[The burden of non-acute dying on society: dying of cancer and chronic disease in the European Union doi 10.1136/bmjspcare-2011-000162]
Cancer and chronic disease account for almost half of gradual deaths in European Union countries, suggests research published online in BMJ Supportive & Palliative Care.
While there are variations in the absolute numbers across all 27 European Union (EU) countries, the figures suggest a need for both long and short term palliative care strategies to accommodate this trend, say the authors.
They base their findings on certifications for all deaths that were not sudden in all 27 European countries in 2007, although the most up to date information in some (Bulgaria, Belgium, Denmark and Malta) only went up to 2004 or 2006.
The total EU population for the study period totalled 495 million, of whom 4.8 million died. Of these, 2 million died of cancer (1 in 4); chronic heart failure (around 1 in 20); chronic respiratory disease; diabetes; chronic liver failure; dementia; neurological diseases; chronic kidney failure; and HIV/AIDS.
Taken together, the crude death rate per 100,000 of the population was 409 for cancer and chronic disease in 2007, although this varied considerably across all the countries. This figure compares with 594 per 100,000 of the population for sudden deaths.
The rate was highest in Bulgaria, Hungary, and Denmark and lowest in Cyprus, Ireland, and Slovakia.
As the crude death rate does not factor in age or gender, it was then looked at specifically in those aged 65 and over, giving an overall figure of 1783 compared with 2789 for sudden deaths.
Bulgaria, Denmark and The Netherlands topped the list of countries with the highest rates among the older age groups, while Latvia, Lithuania, and Estonia had the lowest rates.
Generally, countries with relatively high crude death rates for cancer and chronic diseases had relatively low rates for sudden deaths among those aged 65 and over.
On the basis of this figure, and extrapolating reported data on symptom prevalence, thousands of people would have experienced symptoms such as pain, depression, anxiety, confusion, fatigue and breathlessness before they died, say the authors.
The authors conclude that as the population continues to survive into old age, the numbers dying of cancer and chronic disease is going to increase, requiring palliative care strategies and facilities to alleviate these symptoms and improve the quality of life.