Intended for healthcare professionals

Letters 600 extra deaths a week

Monitoring excess mortality in Europe

BMJ 2013; 347 doi: (Published 18 September 2013) Cite this as: BMJ 2013;347:f5568
  1. Michaël R Laurent, geriatrics registrar1
  1. 1University Hospitals Leuven, 3000 Leuven, Belgium
  1. michael.laurent{at}

The Belgian Scientific Institute for Public Health reported 10% excess mortality in June 2013 (700 additional deaths a month) in those aged 65 and older.1 No likely cause was identified because climatic circumstances, air pollution levels, and physician visits for influenza-like illnesses were unremarkable. However, it is expected that July’s heat wave will further contribute to excess mortality.

Belgium is one of 18 European countries that monitor excess mortality for public health action in the EuroMOMO project.2 Excess mortality was noted from the last weeks of 2012 through the first four months of 2013, but had returned to normal since week 17.

The project clearly shows that overall mortality is dominated by people aged 65 and older. The finding reported by Hawkes that “Up to 65 years of age there are no changes [in mortality], but in older age groups there are sharp increases, especially marked in those aged over 85” is entirely non-specific and consistent with the higher mortality risk with age.3

A Danish analysis showed that influenza activity was remarkably prolonged this winter and associated with higher mortality than in the past three seasons. This may be because H1N1 influenza had been dominant in Denmark since 2009, but this winter H3N2 and influenza B were the main circulating strains and older people would have had little immunity against these strains.4

Further analysis at the European level is needed to investigate recent excess mortality trends. A combination of infectious diseases and climate influences seems a plausible explanation, as in previous investigations.5


Cite this as: BMJ 2013;347:f5568


  • Competing interests: None declared.


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