Respiratory diseases statistics

Data extracted in July 2024.

Planned article update: September 2025.

Highlights

Diseases of the respiratory system accounted for 6.1% of all deaths in the EU in 2021.

In 2022, at least three-quarters of all people aged 65 years and over in Denmark, Portugal and Ireland had been vaccinated against influenza, the highest shares among the EU countries.

On average in 2021, in-patients with diseases of the respiratory system spent between 5.2 days (the Netherlands) and 12.0 days (Czechia) in hospital.

Influenza vaccination rate, people aged 65 years or over, 2022

This article presents an overview of European Union (EU) statistics related to deaths from diseases of the respiratory system and healthcare for diseases of the respiratory system.

The respiratory system is a series of organs that are responsible for breathing; the lungs are the primary organ of this system, which also includes the nasal passage, oral cavity, pharynx, larynx, trachea, bronchi and bronchioles. Diseases of the respiratory system are 1 of the main causes of death in the EU and include conditions such as influenza, chronic obstructive pulmonary disease, pneumonia or asthma. Note that the statistics presented in this article do not cover cancer of the respiratory system (such as lung cancer), which is covered in the article Cancer statistics - specific cancers; diseases of the respiratory does not include data on COVID-19.

This article is 1 of a set of statistical articles concerning healthcare activities in the EU which forms part of an online publication on Health in the European Union – facts and figures.

Deaths from diseases of the respiratory system

Diseases of the respiratory system accounted for 6.1% of all deaths in the EU in 2021

In 2021, there were 324 300 deaths in the EU resulting from diseases of the respiratory system, equivalent to 6.1% of all deaths among residents. Table 1 shows that, in 2021, the proportion of deaths in Malta and Denmark from respiratory diseases was considerably higher than the EU average, at 10.8% and 10.5%, respectively. At the other end of the range, respiratory diseases were the main cause of death for fewer than 3.5% of the population in the Baltic countries, Slovenia and Finland.

Table 1: Causes of death – diseases of the respiratory system, residents, 2021
Source: Eurostat (hlth_cd_aro) and (hlth_cd_asdr2)

Across the EU, a higher proportion of males than females died from diseases of the respiratory system (6.7% compared with 5.6%) in 2021. This situation was repeated in most of the EU countries. The difference was most pronounced in Spain (where the gender gap was 2.2 percentage points higher among males than females), and Romania, which had a gap of 2.0 points. While the shares for males and females were approximately the same in Slovenia, a higher proportion of deaths among females (rather than males) were attributed to diseases of the respiratory system in 5 EU countries: Sweden, Ireland, Greece and Denmark, with the largest gender gap in Malta (0.6 points higher in females than males).

Standardised death rates for respiratory diseases were higher for males than for females

The EU's standardised death rate for diseases of the respiratory system was 65.5 deaths per 100 000 inhabitants in 2021; the death rate for males (92.5 deaths per 100 000 male inhabitants) was almost twice as high as that for females (48.0 deaths per 100 000 female inhabitants). Standardised death rates for males were higher than those for females in 2021 in all of the EU countries. The gender difference may, at least in part, be attributed to different smoking habits between the sexes or to occupational risks (for example, more males work in extractive industries such as coal mining which may increase their risk of respiratory diseases). Standardised death rates from respiratory diseases for males were 3.0 to 3.7 times higher than those for females in all 3 Baltic countries, while elsewhere they were between 1.4 and 2.4 times higher; the smallest gender gap in relative terms was recorded in Malta, where the rate for males was just under 1.4 times higher than for females.

Table 1 shows that standardised death rates for diseases of the respiratory system were particularly concentrated among older people (297.8 deaths per 100 000 elderly inhabitants). The EU's standardised death rate for respiratory diseases among people aged 65 years and over was 32 times higher than the standardised death rate for people aged less than 65 years (9.2 deaths per 100 000 inhabitants under 65). This was considerably higher than the same ratio for all causes of death, where the standardised death rate for the older age group was 21 times higher than that for the younger age group.

A more detailed analysis of causes of death for diseases of the respiratory system is presented in Table 2. It shows that the main causes of death among respiratory diseases were lower respiratory diseases (chronic or other) and pneumonia, while standardised death rates for asthma and for influenza were considerably lower (please see Data sources section for information on influenza mortality in 2021).

Table 2: Standardised death rates – diseases of the respiratory system, residents, 2021
(per 100 000 male/female inhabitants)
Source: Eurostat (hlth_cd_asdr2)

In 2021, the highest standardised death rates for chronic lower respiratory diseases among the EU countries were recorded in Hungary for males (71.5 deaths per 100 000 male inhabitants) and in Denmark for females (59.2 per 100 000 female inhabitants). The lowest rates were recorded in France for males (19.8) and Latvia for females (4.4).

The highest rates for pneumonia were registered in Slovakia for both sexes (175.9 deaths per 100 000 male inhabitants and 107.8 per 100 000 female inhabitants) and Romania (109.2 per 100 000 male inhabitants and 58.3 per 100 000 female inhabitants). The lowest rates were recorded in Finland (0.9 for males and 0.6 for females).

Among the diseases with much lower mortality rates, Cyprus recorded the highest standardised death rates for asthma and status asthmaticus, also known as acute severe asthma, (3.6 deaths per 100 000 male inhabitants and 5.5 per 100 000 female inhabitants), while Greece recorded the lowest rates (0.1 for males and 0.3 for females).

Bulgaria and Sweden had the highest standardised death rates for influenza, with 1.2 deaths per 100 000 male inhabitants and 0.5 deaths per 100 000 female inhabitants, respectively. Several countries (9 for males and 11 for females) reported 0.0 deaths from influenza in 2021 (please see Data sources section for information on influenza mortality in 2021).

The standardised death rate for asthma was higher among females

With the exception of asthma and status asthmaticus, EU standardised death rates in 2021 for males were higher than those for females for each of the causes of death presented in Table 2. Gender differences were most pronounced for other lower respiratory diseases and chronic lower respiratory diseases as the standardised death rates for males in the EU were 2.1 and 2.0 times higher than the corresponding rates for females. The EU standardised death rate for asthma and status asthmaticus was higher for females (1.2 deaths per 100 000 female inhabitants) than the corresponding rate for males (1.0 deaths per 100 000 male inhabitants).

For asthma and status asthmaticus, the rates in 2021 for females were higher than the rates for males for 21 of the EU countries (although often differences could only be seen when looking at data with 2 or more decimal places). This difference between the sexes was largest in Slovenia, where the female standardised death rate for asthma and status asthmaticus was 3.4 times higher than that recorded for males. Large relative differences were also observed in Greece and Spain, where the female death rate was more than twice as high as the male rate. Among the 6 EU countries where the death rate for asthma and status asthmaticus was higher for males than for females, the largest relative difference was in Latvia (1.6 times higher among males).

For the other causes of death presented in Table 2, the rates for females were rarely higher than those for males; this was the case in Czechia, Denmark, Hungary, Romania and Finland for influenza and in Sweden for lower respiratory diseases (both chronic and other).

Preventive care – vaccination

At least three-quarters of people aged 65 years and over in Denmark, Portugal and Ireland were vaccinated against influenza

Vaccination is as effective measure of preventative care which can reduce the number of deaths and some of the costs associated with influenza epidemics. Among the EU countries, there is a range of different policies with respect to making influenza vaccines available to the general public. Often these vaccines are targeted at older age groups or other at-risk groups.

Figure 1 shows the rate of vaccinations against influenza among people aged 65 years and over: there are considerable differences between EU countries. At least three-quarters of people aged 65 years and over in Denmark, Portugal and Ireland were vaccinated against influenza in 2022. By contrast, fewer than 10.0% of people aged 65 years and over were vaccinated against influenza in Slovakia and Poland.

In 18 of the EU countries for which data are presented (see Figure 1 for more information on the coverage), the share of the elderly vaccinated against influenza was higher in 2022 than it was in 2012. The proportion of the population aged 65 years and over that was vaccinated against influenza was more than 20 points higher in 2022 than in 2012 in Portugal, Estonia, Denmark, Sweden and Finland (break in series). By contrast, the share of people aged 65 years and over that was vaccinated fell 15.3 points in Germany (2013–22; break in series) and 11.3 points in Malta (2014–22).

Figure 1: Influenza vaccination rate, people aged 65 years and over, 2012 and 2022
(%)
Source: Eurostat (hlth_ps_immu)

In-patient respiratory healthcare

In 2021, approximately 4.2 million in-patients with diseases of the respiratory system were discharged from EU hospitals

Across the EU in 2021 (2020 data for Malta; no recent data for Denmark, Greece or Luxembourg), in-patients with diseases of the respiratory system (codes J00 to J99) spent a total of 34.5 million days in hospital. By far the highest number of in-patient days was spent in German hospitals (26.6% of the EU total), while Italy (12.6%) was the only other EU country to record a double-digit share.

Around 4.2 million in-patients with diseases of the respiratory system were discharged from EU hospitals in 2021 (2020 data for Malta; no recent data for Denmark, Greece or Luxembourg). Discharges of in-patients treated for respiratory diseases accounted for 14.2% of the total number of hospital in-patient discharges in Romania, 12.7% in Cyprus, 11.6% in Lithuania and 11.2% in Estonia. By contrast, respiratory diseases accounted for a relatively small share of the total number of in-patient discharges in France (4.7%), Latvia (4.7%) and Hungary (4.8%).

Additional information on this topic is available in the article Hospital discharges and length of stay statistics.

Lithuania, Romania and Bulgaria had highest number of in-patient discharges per 100 000 inhabitants

Relative to population size, Lithuania, Romania and Bulgaria recorded the highest in-patient discharge rates among those treated for diseases of the respiratory system in 2021 (see Figure 2), each in excess of 1 800 per 100 000 inhabitants. The Netherlands had the lowest in-patient discharge rates for diseases of the respiratory system, 449 per 100 000 inhabitants.

Figure 2: Hospital discharge rates for in-patients with diseases of the respiratory system, 2021
(per 100 000 inhabitants)
Source: Eurostat (hlth_co_disch2)

The length of hospital stays for in-patients with diseases of the respiratory system was generally close to the average for all types of disease

Table 3 presents an analysis of the average length of hospital stays for in-patients treated for a respiratory disease in 2016 and 2021. The average hospital stay in 2021 ranged in length from 5.2 days in the Netherlands and 5.3 days in Sweden up to 10.8 days in Italy and a peak of 12.0 days in Czechia.

In France, the average length of a hospital stay for those treated for a disease of the respiratory system in 2021 was 2.7 days shorter than the average for all diseases. Aside from France, the average length of a hospital stay due to a disease of the respiratory system was similar to the average for all diseases in most of the EU countries, as this difference generally ranged between 1.2 days shorter for diseases of the respiratory system to 1.3 days longer. However, there were 6 EU countries that reported that the average length of a hospital stay due to a disease of the respiratory system was at least 1.9 days longer than the average for all diseases. The largest differences were observed in Slovenia (2.5 days) and Italy (2.3 days); the other countries in this group were Czechia, Ireland, Cyprus and Belgium.

Table 3: In-patient average length of stay for respiratory diseases, 2016 and 2021
(days)
Source: Eurostat (hlth_co_inpst)

Among the 24 EU countries for which comparable data are available (incomplete or no data for Denmark, Greece and Luxembourg), the average length of a hospital stay for in-patients treated for a disease of the respiratory system increased between 2016 and 2021 in 18, was unchanged in Portugal (2018–21), and fell in the remaining 5 (Finland, Hungary, France, the Netherlands and Sweden). The largest decrease between 2016 and 2021 in the average time spent in hospital for in-patients treated for a disease of the respiratory system was 1.0 days in Finland. By contrast, Estonia, Latvia and Slovenia recorded the largest increases, up 3.6, 2.7 and 2.6 days, respectively.

The remainder of Table 3 provides a more detailed analysis of the average length of hospital stays for in-patients diagnosed with 5 different types of respiratory diseases. On average, in-patients with pneumonia (codes J12 to J18) and with asthma and status asthmaticus (codes J45 to J46) spent the largest number of days in hospital. These data are of interest, insofar as pneumonia was 1 of the leading causes of death among respiratory diseases, in contrast to asthma, which had a relatively low death rate. The average length of stay for pneumonia ranged from 15.8 days in Latvia to 5.5 days in Sweden. Comparatively, the average stay in hospital for in-patients being treated for asthma varied considerably across the EU countries, from highs of 14.6, 13.7 and 13.3 days in Croatia, Czechia and Germany, respectively, to no more than 3.0 days in Sweden, Ireland and France.

An increase of the average length of hospital stays for in-patients diagnosed with pneumonia was observed in 2021 compared with 2016 in 16 countries for which the data are available. This could be an effect of the COVID-19 pandemic in 2021, which demanded increased efforts in treating cases of pneumonia and impacted intensive care unit beds availability.

For in-patients diagnosed with acute upper respiratory infections and influenza (J00-J11) the average length of stay was highest in Czechia at 7.3 days and lowest in Ireland at 1.7 days. For other acute lower respiratory diseases (J20-J22) inpatients in Malta (2020 data) spent an average of 11.8 days in hospital compared with 3.1 in Finland. For the remainder of respiratory diseases in-patients, categorized as other diseases of upper respiratory tract (J60-J99), the average length of stay was less than 6 days in all countries.

Source data for tables and graphs

Respiratory diseases: tables and figures

Data sources

Key concepts

An in-patient is a patient who is formally admitted (or 'hospitalised') to an institution for treatment and/or care and stays for a minimum of 1 night or more than 24 hours in the hospital or other institution providing in-patient care. An in-patient or day care patient is discharged from hospital when formally released after a procedure or course of treatment (episode of care). A discharge may occur because of the finalisation of treatment, signing out against medical advice, transfer to another healthcare institution, or because of death.

The number of deaths from a particular cause of death can be expressed relative to the size of the population. A standardised (rather than crude) death rate can be compiled which is independent of the age and sex structure of a population: this is done as most causes of death vary significantly by age and according to sex and the standardisation facilitates comparisons of rates over time and between countries.

Healthcare resources and activities

Statistics on healthcare activities (such as information on hospital discharges) are documented in this background article on Healthcare non-expenditure statistics - methodology which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions.

For hospital discharges and the length of stay in hospitals, the International Shortlist for Hospital Morbidity Tabulation (ISHMT) is used to classify data from 2000 onwards; Chapter X covers diseases of the respiratory system:

J00-J11 acute upper respiratory infections and influenza (ISHMT code 1001)
J12-J18 pneumonia (ISHMT code 1002)
J20-J22 other acute lower respiratory infections (ISHMT code 1003)
J35 chronic diseases of the tonsils and adenoids (ISHMT code 1004)
J30-J34, J36-J39 other diseases of upper respiratory tract (ISHMT code 1005)
J45-J46 asthma (ISHMT code 1007)
J60-J99 other diseases of the respiratory system (ISHMT code 1008)

For country specific notes on these data collections, please refer to the annexes at the end of the national metadata reports accessible from links at the beginning of the European metadata report.

The Healthcare non-expenditure statistics manual provides an overview of the classifications, both for mandatory variables and variables provided on a voluntary basis.

Eurostat is in the process of updating the technical requirements for countries to submit hospital discharge data in line with Commission Regulation 2294/2022. Therefore, the hospital discharge data in this article refer to reference year 2021.

Causes of death

Statistics on causes of death provide information on mortality patterns, supplying information on developments over time in the underlying causes of death. This source is documented in more detail in this background article on Causes of death statistics - methodology which provides information on the scope of the data, its legal basis, the methodology employed, as well as related concepts and definitions.

Causes of death are classified according to the 86 causes in the European shortlist, which is based on the International Statistical Classification of Diseases and Related Health Problems (ICD). Chapter X of the ICD covers diseases of the respiratory system:

J00 to J06 acute upper respiratory infections
J09 to J18 influenza and pneumonia
J20 to J22 other acute lower respiratory infections
J30 to J39 other diseases of upper respiratory tract
J40 to J47 chronic lower respiratory diseases
J60 to J70 lung diseases due to external agents
J80 to J84 other respiratory diseases principally affecting the interstitium
J85 to J86 suppurative and necrotic conditions of lower respiratory tract
J90 to J94 other diseases of pleura
J95 to J99 other diseases of the respiratory system

The significant decrease in influenza deaths in 2021 could be attributed, at least in part, to a combination of public health measures, such as enhanced vaccination strategies, social distancing, mask mandates and enhanced hygiene practices enacted to tackle the COVID-19 pandemic. It should also be taken into account that at the beginning of the pandemic, WHO guidelines recommended the use of COVID-19 ICD-10 codes for all deaths from clinically compatible illnesses, and where COVID-19 contributed to the death , which may play a part in the underreporting of influenza deaths.

Symbols

Tables in this article use the following notation:

Value in italics: estimate or provisional data
Value is: people available

Context

There are many factors that can affect the health of a person's respiratory system. Most of these are linked to lifestyle or environmental factors, such as smoking or pollution. Indeed, smoking tobacco is the main cause of lung disease in Europe (note that the data presented in this article do not cover cancer; for further information, see an article on specific cancers), while it is also considered to be a major contributory factor to the incidence of chronic obstructive pulmonary disease (COPD) and the development of asthma in children and adults; furthermore, respiratory diseases also occur among people who are subject to passive smoking.

EU countries have taken various tobacco control measures in the form of legislation, recommendations and information campaigns in an attempt to reduce the number of smokers. From a public health perspective, these measures aim to protect citizens from the hazardous effects of smoking and other forms of tobacco consumption.

Air pollution is a major respiratory health issue: activities involving the burning of fossil fuels, such as some industrial activities, power generation, vehicle emissions and household heating/cooking, as well as natural phenomena (such as volcanic eruptions or dust storms) have the potential to cause respiratory diseases. Most sources of outdoor air pollution are beyond the control of individuals and require action by urban, national or international policymakers. Countries that reduce air pollution are likely to benefit from a reduced burden from heart disease, lung cancer, chronic and acute respiratory diseases (including asthma). In urban areas, policies that can potentially alleviate air pollution include support for cleaner transport (including the introduction of low emission zones), energy-efficient housing, or better municipal waste management, while in rural areas air pollution may be alleviated by reducing agricultural waste incineration, forest fires and certain agro-forestry activities.

Indoor air pollution is also generated by a variety of sources, including human activity (smoking, fuel used for heating or cooking, the use of cleaning materials), pets, plants, dust or damp, and may be exacerbated by poor ventilation.

Influenza is an annual, seasonal infectious disease caused by the influenza virus; it affects Europe in the winter. The majority of people who die from influenza are aged 65 years and over and face complications based on chronic diseases such as cardiovascular diseases or chronic lung diseases. During an influenza epidemic, there may be significant costs for health services (associated with caring for those who fall sick) and for businesses in general (lost production because of time taken off work).

Chronic respiratory diseases are included as 1 of the 5 main strands covered by the European Commission's Healthier together – EU non-communicable diseases (NCD) initiative. The initiative was launched in December 2021 and aims to support EU countries in identifying and implementing effective policies and actions to reduce the burden of major non-communicable diseases and improve citizens' health and well-being.

Explore further

Database

Health (hlth), see

Health care (hlth_care)

Health care activities (hlth_act)

Hospital discharges and length of stay for inpatient and curative care (hlth_co_dischls)

Hospital discharges - national data (hlth_hosd)

Length of stay in hospital (hlth_hostay)

Preventive services (hlth_prev)

Vaccination against influenza of population aged 65 and over (hlth_ps_immu)

Causes of death (hlth_cdeath)

General mortality (hlth_cd_gmor)

Causes of death - deaths by country of residence and occurrence (hlth_cd_aro)

Causes of death - standardised death rate by NUTS 2 region of residence (hlth_cd_asdr2)

Thematic section

Health

Publications

Atlas

Health statistics – Atlas on mortality in the European Union

News releases

Selected datasets

Health (t_hlth), see

Causes of death (t_hlth_cdeath)

Death due to pneumonia, by sex (tps00128)

Methodology

Manuals and guidelines

Healthcare non-expenditure statistics manual – Guidelines for completing the Joint questionnaire on non-monetary healthcare statistics – 2023 edition

Metadata

Causes of death (SIMS metadata file – hlth_cdeath_sims)
Health care resources (ESMS metadata file – hlth_res_esms)

External links