Spatial Differences in Avoidable Mortality Across 581 European Districts, 2002–2019

Bibliographic Data

ID11295261
AuthorsSophie Stroisch (0000-0002-9398-6934, University of Groningen, corresponding author), Michael Mühlichen (0000-0002-7396-069X, Federal Institute for Population Research), Pavel Grigoriev (0000-0003-1419-9885, Federal Institute for Population Research), Tobias Vogt (0000-0002-4731-2787), Tobias C Vogt (0000-0002-1962-3473, University of Groningen)
Year2026
Volume42
Issue1
Pages5-5
Publication date2026-12-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueEuropean Journal of Population / Revue européenne de Démographie (JOURNAL)
Journal identifiersISSN: 0168-6577 • E-ISSN: 1572-9885
PublisherSpringer Science and Business Media LLC (PUBLISHER)
DOI10.1007/s10680-025-09761-7
PMID41364281
OpenAlexW4417150334
LanguageEN
Citations received3
References cited47

Despite ongoing efforts to reduce health disparities, substantial mortality differences persist across and within European countries. Avoidable mortality, i.e. deaths preventable through timely medical care or effective public health measures, provides a useful framework for assessing these inequalities. While previous studies largely focus on national differences, this study examines spatial differences and trends in avoidable mortality at the district level. We analysed official cause-of-death statistics for 581 districts across 10 European countries from 2002 to 2019, using age-standardised death rates (SDR) as the primary outcome. Spatiotemporal clusters were identified using emerging hotspot analysis. Our results show that SDRs for avoidable mortality declined across most districts for both sexes, yet marked disparities persist between men and women and between amenable and preventable mortality. Districts in Central and Eastern Europe consistently exhibited higher SDRs than those in Western and Southern Europe, while Germany occupies an intermediate position with particularly high rates for amenable mortality. Spatiotemporal hotspot analysis confirmed these patterns and showed that persistent high-mortality (hotspots) and low-mortality (coldspots) clusters persist, reflecting both substantial within-country inequalities and cohesive cross-border mortality patterns. These findings suggest that national boundaries are not always the most meaningful lines for explaining health outcomes. Instead, local socioeconomic and structural determinants of health play a central role. Persistent hotspots highlight areas where targeted interventions are urgently needed, while coldspots may offer lessons for best practices. Addressing these inequalities requires targeted, place-based, and transnational strategies to effectively reduce health inequalities in Europe

Global health · Health care · Health equity · Inequality · Mortality rate · Psychological intervention · Public health · Socioeconomic status · Chronic Disease Management Strategies · Employment and Welfare Studies · Health disparities and outcomes