 were ischaemic heart disease (74 deaths [95% UI: 68–79] per 100,000), tracheal, bronchus, and lung cancer (henceforth referred to as “lung cancer”) (55 deaths [95% UI: 51–58] per 100,000), chronic obstructive pulmonary disease (COPD) (37 deaths [95% UI: 32–42] per 100,000), stroke (35 deaths [95% UI: 31–39] per 100,000), and lower respiratory infections (27 deaths [95% UI: 24–30] per 100,000). The top five causes of mortality identified in women were ischaemic heart disease (40 deaths [95% UI: 34–44] per 100,000), stroke (30 deaths [95% UI: 26–34] per 100,000), breast cancer (23 deaths [95% UI: 21–25] per 100,000), Alzheimer’s disease and other dementias (henceforth referred to as “dementia” (22 deaths [95% UI: 6–56] per 100,000), and lung cancer (19 deaths [95% UI: 18–21] per 100,000).

Evolution 1990–2019

Age-standardised mortality rates for men significantly dropped from 924 [95% UI: 916–931] per 100,000 in 1990 to 559 [95%UI: 546–572] per 100,000 in 2019 (-365 deaths per 100,000; -40%). The main contributors to this significant decrease were ischaemic heart disease (-121 deaths per 100,000), lung cancer (-49 deaths per 100,000), stroke (-49 deaths per 100,000), COPD (-27 deaths per 100,000), and road injuries (-19 deaths per 100,000) (Fig. 2).

Fig. 2

Absolute change in age-standardised death rates per 100,000 in men, 1990–2019, Belgium

Age-standardised mortality rates for women also decreased significantly, from 541 [95% UI: 536–546] per 100,000 in 1990 to 362 [95% UI: 354–371] per 100,000 in 2019 (-179 deaths per 100,000; -33%). The main contributors to this significant decrease were ischaemic heart disease (-68 deaths per 100,000), stroke (-40 deaths per 100,000), breast cancer (-13 deaths per 100,000), colorectal cancer (-9 deaths per 100,000), and diabetes mellitus (-7 deaths per 100,000). Deaths caused by lung cancer however significantly increased from 13 deaths [95% UI: 12–14] per 100,000 to 20 deaths [95% UI: 18–21] per 100,000 (+ 7 deaths per 100,000) (Fig. 3).

Fig. 3

Absolute change in age-standardised death rates per 100,000 in women, 1990–2019, Belgium

Benchmarking

In 2019, the age-standardised mortality rate was higher than the EU-15 average for both Belgian men (BE: 559 deaths [95% UI: 546–572] – EU-15: 526 deaths [95% UI: 513–541]), and women (BE: 362 deaths [95% UI: 354–371] – EU-15: 348 deaths [95% UI: 340–357]). Across the EU-15 countries, Belgium ranked 12th and 10th in terms of age-standardised mortality rates for men and women, respectively. This is a worsening compared to 1990, when Belgium ranked 9th and 6th, respectively.

In Belgium, men performed significantly worse compared to the EU-15 average in terms of lung cancer (+ 13 deaths per 100,000), lower respiratory infections (+ 9 deaths per 100,000), COPD (+ 8 deaths per 100,000), self-harm (+ 8 deaths per 100,000), and falls (+ 3 deaths per 100,000). Men however performed significantly better in terms of ischaemic heart disease (-12 deaths per 100,000) and hypertensive heart disease (-4 deaths per 100,000). Belgian women performed significantly worse in terms of lower respiratory infections (+ 5 deaths per 100,000), self-harm (+ 4 deaths per 100,000) and breast cancer (+ 3 deaths per 100,000) but significantly better in terms of ischaemic heart disease (-8 deaths per 100,000) and hypertensive heart disease (-4 deaths per 100,000).

Compared to each individual EU-15 country, Belgian men performed worse than men in 8 other countries in terms of lung cancer, and better than men in 7 countries in terms of ischaemic heart disease. Belgian women performed worst in terms of lower respiratory infections (6 countries), and best in terms of ischaemic heart disease (5 countries).

Years of life lost

In men, in 2019, age-standardised YLL rates were primarily due to ischaemic heart disease (1,221 YLLs [95% UI: 1,151–1,285] per 100,000), lung cancer (1,141 YLLs [95% UI: 1,071–1,208] per 100,000), self-harm (951 YLLs [95% UI: 895–1,014] per 100,000), COPD (543 YLLs [95% UI: 479–623] per 100,000), and stroke (519 YLLs [95% UI: 471–564] per 100,000). The major causes of age-standardised YLLs in women were breast cancer (557 YLLs [95% UI: 520–599] per 100,000), ischaemic heart disease (529 YLLs [95% UI: 472–573] per 100,000), lung cancer (471 YLLs [95% UI: 435–510] per 100,000), stroke (416 YLLs [95% UI: 367–457] per 100,000) and self-harm (336 YLLs [95% UI: 313–360] per 100,000).

Evolution 1990–2019

Age-standardised YLL rates for men significantly decreased from 20,493 [95% UI: 20,296–20,692] per 100,000 in 1990, to 11,526 [95%UI: 11,161–11,930] per 100,000 in 2019 (-8967 YLLs per 100,000; -44%) (Fig. 4). The main contributors to the significant YLL decrease in men were ischaemic heart disease (-2,283 YLLs per 100,000), lung cancer (-1,112 YLLs per 100,000), road injuries (-1,054 YLLs per 100,000), stroke (-793 YLLs per 100,000), and COPD (-442 YLLs per 100,000). YLLs however increased between 1990 and 2019 for drug use disorders (+ 84 YLLs per 100,000), alcohol use disorders (+ 46 YLLs per 100,000), and liver cancer (+ 36 YLLs per 100,000) (Fig. 5). Drug use disorders are related to the use of opioids, amphetamines, cocaine, cannabis and others [19].

Fig. 4

Evolution of age-standardised Years Lived with Disability (YLDs) and Years of Life Lost (YLLs) rates per 100,000 in men and women, Belgium, 1990–2019

Fig. 5

Absolute change in age-standardised Years of Life Lost (YLLs) rates per 100,000 in men, 1990–2019, Belgium

Age-standardised YLL rates for women also decreased significantly, from 11,396 [95% UI: 11,271–11,524] per 100,000 in 1990, to 6,962 [95%UI: 6,740–7,208] per 100,000 in 2019 (-4,434 deaths per 100,000; -40%) (Fig. 4). The main causes of the significant decrease in YLLs in women were ischaemic heart disease (-1,036 YLLs per 100,000), stroke (-627 YLLs per 100,000), breast cancer (-397 YLLs per 100,000), road injuries (-371 YLLs per 100,000) and neonatal disorders (-303 YLLs per 100,000). YLLs caused by lung cancer, however, significantly increased from 317 YLLs [95% UI: 301–333] per 100,000 to 471 YLLs [95% UI: 435–510] per 100,000 (+ 154 per 100,000; + 54%) (Fig. 6).

Fig. 6

Absolute change in age-standardised Years of Life Lost (YLLs) rates per 100,000 in women, 1990–2019, Belgium

Benchmarking

In 2019, the age-standardised YLL rate in Belgium was higher than the EU-15 average for both men (BE: 11,526 YLLS [95%UI: 11,161–11,930] – EU-15: 10,737 YLLs [95% UI: 10,368–11,153]), and women (BE: 6,962 YLLs [95%UI: 6,740–7,208] – EU-15: 6,497 YLLs [95% UI: 6274–6750]). Across the EU-15 countries, Belgium ranked 12th and 10th in terms of age-standardised YLL rates for men and women, respectively. This is a worsening compared to 1990, where Belgium ranked 8th for both men and women.

Belgian men performed significantly worse compared to the EU-15 average in terms of self-harm (+ 358 YLLs per 100,000), lung cancer (+ 259 YLLs per 100,000), COPD (+ 148 YLLs per 100,000), road injuries (+ 113 YLLs per 100,000), and lower respiratory infections (+ 107 YLLs per 100,000). Men however performed significantly better in terms of ischaemic heart disease (-196 YLLs per 100,000) and drug use disorders (-56 YLLS per 100,000). Belgian women performed significantly worse in terms of self-harm (+ 150 YLLs per 100,000), and breast cancer (+ 76 YLLs per 100,000) but significantly better in terms of ischaemic heart disease (-63 YLLs per 100,000) and hypertensive heart disease (-40 YLLs per 100,000).

Compared to the individual EU-15 countries, in terms of self-harm, Belgian men and women performed worse than 9 and 8 countries respectively, and better than 6 countries in terms of ischaemic heart disease for both men and women.

Years lived with disability (YLD)

In 2019, the main causes of age-standardised YLD rates in men were low back pain (898 YLDs [95% UI: 624–1,215] per 100,000), falls (596 YLDs [95% UI: 408–855] per 100,000), headache disorders (576 YLDs [95% UI: 87–1,309] per 100,000), depressive disorders (478 YLDs [95% UI: 329–660] per 100,000), and diabetes mellitus (424 YLDs [95% UI: 277–606] per 100,000). The main causes of age-standardised YLD rates in women were headache disorders (1,206 YLDs [95% UI: 184–2,802] per 100,000), low back pain (1,184 YLDs [95% UI: 833–1,595] per 100,000), gynaecological disorders (1,129 YLDs [95% UI: 764–1,568] per 100,000), depressive disorders (762 YLDs [95% UI: 517–1,069] per 100,000), and falls (616 YLDs [95% UI: 427–862] per 100,000).

Evolution 1990–2019

Age-standardised YLD rates for men increased, albeit with overlapping UIs, from 9,726 [95% UI: 7,192–12,669] per 100,000 in 1990, to 9,901 [95%UI: 7,332- 12,889] per 100,000 in 2019 (+ 175 YLDs per 100,000; + 1.8%) (Fig. 4). The main contributors to the increase in YLDs between 1990 and 2019 in men were diabetes mellitus (+ 169 YLDs per 100,000), falls (+ 114 YLDs per 100,000), drug use disorders (+ 55 YLDs per 100,000), depressive disorders (+ 43 YLDs per 100,000), and other musculoskeletal disorders (+ 40 YLDs per 100,000). In the same period, YLDs caused by asthma and road injuries have decreased (-106 YLDs per 100,000 and -71 YLDs per 100,000, respectively) (Fig. 7).

Fig. 7

Absolute change in age-standardised Years Lived with Disability (YLDs) rates per 100,000 in men, 1990–2019, Belgium

As for men, there was an increase in age-standardised YLD rates for women, from 11,808 [95% UI: 8,623–15,448] per 100,000 in 1990, to 12,178 [95%UI: 8,886–15,797] per 100,000 in 2019 (+ 371 YLDs per 100,000; + 3.1%) (Fig. 4). The main contributors to the increase in YLDs in women were falls (+ 158 YLDs per 100,000), diabetes mellitus (+ 133 YLDs per 100,000), headache disorders (+ 116 YLDs per 100,000), depressive disorders (+ 58 YLDs per 100,000), and COPD (+ 52 YLDs per 100,000). In the same period, YLDs caused by asthma (-97 YLDs per 100,000) decreased (Fig. 8).

Fig. 8

Absolute change in age-standardised Years Lived with Disability (YLDs) rates per 100,000 in women, 1990–2019, Belgium

Benchmarking

In 2019, the age-standardised YLD rate in Belgium was higher, albeit with overlapping UIs, than the EU-15 average for both men (BE: 9,900 YLDs [95%UI: 7,332- 12,889] – EU-15: 9,571 YLDs [95% UI: 7,082–12,403]), and women (BE: 12,178 YLDs [95%UI: 8,886–15,797] – EU-15: 12,023 YLDs [95% UI: 8,821–15,684]). Across the EU-15 countries, Belgium ranked 14th and 12th in terms of age-standardised YLD rates for men and women, respectively. This is a worsening compared to 1990, where Belgium ranked 9th and 5th for men and women, respectively.

Belgian men performed worse compared to the EU-15 average in terms of endocrine, metabolic, blood, and immune disorders (+ 119 YLDs per 100,000), falls (+ 110 YLDs per 100,000), headache disorders (+ 83 YLDs per 100,000), osteoarthritis (+ 52 YLDs per 100,000) and, COPD (+ 49 YLDs per 100,000). Men performed better, albeit with overlapping UIs, in terms of asthma (-51 YLDs per 100,000) and neck pain (-50 YLDs per 100,000). Belgian women performed worse in terms of headache disorders (+ 225 YLDs per 100,000), falls (+ 174 YLDs per 100,000), gynaecological disorders (+ 138 YLDs per 100,000), oral disorders (+ 50 YLDs per 100,000), and COPD (+ 37 YLDs per 100,000). Women performed better, albeit with overlapping UIs, in terms of anxiety disorders (-122 YLDs per 100,000) and depressive disorders (-105 YLDs per 100,000).

Compared to the individual EU-15 countries, Belgian men performed worst in terms of falls (6 countries), and best in terms of low back pain (3 countries). Belgian women performed worst in terms of headache disorders (8 countries), and best in terms of anxiety disorders (7 countries).

Disability-adjusted life years (DALY)

In 2019, the main causes of age-standardised DALY rates in men were ischaemic heart disease (1,291 DALYs [95% UI: 1,221–1,362] per 100,000), lung cancer (1,156 DALYs [95% UI: 1,084–1,223] per 100,000), self-harm (968 DALYs [95% UI: 913–1,034] per 100,000), low back pain (898 DALYs [95% UI: 624–1,215] per 100,000), and falls (840 DALYs [95% UI: 648–1,094] per 100,000) (Table 1). The main causes of age-standardised DALY rates in women were headache disorders (1,206 DALYs [95% UI: 184–2,801] per 100,000), low back pain (1,184 DALYs [95% UI: 833–1,595] per 100,000), gynaecological disorders (1,129 DALYs [95% UI: 765–1,569] per 100,000), depressive disorders (762 DALYs [95% UI: 517–1,069] per 100,000), and falls (751 DALYs [95% UI: 558–998] per 100,000) (Table 2).

Table 1 Age-standardised Disability-Adjusted Life Years (DALYs) per 100,000 by cause, men, 1990 and 2019, BelgiumTable 2 Age-standardised Disability-Adjusted Life Years (DALYs) per 100,000 by cause, women, 1990 and 2019, BelgiumEvolution 1990–2019

Age-standardised DALY rates for men significantly decreased from 30,219 DALYs [95% UI: 27,638–33,092] per 100,000 in 1990, to 21,427 DALYs [95% UI: 18,812–24,409] per 100,000 in 2019 (-8,792 DALYs per 100,000). The main contributors to the significant DALY decrease in men were ischaemic heart disease (-2,307 DALYs per 100,000), road injuries (-1,125 DALYs per 100,000), lung cancer (-1,121 DALYs per 100,000), stroke (-832 DALYs per 100,000) and COPD (-442 DALYs per 100,000). On the other hand, DALYs associated with drug use disorders (+ 139 DALYs per 100,000), diabetes mellitus (+ 115 DALYs per 100,000), falls (+ 107 DALYs per 100,000), alcohol use disorders (+ 48 DALYs per 100,000), and endocrine, metabolic, blood, and immune disorders (+ 48 DALYs per 100,000) increased between 1990 and 2019, although the corresponding UIs were overlapping (Fig. 9).

Fig. 9

Absolute change in age-standardised Disability-Adjusted Life Year (DALY) rates per 100,000 in men, 1990–2019, Belgium

Age-standardised DALY rates for women also decreased, albeit with overlapping UIs, from 23,203 [95% UI: 20,051–26,847] per 100,000 in 1990, to 19,140 [95%UI: 15,835–22,728] per 100,000 in 2019 (-4,063 DALYs per 100,000; -18%). The main causes of the decrease in DALYs in women were ischaemic heart disease (-1,049 DALYs per 100,000), stroke (-662 DALYs per 100,000), road injuries (-410 DALYs per 100,000), breast cancer (-400 DALYs per 100,000), and neonatal disorders (-288 DALYs per 100,000). DALYs associated with lung cancer (+ 157 DALYs per 100,000), falls (+ 150 DALYs per 100,000), headache disorders (+ 116 DALYs per 100,000), COPD (+ 75 DALYs per 100,000), and drug use disorders (+ 65 DALYs per 100,000), increased between 1990 and 2019 (Fig. 10).

Fig. 10

Absolute change in age-standardised Disability-Adjusted Life Year (DALY) rates per 100,000 in women, 1990–2019, Belgium

Benchmarking

In 2019, the age-standardised DALY rate in Belgium was higher, albeit with overlapping UIs, than the EU-15 average for both men (BE: 21,427 DALYs [95% UI: 18,812–24,409] – EU-15: 20,307 DALYs per 100,000 [95% UI: 17,778–23,174]), and women (BE: 19,140 DALYs [95%UI: 15,835–22,728] – EU-15: 18,521 DALYs per 100,000 [95% UI: 15,328–22,184]). Across the EU-15 countries, Belgium ranked 12th in terms of age-standardised DALY rates for both men and women, respectively. This is a worsening compared to 1990, where Belgium ranked 7th and 8th for men and women, respectively.

In 2019, Belgian men performed significantly worse compared to the EU-15 average in terms of self-harm (+ 365 DALYs per 100,000), lung cancer (+ 262 DALYs per 100,000), COPD (+ 198 DALYs per 100,000). Men however performed significantly better in terms of ischaemic heart disease (-190 DALYs per 100,000). Belgian women performed worse in terms of falls (+ 229 DALYs per 100,000), headache disorders (+ 225 DALYs per 100,000), self-harm (+ 159 DALYs per 100,000), gynaecological disorders (+ 138 DALYs per 100,000), and breast cancer (+ 83 DALYs per 100,000). Women performed better in terms of anxiety and depressive disorders (-122 and -105 DALYs per 100,000, respectively).

Compared to the individual EU-15 countries, Belgian men performed worse than 9 countries in terms of self-harm, and better than 6 countries in terms of ischaemic heart disease. Belgian women performed worse than 6 countries in terms of falls, and better than 6 countries in terms of anxiety disorders.