Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694840148285.pdf (Malta)
DIRETTORAT TAL-INFORMAZZJONI TAS-SAĦĦA - RAPPORT ANNWALI TAL- IMWIET F’PAJJIŻNA 5477.

L-ONOR.

CLAUDETTE BUTTIGIEG staqsiet lill- Deputat Prim Ministru u Ministru għas-Saħħa: Jista’ d-Deputat Prim Ministru u Ministru għas-Saħħa jpoġġi fuq il-Mejda tal- Kamra r-rapport annwali tal-imwiet f’pajjiżna maħruġ mid-Direttorat tal-Informazzjoni tas- Saħħa u tar-Riċerka għas-snin 2018, 2019, 2020, 2021 u 2022?

20/01/2023 ONOR.
20/01/2023 ONOR.

CHRIS FEARNE: Ninforma lill-Onorevoli Interpellant illi waqt li r-rapporti tas-snin 2020, 2021 u 2022 qegħdin jinħadmu, qed impoġġi fuq il-mejda tal-kamra dokument bl- informazzjoni mitluba minnha tas-snin 2018 u 2019.

Seduta 81 25/01/2023 Annual Mortality Report 2018 Annual Mortality Report 2018 • During the year 2018, there were 3688 deaths among residents of the Maltese Islands, with a stable trend in the crude mortality rate and a downward trend in the standardised mortality rate.
• 70.6% of deaths occurred within a hospital setting.

The subset of these deaths which occurred at Mater Dei Hospital amounts to 54.4% of total deaths.

• Circulatory diseases, including heart disease and stroke, accounted for 33.5% of all deaths, while cancer deaths accounted for 28.3%.
• Standardised mortality rates for major causes of death including heart disease, cerebrovascular diseases and respiratory diseases are showing a downward or stable trend, whilst standardised mortality rate for lung cancer in females and diabetes mellitus in males is showing an upward trend.

• Standardised mortality rate for diabetes mellitus in Malta is higher than the EU average in both genders, especially in females.
• Causes of death vary with age and gender, with external causes of morbidity and mortality accounting for a large proportion of deaths in the younger age groups, cancers dominating the middle-aged groups, and circulatory diseases increasing in importance with increasing age.

Conditions such as dementia, pneumonia and diabetes mellitus are emerging as significant causes of death in the older age groups.
• Malta National Mortality Registry Page | 1 Annual Mortality Report 2018 Overview During the year 2018, there were 3688 deaths among residents of the Maltese Islands dying in Malta or abroad.

Of these, 1876 were male deaths and 1812 were female deaths.

This was an increase of 61 male and 56 female deaths from 2017.

There were also 79 deaths in non- residents dying in the Maltese Islands in 2018, an increase of 7 deaths from 2017.
Figure 1 below shows the number of deaths in residents during the year 2018 by age group and gender.

Figure 1: Number of deaths in 2018 by age group and gender Trends in the number of deaths and crude mortality rate over time Over the past 20 years (1999-2018), there has been an increasing trend in the number of deaths, with generally more male than female deaths.

However, this increase in number of deaths is due to population growth over the years.
In fact, the crude mortality rate (total number of deaths by gender divided by total mid-year population by gender multiplied by 100,000) has remained stable, indicating that the proportion of deaths per year has remained stable over the past 20 years (Figure 2).
Malta National Mortality Registry Page | 2 Annual Mortality Report 2018 Trends in number of deaths and crude mortality rate by gender 2000 1800 1600 1400 1200 1000 800 600 400 200 0 , 0 0 0 0 0 1 r e p e t a r y t i l a t r o m e d u r C / s h t a e d f o r e b m u N Year Number of deaths - males Number of deaths - females Crude mortality rate - males Crude mortality rate - females Figure 2: Number of deaths and crude mortality rate by gender over 20 years According to Eurostat, the life expectancy at birth for Malta was 80.4 years for males and 84.6 years for females in 2018, whilst life expectancy at age 65 stood at 19.2 years for males and 22.3 years for females.1 The oldest deaths recorded in 2018 were 101 years in males and 105 years in females.
The mean age at death was 74.0 years in males (median 77 years) and 79.5 years in females (median 83 years).

Standardised mortality rate in Malta compared with the European Union The age-standardised mortality rate (SMR) in Malta and the EU is showing a downward trend in both males and females, with rates for males being higher than in females.
Standardised mortality rates for both genders in Malta compare favourably with the EU average, with rates being lower for Malta than the EU average particularly in men (Figure 3).
1 Source: Eurostat database Malta National Mortality Registry Page | 3 Annual Mortality Report 2018 Standardised death rate , ) 0 0 0 0 0 1 r e p ( s e s u a c l l A 1200 1000 800 600 400 200 0 SDR MT - males SDR MT - females SDR EU - males SDR EU - females Year Figure 3: Trends in standardised mortality rate for males and females in Malta compared with the EU average 2 Distribution by type of place of death 70.6% of all deaths among residents occurred within a hospital setting, including both public and private hospitals but excluding residential homes.
There was a slight increase from 2017, whereby 69.8% of all deaths occurred in a hospital setting.

Figure 4 shows that 54.4% of total deaths occurred at Mater Dei Hospital (MDH), compared with 53.7% in 2017.

Thus, there was a slight increase in the proportion of deaths which occurred at MDH in the year 2018.
2 Source: European Health for All database (WHO); https://dw.euro.who.int/api/v3/export?code=HFA_194 Malta National Mortality Registry Page | 4 Annual Mortality Report 2018 Place of death Outside/not usual residence 2.2% Other 0.3% GGH 5.2% Other residential institutions 5.5% SVPR 10.0% Other hospitals 11.0% Usual residence 11.6% MDH 54.4% Figure 4: Percentage of deaths by place of death Causes of death Diseases of the circulatory system were the leading cause of death in 2018, with 1234 deaths or 33.5% of total deaths (Figure 5).
There was a decrease of 14 deaths (1.5% decrease) from the year 2017.

The three major causes of death within this category were ischaemic heart disease (624 deaths), cerebrovascular diseases (261 deaths), and other heart diseases including heart failure (236 deaths).

The number of deaths from neoplasms totalled 1056 (28.6% of total deaths), an increase of 93 deaths (1.6% increase) from 2017.
There were 389 deaths (10.5% of total) due to respiratory conditions, with the major causes being pneumonia (121 deaths) and chronic obstructive pulmonary disease (97 deaths).

Mental and behavioural disorders, including dementia which is an important cause of death in the elderly population, accounted for 7.1% of all deaths (261 deaths).

Endocrine and metabolic diseases accounted for 6.0% of all deaths (222 deaths), with the leading cause being diabetes mellitus (209 deaths).
Malta National Mortality Registry Page | 5 Annual Mortality Report 2018 Main causes of death Diseases of the genitourinary system 2.3% Other 2.1% Diseases of the nervous system 2.7% Infectious and parasitic diseases 1.3% Diseases of the digesive system 2.8% External causes 3.1% Endocrine, nutritional and metabolic diseases 6.0% Diseases of the circulatory system 33.5% Mental and behavioural disorders 7.1% Diseases of the respiratory system 10.5% Neoplasms 28.6% Figure 5: Main causes of death in 2018 Leading causes of death in males The main cause of death in males was ischaemic heart disease, which accounted for 18.9% of all male deaths in 2018 (Table 1), showing a decline from 2017 (21.2% of total male deaths).
In comparison, other diseases of the circulatory system showed a slight increase from 2017, namely cerebrovascular diseases (6.9% in 2018 compared with 6.0% in 2017) and other heart diseases (4.7% in 2018 compared with 4.2% in 2017).

Malignancy of the bronchus/lung was the second commonest cause of death, accounting for 7.7% of total deaths.
Other leading cancer deaths in males included colorectal cancer (4.1%) and prostate cancer (2.5%) which replaced pancreatic cancer in the top 10 causes of male deaths (pancreatic cancer accounted for 2.6% of total deaths in 2017 decreasing to 2.2% in 2018).

Other important causes of male Malta National Mortality Registry Page | 6 Annual Mortality Report 2018 deaths included diabetes mellitus and dementia which have both shown an increase when compared with 2017.
Diabetes mellitus accounted for 5.6% of total deaths in 2018 compared with 4.3% in 2017.

Dementia accounted for 5.0% of total deaths in 2018 compared with 3.5% in 2017.

Pneumonia and other acute lower respiratory tract infections showed a decline (4.7% of total male deaths in 2017 decreasing to 3.7% in 2018).
Cause of death Ischaemic heart disease Malignant neoplasm of bronchus and lung Cerebrovascular diseases Diabetes mellitus Dementia Other heart diseases Chronic lower respiratory diseases Malignant neoplasm of colon, rectum and anus Pneumonia and other acute lower respiratory infections Malignant neoplasm of prostate ICD-10 code I20-I25 C34 I60-I69 E10-E14 F01-F03, G30 I26-I51 J40-J47 C18-C21 J12-J22 C61 Table 1: Leading causes of death in males in the year 2018 Number of deaths 355 145 129 105 94 89 86 % of male deaths 18.9% 7.7% 6.9% 5.6% 5.0% 4.7% 4.6% 76 70 46 4.1% 3.7% 2.5% Leading causes of death in females Ischaemic heart disease continued to feature as the main cause of death in women, although there was a decline from the previous year (334 deaths or 19.0% of total female deaths in 2017, decreasing to 269 deaths or 14.8% of total deaths in 2018) (Table 2).
This was followed by dementia, which has shown an increase in recent years, with 105 deaths (6.2%) in 2016, 134 deaths (7.6%) in 2017, and 172 deaths (9.5%) in 2018.

Other diseases of the circulatory system, namely cerebrovascular diseases and other heart diseases, were also among the major causes of female deaths in 2018, followed by pneumonia and diabetes mellitus which were an important cause of death particularly in older women.
Malignant neoplasm of the breast (5.1% in 2018 from 3.6% in 2017) overtook colorectal malignancy (3.8% in 2018 from Malta National Mortality Registry Page | 7 Annual Mortality Report 2018 4.1% in 2017), thus becoming the leading cause of cancer deaths in females.

Other leading cancer deaths included malignancy of the bronchus/lung (2.8%) and pancreatic cancer (2.4%).
Cause of death Ischaemic heart disease Dementia Other heart diseases Cerebrovascular diseases Pneumonia and other acute lower respiratory infections Diabetes mellitus Malignant neoplasm of breast Malignant neoplasm of colon, rectum and anus Malignant neoplasm of bronchus and lung Malignant neoplasm of pancreas ICD-10 code I20-I25 F01-F03, G30 I26-I51 I60-I69 Number of deaths 269 172 147 132 % of female deaths 14.8% 9.5% 8.1% 7.3% J12-J22 E10-E14 C50 C18-C21 C34 C25 107 104 93 68 51 44 5.9% 5.7% 5.1% 3.8% 2.8% 2.4% Table 2: Leading causes of death in females in the year 2018 Trends in major groups of causes of death Overall, the major causes of death are showing a downward or stable trend in the standardised mortality rate in both genders (Table 3).
The exceptions include malignant neoplasm of the bronchus and lung which is showing an upward trend in females and diabetes mellitus which is on the rise in males.
Trend over 20 years (1999-2018) Cause of death All causes of death (A00-Y89) Certain infectious and parasitic diseases (A00-B99) Malignant neoplasms (C00-C97) Malignant neoplasm of trachea, bronchus and lung (C33-C34) Malignant neoplasm of breast (C50) Diabetes mellitus (E10-E14) Diseases of the circulatory system (I00-I99) Males ↓ ↓ ↓ ↓ N/A ↑ ↓ Females ↓ ↑ ↓ ↑ ↓ ↔ ↓ Malta National Mortality Registry Page | 8 Annual Mortality Report 2018 Ischaemic heart disease (I20-I25) Cerebrovascular diseases (I60-I69) Diseases of the respiratory system (J00-J99) Diseases of the digestive system (K00-K93) Diseases of the genitourinary system (N00-N99) External causes of morbidity and mortality (V01-Y89) Transport accidents (V01-V99) Intentional self-harm (X60-X84) Table 3: Long-term trends in major causes of death ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↔ ↓ ↓ ↓ ↓ ↔ ↓ ↔ ↔ Major causes of death in males and females in Malta compared with the EU average Figures 6 and 7 below show how Malta compares with the EU average as well as with EU countries with the best and worst outcomes for a number of causes of death.
Methodology used is that developed by the Joint Assessment Framework, which is described in more detail in the methodology section of this report.

The dark grey bars represent the best performing country for a particular indicator, whilst the light grey bars represent the worst performing country for the same indicator.
Scores for Malta were taken over a 3-year average (2016- 2018) and are shown in light green and dark green for progressively better scores than the EU average, orange and red for progressively worse scores than the EU average, and white for a score which lies around the EU average.

For both males and females, Malta scores better than the EU average for many of the causes of death, including all-cause mortality.
Poorer outcomes were observed for diabetes mellitus, dementia, and respiratory diseases in both genders.

Additionally, poorer outcomes were observed for colorectal, pancreatic, and ovarian cancers in females (Figures 6 and 7).
Malta National Mortality Registry Page | 9 Annual Mortality Report 2018 All causes of death Certain infectious and parasitic diseases Malignant neoplasms Malignant neoplasm of stomach Malignant neoplasm of colon, rectum and anus Malignant neoplasm of pancreas Malignant neoplasm of trachea, bronchus and lung Malignant neoplasm of prostate Malignant neoplasm of brain and central nervous… Hodgkin disease and lymphomas Leukaemia Diabetes mellitus Dementia Diseases of the circulatory system Ischaemic heart diseases Other heart diseases Cerebrovascular diseases Diseases of the respiratory system Chronic lower respiratory diseases Chronic liver disease Diseases of kidney and ureter Transport accidents Intentional self-harm -30 -20 -10 0 10 20 30 40 50 60 Best outcome Worst outcome Figure 6: Causes of death in males in Malta compared with the EU average 1 1 Source: Eurostat database (N.B.
The latest available data for France was for 2016) Malta National Mortality Registry Page | 10 Annual Mortality Report 2018 All causes of death Certain infectious and parasitic diseases Malignant neoplasms Malignant neoplasm of stomach Malignant neoplasm of colon, rectum and anus Malignant neoplasm of pancreas Malignant neoplasm of trachea, bronchus and lung Malignant neoplasm of breast Malignant neoplasm of cervix uteri Malignant neoplasm of other parts of uterus Malignant neoplasm of ovary Malignant neoplasm of brain and central nervous… Hodgkin disease and lymphomas Leukaemia Diabetes mellitus Dementia Diseases of the circulatory system Ischaemic heart diseases Other heart diseases Cerebrovascular diseases Diseases of the respiratory system Chronic lower respiratory diseases Chronic liver disease Diseases of kidney and ureter Transport accidents Intentional self-harm -30 -20 -10 0 10 20 30 40 50 Best outcome Worst outcome Figure 7: Causes of death in females in Malta compared with the EU average 1 Deaths due to malignancy There were 1044 deaths due to malignant neoplasms during the year 2018, 566 in males and 478 in females.
Cancer of the bronchus and lung was the commonest cause of cancer deaths in men, while breast cancer was the commonest in women.

Overall, the majority of deaths were from lung cancer, followed by colorectal, breast, pancreatic, prostate and bladder cancer, as shown in table 4 below.

1 Source: Eurostat database (N.B.
The latest available data for France was for 2016) Malta National Mortality Registry Page | 11 Annual Mortality Report 2018 ICD-10 code C34 Number of deaths 196 % of cancer deaths 18.8% C18-C21 144 13.8% C50 C25 C61 C67 93 85 46 41 8.9% 8.1% 4.4% 3.9% Cause of death Malignant neoplasm of bronchus and lung Malignant neoplasm of colon, rectum and anus Malignant neoplasm of breast Malignant neoplasm of pancreas Malignant neoplasm of prostate Malignant neoplasm of bladder Table 4: Commonest cancer deaths in 2018 Commonest causes of death by age group The relative importance of different causes of death varies by age group.
Deaths in children below the age of 1 year There were 25 deaths in infants during the year 2018, which accounted for 0.68% of total deaths.

Of these, 16 occurred in males and 9 in females.

There was a decrease of 4 infant deaths (0.12% decrease) from 2017.

The most important causes of death in this age group were conditions originating in the perinatal period (13 deaths), followed by congenital anomalies (8 deaths).
In 2018, the infant mortality rate for Malta was 5.6 deaths per 1000 live births, higher than that of the EU average which was 3.5 deaths per 1000 live births.1 One reason for this is that in Malta termination of pregnancy is illegal and therefore infants with terminal congenital anomalies may die soon after birth rather than being aborted during pregnancy, thereby contributing to higher infant mortality rates (Figure 8).
1 Source: Eurostat database Malta National Mortality Registry Page | 12 Annual Mortality Report 2018 Infant mortality rates in Malta and EU European Union - 28 countries Euro area - 19 countries Malta Year Figure 8: Trends in infant mortality rate in Malta compared with the EU average 1 Deaths in children aged 1-14 years There were 6 deaths in this age group, which accounted for 0.16% of total deaths.
This figure remained stable from the previous year.

Causes of death included congenital malformations, diseases of blood and of the immune mechanism, external causes, malignant neoplasm of bone, and metabolic disorders.

Deaths in the 15-44 age group 105 deaths were reported in this age group, which accounted for 2.85% of total deaths.

There was an increase of 11 deaths (0.22% increase) from 2017.

Of the 105 deaths, 64 occurred in males and 41 in females.
External causes of morbidity and mortality accounted for the largest number of deaths in this age group (36.2%), with the most common causes being intentional self-harm and motor vehicle accidents.

This was followed by neoplasms and circulatory diseases (Table 5).
1 Source: Eurostat database Malta National Mortality Registry Page | 13 Annual Mortality Report 2018 Cause of death External causes Neoplasms Diseases of the circulatory system ICD-10 code M 33 8 12 V01-Y89 C00-D48 I00-I99 F 5 20 7 Total 38 28 19 Table 5: The commonest causes of death in persons aged 15-44 years % of total for age group 36.2% 26.7% 18.1% Deaths in the 45-64 age group 458 deaths were reported in this age group, which accounted for 12.42% of total deaths.
There was an increase of 17 deaths (0.07% increase) from 2017.

Of the 458 deaths, 284 occurred in males and 174 in females.

Ischaemic heart disease and lung cancer were the two leading causes of death in this relatively young age group (Table 6).
Cause of death Ischaemic heart disease Malignant neoplasm of bronchus and lung Malignant neoplasm of colon, rectum and anus Diabetes mellitus Malignant neoplasm of pancreas ICD-10 code M 57 I20-I25 F 14 Total 71 % of total for age group 15.5% C34 28 15 43 9.4% C18-C21 E10-E14 C25 15 14 15 9 9 7 24 23 22 5.2% 5.0% 4.8% Table 6: The commonest causes of death in persons aged 45-64 years Deaths in the 65-84 age group 1842 deaths were reported in this age group, which accounted for 49.9% of total deaths.
There was an increase of 92 deaths (0.9% increase) from 2017.

Of the 1842 deaths, 1046 occurred in males and 796 in females.

Ischaemic heart disease and lung cancer were the two leading causes of death in this age group too (Table 7).
Malta National Mortality Registry Page | 14 Annual Mortality Report 2018 Cause of death Ischaemic heart disease Malignant neoplasm of bronchus and lung Cerebrovascular diseases Diabetes mellitus Dementia ICD-10 code M F I20-I25 204 108 Total 312 C34 104 30 I60-I69 E10-E14 F01-F03, G30 76 69 48 46 52 51 134 122 121 99 Table 7: The commonest causes of death in persons aged 65-84 years % of total for age group 16.9% 7.3% 6.6% 6.6% 5.4% Deaths in the 85+ age group 1252 deaths were reported in this age group, which accounted for 33.9% of total deaths, representing a decrease of 1.2% from 2017.
Of the 1252 deaths, 463 occurred in males and 789 in females.

Diseases of the circulatory system were noted to predominate in this age group (Table 8).

However, other conditions such as dementia, respiratory infections, and diabetes mellitus were also important causes of mortality in older persons.
Cause of death Ischaemic heart disease Dementia Cerebrovascular diseases Other heart diseases Pneumonia and other acute lower respiratory infections ICD-10 code M 89 46 35 39 I20-I25 F01-F03, G30 I60-I69 I26-I51 F 144 119 81 73 Total 233 165 116 112 % of total for age group 18.6% 13.2% 9.3% 8.9% J12-J22 39 67 106 8.5% Table 8: The commonest causes of death in persons aged 85+ Malta National Mortality Registry Page | 15 Annual Mortality Report 2018 Document Information Document reference DHIR/MNMR/2018 Release date 21/09/2021 Document owner Directorate of Health Information and Research Document type National Mortality Statistics e-mail healthinfo@gov.mt Compilation Dr Kristina Cassar Dr Kathleen England Acknowledgements The compilers of this document would like to acknowledge the support of colleagues, and the Director, Prof. Neville Calleja at the Directorate of Health Information and Research.
Close collaboration with certifying doctors, pathologists, public health specialists, the Police Statistics Office, the Medical Records Department at Mater Dei Hospital, the Mortuary Department and the National Statistics Office were vital to the maintenance of an updated mortality register whose aim is to always improve accuracy and timeliness.

Special thanks go to Ms Connie Scicluna and Ms Desire D’Amato who work unremittingly on the National Mortality Registry.
Methodology Data Analysis The information used is based on details obtained from death certificates and supplemented by other sources of information including iSOFT, electronic case summary, newspaper cuttings as well as collaboration with pathologists, public health doctors, police and certifying doctors.

These additional sources of information are needed for verification.

They add detail and ensure that mortality data is as reliable and as accurate as possible.
The International Statistical Classification of Diseases and Related Health Problems- ICD-10 is used to translate diagnoses of diseases from words into alphanumeric codes in order to Malta National Mortality Registry Page | 16 Annual Mortality Report 2018 permit easier storage, retrieval and analysis of the data.

This also allows comparison between different countries and over different periods of time.
Additional Sources of Data The National Statistics Office of Malta was the source from which information about mid-year population 2018 by age group and gender was obtained.

WHO Gateway and Eurostat database were used as a source of data for some of the figures in this report.

Definitions Crude Death Rate This is equal to the total number of registered deaths divided by the estimated resident mid- yearly population of that year multiplied by 100,000.
The following mid-year population of 2018, provided by the National Statistics Office, has been used for this annual report.
Age group (years) All ages 0 1 2 3 4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 Male 246244 2294 2456 2493 2426 2393 11614 10850 11484 16861 21949 21570 20035 18011 15263 14283 15704 15253 14259 12981 6362 4740 2104 Female 238438 2195 2275 2325 2246 2139 11031 10138 11016 14732 19862 18749 17816 16246 13987 13591 15433 15093 14718 14257 7884 6718 4000 Total 484682 4489 4731 4818 4672 4532 22645 20988 22500 31593 41811 40319 37851 34257 29250 27874 31137 30346 28977 27238 14246 11458 6104 Malta National Mortality Registry Page | 17 Annual Mortality Report 2018 90-94 95-99 100+ 724 115 20 1563 371 53 2287 486 73 Age-Standardised Death/Mortality Rate The age-standardised death/mortality rate for a particular condition is that which would have occurred if the observed age-specific death rates for the condition were applied in a given standard population.
The European Standard Population as reported by WHO and Eurostat have been used in this report.

Methodology used to develop Figures 6 and 7: Causes of death in males and females in Malta compared with the EU average The methodology applied for these graphs was adopted from the Joint Assessment Framework (JAF).
The EU average was taken as the mean, which is taken as 0 in the graphs, while the dark grey bars represent the best performing EU country, and the light grey bars represent the worst performing EU country.

The EU average (un-weighted) was calculated from the data available on Eurostat database for the 28 EU countries.
The values for each indicator are standardised, the score being calculated using the following method: Standardised score indicator x = [(value of indicator x – EU average of x)/standard deviation across EU MS of x]*10 The interpretation of the standardised scores was the same as that used in the JAF report.

The standardised score for Malta (taken as the average for 3 years: 2016-2018) for each indicator is interpreted with respect to the EU average.
Standardised scores between -7 and 7 are defined as around the EU average (0) and the bars are shaded in white.

Standardised scores from -7 to -13 (bars coloured in light green) are better (+) than the EU average and standardised scores smaller than -13 (bars coloured in dark green) are considerably better (++) than the EU average.
Conversely, standardised scores from 7 to 13 (bars coloured in orange) are worse (-) than the EU average and standardised scores larger than 13 (bars coloured in red) are considerably worse (- -) than the EU average.
Malta National Mortality Registry Page | 18 Annual Mortality Report 2018 Malta National Mortality Registry Page | 19 Deaths 2018 in residentsMTL1*Cause of deathSex0-45-1415-2425-3435-4445-5455-6465-7475-8485+TotalAll causesT292103560118340764107812523688All malesM19082333752094855614631876All femalesF102212274313127951778918121001Certain infectious and parasitic diseases (A00-B99)M000000164718F00001023518291003Diarrhoea and gastroenteritis of presumed infectious origin (A09)M00000000101F000000000001012Septicaemia (A40-A41)M000000152614F00001021418261019Viral hepatitis (B15-B19)M00000001102F000000000001025M00000000011F00000002103B66-B94, B99)1026Neoplasms (C00-D48)M00134299019517774573F0103172673125149894831027Malignant neoplasm of lip, oral cavity and pharynx (C00-C14)M000001544216F000100121051028Malignant neoplasm of oesophagus (C15)M000002352113F000000004151029Malignant neoplasm of stomach (C16)M000000384520F0000001445141030Malignant neoplasm of colon, rectum and anus (C18-C21)M0000251029201076F0000236142221681031Malignant neoplasm of liver and intrahepatic bile ducts (C22)M000000698124F0000011532121032Malignant neoplasm of pancreas (C25)M00000691410241F000001611206441033Malignant neoplasm of larynx (C32)M00000113016F000001010021034Malignant neoplasm of trachea, bronchus and lung (C33-C34)M00001226554912145F0000131217135511035Malignant neoplasm of skin (C43)M00000003429F000000120031036Malignant neoplasm of breast (C50)M00000000000F00017318252316931037Malignant neoplasm of cervix uteri (C53)F000012101051038Malignant neoplasm of other and unspecified parts of uterus (C54-C55)F0000004671181039Malignant neoplasm of ovary (C56)F00000539126351040Malignant neoplasm of prostate (C61)M000001472212461041Malignant neoplasm of bladder (C67)M00000133141233F000000033281042M000205292020F0000128350191043Non-Hodgkin's lymphoma (C82-C85)M000001473217F000121217216Age GroupsRemainder of certain infectious and parasitic diseases (A21-A32, A38, A42-A49, A65-A79, A81, A83-A89, B00-B04, B06-B09, B25-B49, B58-B64, Malignant neoplasm of
 meninges, brain and other parts of central nervous system (C70-C72) Annual Mortality Report 2018 Malta National Mortality Registry Page | 20 Deaths 2018 in residentsMTL1*Cause of deathSex0-45-1415-2425-3435-4445-5455-6465-7475-8485+Total1044Multiple myeloma and malignant plasma cell neoplasms (C90)M00000210205F000001141071045Leukaemia (C91-C95)M000110084216F0000001553141046M001002132827879F0100337131517591047Remainder of neoplasms (D00-D48)M00000003227F000000003251048Diseases of the blood and blood-forming organs and certainM00000010102disorders involving the immune mechanism (D50-D89)F010000120371049Anaemias (D50-D64)M00000010102F010000010351050M00000000000F000000110021051Endocrine, nutritional and metabolic diseases (E00-E88)M20002115353522112F00000192035451101052Diabetes mellitus (E10-E14)M00001014343521105F00000091834431041054M20001111017F000001021261055Mental and behavioural disorders (F01-F99)M000001111384697F00000116391171641056M00000101002F000000010011057M000000110384695F00000115391171631058Diseases of the nervous system (G00-G98)M000022412111344F0001525131416561059Meningitis ( G00, G03)M00000010001F000000000001060Alzheimer's disease (G30)M00000000000F0000001253111061Remainder of diseases of the nervous system (G04-G25, G31-G98)M000022312111343F000152411913451064Diseases of the circulatory system (I00-I99)M002192068149192174615F10052822571883366191065Acute rheumatic fever and chronic rheumatic heart diseases (I00-M00000010203I09)F000000022041066Hypertensive diseases (I10-I14)M000000025916F000000241026421067Ischaemic heart diseases (I20-I25)M0000514439510989355F000125923851442691068Other heart diseases (I26-I51)M001013812253989F10040351447731471069Cerebrovascular diseases (I60-I69)M00101214344235129F0000005103681132Remainder of endocrine, nutritional and metabolic diseases (E00-E07, E15-E34, E50-E88)Mental and behavioural disorders due to psychoactive substance use (F10-F19)Remainder of mental and behavioural disorders (F01-F09, F20-F99)Remainder of
 diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D65-D89)Remainder of malignant neoplasms (C17, C23-C24, C26-C31, C37-C41, C44-C49, C51-C52, C57-C60, C62-C66, C68-C69, C73-C81, C88, C96-C97)Age Groups Annual Mortality Report 2018 Malta National Mortality Registry Page | 21 Deaths 2018 in residentsMTL1*Cause of deathSex0-45-1415-2425-3435-4445-5455-6465-7475-8485+Total1070Atherosclerosis (I70)M00000003306F0000000037101071Remainder of diseases of the circulatory system (I71-I99)M000121236217F0000001455151072Diseases of the respiratory system (J00-J98) M1000037406591207F00000292549971821073Influenza (J10-J11)M00000100236F0000000226101074Pneumonia (J12-J18)M10000108112647F000002262044741075Other acute lower respiratory infections (J20-J22)M0000000281323F00000003723331076Chronic lower respiratory diseases (J40-J47)M000000418323286F00000047913331077M000001312121745F000000371111321078Diseases of the digestive system (K00-K92)M00011581714753F0000005131220501079Gastric and duodenal ulcer (K25-K27)M00010003105F000000001121080Diseases of the liver (K70-K76)M000014595024F000000323081081M000001358724F000000211819401082Diseases of the skin and subcutaneous tissue (L00-L98)M00000000022F000000011351083Diseases of the musculoskeletal system and connective tissue M00000111014(M00-M99)F000000033281084Diseases of the genitourinary system (N00-N98)M10000128121842F000000031226411085Glomerular and renal tubulo-interstitial diseases (N00-N15)M10000100002F000000001011086Remainder of diseases of the genito-urinary system (N17-N98)M00000028121840F000000031126401092Certain conditions originating in the perinatal period (P00-P96)M80000000008F500000000051093M60000110019F300000140081094M100323001212F000120020381095External causes of morbidity and mortality (V01-Y89)M00515138101111578F102203321014371096Transport accidents (V01-V99)M002243101114F002000201051097Falls (W00-W19)M000202346118F0000010081221Remainder of diseases of the respiratory system
 (J00-J06, J30-J39, J60-J98)Remainder of diseases of the digestive system (K00-K22, K28-K66, K80-K92)Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)Age Groups Annual Mortality Report 2018 Malta National Mortality Registry Page | 22 Deaths 2018 in residentsMTL1*Cause of deathSex0-45-1415-2425-3435-4445-5455-6465-7475-8485+Total1098Accidental drowning and submersion (W65-W74)M00000100012F100000000011099Exposure to smoke, fire and flames (X00-X09)M00001000001F000000001011100Accidental poisoning and exposure to noxious substances (X40-M00021010004X49)F000001000011101Intentional self-harm (X60-X84)M001741331020F000001000011102Assault (X85-Y09)M00011110004F000200020041103M002120143215F00000010023* Mortality tabulation list 1Age GroupsAll other external causes (W20-W64, W75-W99, X10-X39, X50-X59, Y10-Y89) Annual Mortality Report 2019 Annual Mortality Report 2019 • During the year 2019, there were 3688 deaths among residents of the Maltese Islands, with a stable trend in the crude mortality rate and a downward trend in the standardised mortality rate.
• 72.1% of deaths occurred within a hospital setting.

The subset of these deaths which occurred at Mater Dei Hospital amounts to 56.4% of total deaths.

• Circulatory diseases, including heart disease and stroke, accounted for 33.8% of all deaths, while cancer deaths accounted for 26%.
• Standardised mortality rates for major causes of death including heart disease and cerebrovascular diseases are showing a downward or stable trend, whilst standardised mortality rate for diabetes mellitus in both genders is showing an upward trend.

• Standardised mortality rate for diabetes mellitus, dementia and respiratory conditions in Malta is higher than the EU average in both genders while Malta fairs better than the EU average for a number of neoplasms.
• Causes of death vary with age and gender, with external causes of mortality accounting for a large proportion of deaths in the younger age groups, cancers and ischaemic heart disease dominating the middle-aged groups, and circulatory diseases increasing in importance with increasing age.

Conditions such as dementia, pneumonia and diabetes mellitus are emerging as significant causes of death in the older age groups.
• Malta National Mortality Registry Page | 1 Annual Mortality Report 2019 Overview During the year 2019, there were 3688 deaths among residents of the Maltese Islands dying in Malta or abroad, the same number of deaths as in 2018.

Of these, 1869 were male deaths and 1819 were female deaths.

This was a decrease of 7 male and an increase of 7 female deaths from 2018.

There were also 57 deaths in non-residents dying in the Maltese Islands in 2019, a decrease of 22 deaths from 2018.
Figure 1 below shows the number of deaths in residents during the year 2019 by age group and gender.

Figure 1: Number of deaths in 2019 by age group and gender Trends in the number of deaths and crude mortality rate over time Over the past 20 years (2000-2019), there has been an increasing trend in the number of deaths, with generally more male than female deaths.

However, this increase in number of deaths is due to population growth over the years.
In fact, the crude mortality rate (total number of deaths by gender divided by total mid-year population by gender multiplied by 100,000) has remained stable, indicating that the proportion of deaths per year has remained stable over the past 20 years (Figure 2).
Malta National Mortality Registry Page | 2 Annual Mortality Report 2019 Figure 2: Number of deaths and crude mortality rate by gender over 20 years According to Eurostat, the life expectancy at birth for Malta was 81.2 years for males and 84.6 years for females in 2019, whilst life expectancy at age 65 stood at 19.4 years for males and 22.5 years for females.1 The oldest deaths recorded in 2019 were 101 years in males and 106 years in females.
The mean age at death was 74.8 years in males (median 77 years) and 79.3 years in females (median 83 years).

Standardised mortality rate in Malta compared with the European Union The overall age-standardised mortality rate (SMR) in Malta and the EU is showing a downward trend in both males and females, with rates for males being higher than in females.
Standardised mortality rates for both genders in Malta compare favourably with the EU average, with rates being lower for Malta than the EU average particularly in men (Figure 3).
1 Source: Eurostat database Malta National Mortality Registry Page | 3 Annual Mortality Report 2019 Figure 3: Trends in standardised mortality rate for males and females in Malta compared with the EU average 2 Distribution by type of place of death 72.1% of all deaths among residents occurred within a hospital setting, including both public and private hospitals but excluding residential homes.

There was a slight increase from 2018, whereby 70.6% of all deaths occurred in a hospital setting.
Figure 4 shows that 56.4% of total deaths occurred at Mater Dei Hospital, compared with 54.4% in 2018.

Thus, there was a slight increase in the proportion of deaths which occurred at MDH in the year 2019.
2 Source: https://gateway.euro.who.int/en/indicators/ Malta National Mortality Registry Page | 4 Annual Mortality Report 2019 Figure 4: Percentage of deaths by place of death Causes of death Diseases of the circulatory system were the leading cause of death in 2019, with 1245 deaths or 33.8% of total deaths (Figure 5).

There was an increase of 11 deaths from the year 2018.
The three major causes of death within this category were ischaemic heart disease (682 deaths), other heart diseases including heart failure (242 deaths) and cerebrovascular diseases (234 deaths).

The number of deaths from neoplasms totalled 959 (26% of total deaths), a decrease of 97 deaths from 2018.
There were 456 deaths (12.4% of total) due to respiratory conditions, an increase of 67 deaths, with the major causes being pneumonia/chest infections (169 deaths) and chronic lower respiratory diseases (94 deaths).

Mental and behavioural disorders, including dementia which is an important cause of death in the elderly population, accounted for 6.3% of all deaths (234 deaths).
Endocrine and metabolic diseases accounted for 6.1% of all deaths (224 deaths), with the leading cause being diabetes mellitus (203 deaths).
Malta National Mortality Registry Page | 5 Annual Mortality Report 2019 External causes of morbidity and mortality 3.2% Endocrine, nutritional and metabolic diseases 6.1% Mental and behavioural disorders 6.3% Others 12.3% Diseases of the respiratory system 12.4% Diseases of the circulatory system 33.8% Neoplasms 26% Figure 5: Main causes of death in 2019 Leading causes of death in males The main cause of death in males was ischaemic heart disease, which accounted for 21.4% of all male deaths in 2019 (Table 1), showing an increase from 2018 (18.9% of total male deaths).
In comparison, cerebrovascular diseases showed a slight decrease from 2018 (5.1% in 2019 compared with 6.9% in 2018), while other heart diseases also showed an increase (5.4% in 2019 compared with 4.7% in 2018).

Pneumonia and other acute lower respiratory infections were the second commonest cause of death, accounting for 6.6% of total deaths.

The third commonest cause of death was malignant neoplasm of trachea, bronchus and lung which accounted for 5.4%.
Other leading cancer deaths in males included colorectal cancer (2.8%) and prostate cancer (2.5%).

Other important causes of male deaths included diabetes mellitus and dementia which have both shown a decrease when compared with 2018.

Diabetes mellitus accounted for 4.9% of total deaths in 2019 compared with 5.6% in 2018.

Dementia accounted for 4.3% of total deaths in 2019 compared with 5.0% in 2018.
Chronic lower Malta National Mortality Registry Page | 6 Annual Mortality Report 2019 respiratory diseases showed a decline (4.6% of total male deaths in 2018 decreasing to 3.6% in 2019).
Cause of death Ischaemic heart disease Pneumonia and other acute lower respiratory infections Malignant neoplasm of trachea, bronchus and lung Other heart diseases Cerebrovascular diseases Diabetes mellitus Dementia Chronic lower respiratory diseases Malignant neoplasm of colon, rectum and anus Malignant neoplasm of prostate ICD-10 code I20-I25 J12-J22 C33-C34 I26-I51 I60-I69 E10-E14 F01-F03, G30 J40-J47 C18-C21 C61 Table 1: Leading causes of death in males in the year 2019 Number of deaths 401 124 % of male deaths 21.4% 6.6% 108 102 95 92 80 68 52 46 5.7% 5.4% 5.1% 4.9% 4.3% 3.6% 2.8% 2.5% Leading causes of death in females Ischaemic heart disease continued to feature as the main cause of death in women with an increase from the previous year (269 deaths or 14.8% of total female deaths in 2018, increasing to 281 deaths or 15.5% of total deaths in 2019) (Table 2).
This was followed by dementia, which has shown a decrease compared to the previous year (157 deaths (8.7%) deaths in 2019 compared with 172 deaths (9.5%) in 2018).

Other diseases of the circulatory system, namely other heart diseases and cerebrovascular diseases were also among the major causes of female deaths in 2019.

Other important causes of death in females were also pneumonia and chest infections (7.7%) and diabetes mellitus (6.1%), particularly in older women.
Malignant neoplasm of the breast remained the leading cause of cancer deaths in females but with a slight decline from the previous year (4.4% in 2019 compared with 5.1% in 2018).

Malta National Mortality Registry Page | 7 Annual Mortality Report 2019 Other leading cancer deaths in females included colorectal cancer (2.5%), ovarian cancer (2.2%) and pancreatic cancer (2.2%), the last two thus overtook lung cancer (2.8% in 2018 with a decrease to 2.1% in 2019).
Cause of death Ischaemic heart disease Dementia Other heart diseases Pneumonia and other acute lower respiratory infections Cerebrovascular diseases Diabetes mellitus Malignant neoplasm of breast Malignant neoplasm of colon, rectum and anus Malignant neoplasm of ovary Malignant neoplasm of pancreas ICD-10 code I20-I25 F01-F03, G30 I26-I51 J12-J22 Number of deaths 281 157 140 140 % of female deaths 15.5% 8.7% 7.7% 7.7% I60-I69 E10-E14 C50 C18-C21 C56 C25 139 111 79 46 40 40 7.7% 6.1% 4.4% 2.5% 2.2% 2.2% Table 2: Leading causes of death in females in the year 2019 Trends in major groups of causes of death Overall, the major causes of death are showing a downward or stable trend in the standardised mortality rate in both genders (Table 3).
The exceptions include certain infectious and parasitic diseases, which is showing an increase in both genders, neoplasm of the bronchus and lung which is showing an upward trend in females in the last 20 years however has been stable over the last 10, diabetes mellitus which is on the rise in both males in the last 20 years and females in the last 10 and transport incidents which is also showing an increase in females.
Diseases of the respiratory system is also showing an increase in the last 10 years in females.
Trend over 20 years (2000-2019) Trend over 10 years (2000-2019) Cause of death Males Females Males Females All causes of death (A00-Y89) ↓ ↓ ↓ ↓ Malta National Mortality Registry Page | 8 Annual Mortality Report 2019 Certain infectious and parasitic diseases (A00-B99) Malignant neoplasms (C00-C97) Malignant neoplasm of trachea, bronchus and lung (C33-C34) ↑ ↓ ↓ Malignant neoplasm of breast (C50) N/A Diabetes mellitus (E10-E14) Diseases of the circulatory system (I00- I99) Ischaemic heart disease (I20-I25) Cerebrovascular diseases (I60-I69) Diseases of the respiratory system (J00- J99) Diseases of the digestive system (K00- K93) Diseases of the genitourinary system (N00-N99) External causes of morbidity and mortality (V01-Y89) Transport accidents (V01-V99) ↑ ↓ ↓ ↓ ↓ ↓ ↓ ↓ ↓ Intentional self-harm (X60-X84) ↔ Table 3: Long-term trends in major causes of death ↑ ↓ ↑ ↓ ↔ ↓ ↓ ↓ ↓ ↓ ↔ ↓ ↑ ↓ ↑ ↓ ↓ N/A ↑ ↓ ↓ ↓ ↔ ↓ ↔ ↓ ↓ ↓ ↑ ↓ ↔ ↓ ↑ ↓ ↓ ↓ ↑ ↓ ↓ ↔ ↑ ↔ Major causes of death in males and females in Malta compared with the EU average Figures 6 and 7 below show how Malta compares with the EU average as well as with EU countries with the best and worst outcomes for a number of causes of death.
Methodology used is that developed by the Joint Assessment Framework, which is described in more detail in the methodology section of this report.

The dark grey bars represent the best performing country for a particular indicator, whilst the light grey bars represent the worst performing country for the same indicator.
Scores for Malta are shown in light green and dark green for progressively better scores than the EU average, orange and red for progressively worse scores than the EU average, and white for a score which lies around the EU average.

For both males and females, Malta scores better than the EU average for many of the causes of death, Malta National Mortality Registry Page | 9 Annual Mortality Report 2019 including all-cause mortality.
Poorer outcomes were observed for diabetes mellitus, dementia, and respiratory diseases in both genders.

Additionally, poorer outcomes were observed for Hodgkin disease and lymphoma and ovarian cancers as well in females (Figures 6 and 7).
All causes of death Certain infectious and parasitic diseases Malignant neoplasms Malignant neoplasm of stomach Malignant neoplasm of colon, rectum and anus Malignant neoplasm of pancreas Malignant neoplasm of trachea, bronchus and lung Malignant neoplasm of prostate Malignant neoplasm of brain and central nervous system Hodgkin disease and lymphomas Leukaemia Diabetes mellitus Dementia Diseases of the circulatory system Ischaemic heart diseases Other heart diseases Cerebrovascular diseases Diseases of the respiratory system Chronic lower respiratory diseases Chronic liver disease Diseases of kidney and ureter Transport accidents Intentional self-harm -40 -20 0 20 60 40 Best outcome Worst outcome Figure 6: Causes of death in males in Malta compared with the EU average 1 1 Source: Eurostat database (N.B.
The latest available data for France was for 2017) Malta National Mortality Registry Page | 10 Annual Mortality Report 2019 All causes of death Certain infectious and parasitic diseases Malignant neoplasms Malignant neoplasm of stomach Malignant neoplasm of colon, rectum and anus Malignant neoplasm of pancreas Malignant neoplasm of trachea, bronchus and lung Malignant neoplasm of breast Malignant neoplasm of cervix uteri Malignant neoplasm of other parts of uterus Malignant neoplasm of ovary Malignant neoplasm of brain and central nervous system Hodgkin disease and lymphomas Leukaemia Diabetes mellitus Dementia Diseases of the circulatory system Ischaemic heart diseases Other heart diseases Cerebrovascular diseases Diseases of the respiratory system Chronic lower respiratory diseases Chronic liver disease Diseases of kidney and ureter Transport accidents Intentional self-harm -40 -20 0 20 40 60 Best outcome Worst outcome Figure 7: Causes of death in females in Malta compared with the EU average 1 Deaths due to malignancy There were 959 deaths due to malignant neoplasms during the year 2019, 515 in males and 444 in females.
Cancer of the bronchus and lung was the commonest cause of cancer deaths in men, while breast cancer was the commonest in women.

Overall, the majority of deaths were from lung cancer, followed by colorectal, pancreatic, breast, prostate and stomach cancer, as shown in table 4 below.

1 Source: Eurostat database (N.B.
The latest available data for France was for 2017) Malta National Mortality Registry Page | 11 Annual Mortality Report 2019 ICD-10 code C33-C34 Number of deaths 146 % of cancer deaths 15.2% C18-C21 C25 C50 C61 C16 98 84 79 46 46 10.2% 8.8% 8.2% 4.8% 4.8% Cause of death Malignant neoplasm of trachea, bronchus and lung Malignant neoplasm of colon, rectum and anus Malignant neoplasm of pancreas Malignant neoplasm of breast Malignant neoplasm of prostate Malignant neoplasm of stomach Table 4: Commonest cancer deaths in 2019 Commonest causes of death by age group The relative importance of different causes of death varies by age group.
Deaths in children below the age of 1 year There were 29 deaths in infants during the year 2019, which accounted for 0.79% of total deaths.

Of these, 9 occurred in males and 20 in females.

There was an increase of 4 infant deaths from 2018.

The most important causes of death in this age group were conditions originating in the perinatal period (18 deaths), followed by congenital anomalies (6 deaths).
In 2019, the infant mortality rate for Malta was 6.7 deaths per 1000 live births, higher than that of the EU average (estimated) which was 3.4 deaths per 1000 live births.2 One reason for this is that in Malta termination of pregnancy is illegal and therefore infants with terminal congenital anomalies may die soon after birth rather than being aborted during pregnancy, thereby contributing to higher infant mortality rates (Figure 8).
2 Source: https://gateway.euro.who.int/en/indicators/ Malta National Mortality Registry Page | 12 Annual Mortality Report 2019 Figure 8: Trends in infant mortality rate in Malta compared with the EU average 2 Deaths in children aged 1-14 years There were 14 deaths in this age group, which accounted for 0.38% of total deaths.

There was an increase of 8 deaths from 2018.


Causes of death in this age group are diverse and include, conditions of the nervous system, congenital malformations, external causes of death and acute respiratory infections among others.

Deaths in the 15-44 age group 86 deaths were reported in this age group, which accounted for 2.33% of total deaths.

There was a decrease of 16 deaths from 2018.

Of the 86 deaths, 53 occurred in males and 33 in females.
External causes of morbidity and mortality accounted for the largest number of deaths in this age group (37.2%), with the most common causes being intentional self-harm and motor vehicle accidents.

This was followed by neoplasms and circulatory diseases (Table 5).
Malta National Mortality Registry Page | 13 Annual Mortality Report 2019 1 Source: Eurostat database Cause of death External causes Neoplasms Diseases of the circulatory system ICD-10 code M 27 8 5 V01-Y89 C00-D48 I00-I99 F 5 14 7 Total 32 22 12 Table 5: The commonest causes of death in persons aged 15-44 years % of total for age group 37.2% 25.6% 14.0% Deaths in the 45-64 age group 401 deaths were reported in this age group, which accounted for 10.87% of total deaths.
There was a decrease of 57 deaths from 2018.

Of the 401 deaths, 250 occurred in males and 151 in females.

Ischaemic heart disease and lung cancer were the two leading causes of death in this relatively young age group (Table 6).
Cause of death Ischaemic heart disease Malignant neoplasm of trachea, bronchus and lung Malignant neoplasm of breast Diabetes mellitus Malignant neoplasm of colon, rectum and anus ICD-10 code M 62 20 I20-I25 C33, C34 C50 E10-E14 C18-C21 0 15 7 F 18 7 22 7 10 % of total for age group 20.0% 6.7% Total 80 27 22 22 17 5.5% 5.5% 4.2% Table 6: The commonest causes of death in persons aged 45-64 years Deaths in the 65-84 age group 1898 deaths were reported in this age group, which accounted for 51.45% of total deaths.
There was an increase of 56 deaths from 2018.

Of the 1842 deaths, 1085 occurred in males and 813 in females.

Ischaemic heart disease and other heart diseases were the two leading causes of death in this age group (Table 7).
Malta National Mortality Registry Page | 14 Annual Mortality Report 2019 Cause of death Ischaemic heart disease Other heart diseases Diabetes mellitus Cerebrovascular diseases Pneumonia and other acute lower respiratory infections ICD-10 code M F I20-I25 I26-I51 E10-E14 I60-I69 J12-J22 242 117 59 55 56 56 52 58 51 59 % of total for age group 18.9% 6.0% 5.9% 5.8% 5.8% Total 359 114 112 110 110 Table 7: The commonest causes of death in persons aged 65-84 years Deaths in the 85+ age group 1260 deaths were reported in this age group, which accounted for 34.2% of total deaths, representing an increase of 8 deaths from 2018.
Of the 1252 deaths, 463 occurred in males and 797 in females.

Diseases of the circulatory system were noted to predominate in this age group (Table 8).

However, other conditions such as dementia, pneumonia and other acute lower respiratory infections were also important causes of mortality in older persons.
Cause of death Ischaemic heart disease Pneumonia and other acute lower respiratory infections Dementia Other heart diseases Cerebrovascular diseases ICD-10 code M 96 55 I20-I25 J12-J22 F01-F03, G30 I26-I51 I60-I69 38 35 27 F 142 87 103 73 80 Total 238 142 141 108 107 Table 8: The commonest causes of death in persons aged 85+ % of total for age group 18.9% 11.3% 11.2% 8.6% 8.5% Malta National Mortality Registry Page | 15 Annual Mortality Report 2019 Document Information Document reference DHIR/MNMR/2019 Release date 30/08/2022 Document owner Directorate of Health Information and Research, Ministry for Health, Malta Document type National Mortality Statistics e-mail healthinfo@gov.mt Compilation Ms Ada Zora Polak Dr Kathleen England Acknowledgements The compilers of this document would like to acknowledge the support of colleagues, and the Director, Prof. Neville Calleja at the Directorate of Health Information and Research.
Close collaboration with certifying doctors, pathologists, public health specialists, the Police Statistics Office, the Medical Records Department at Mater Dei Hospital, the Mortuary Department and the National Statistics Office were vital to the maintenance of an updated mortality register whose aim is to always improve accuracy and timeliness.

Special thanks go to Ms Connie Scicluna and Ms Desire D’Amato who work unremittingly on the National Mortality Registry.
Methodology Data Analysis The information used is based on details obtained from death certificates and supplemented by other sources of information as well as collaboration with pathologists, public health doctors, police and certifying doctors.

These additional sources of information are needed for verification.

They add detail and ensure that mortality data is as reliable and as accurate as possible.
The International Statistical Classification of Diseases and Related Health Problems- ICD-10 is used to translate diagnoses of diseases from words into alphanumeric codes in order to permit easier storage, retrieval and analysis of the data.

This also allows comparison between different countries and over different periods of time.
Malta National Mortality Registry Page | 16 Annual Mortality Report 2019 Additional Sources of Data The National Statistics Office of Malta was the source from which information about mid-year population 2019 by age group and gender was obtained.

WHO Gateway and Eurostat database were used as a source of data for some of the figures in this report.
Definitions Crude Death Rate This is equal to the total number of registered deaths divided by the estimated resident mid- yearly population of that year multiplied by 100,000.

The following mid-year population of 2019, provided by the National Statistics Office, has been used for this annual report.
Age group 0 1 2 3 4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95-99 100+ Total Males 2291 2430 2526 2547 2481 11914 11177 11352 17561 24030 24077 21892 19494 16422 14589 15786 15512 14076 13501 7048 4960 2254 755 124 25 258824 Females 2155 2306 2331 2374 2279 11161 10367 10883 14860 20826 20339 18748 17036 14665 13544 15150 15372 14472 14738 8519 6900 4189 1618 393 66 245291 Total 4446 4736 4857 4921 4760 23075 21544 22235 32421 44856 44416 40640 36530 31087 28133 30936 30884 28548 28239 15567 11860 6443 2373 517 91 504115 Malta National Mortality Registry Page | 17 Annual Mortality Report 2019 Age-Standardised Death/Mortality Rate The age-standardised death/mortality rate for a particular condition is that which would have occurred if the observed age-specific death rates for the condition were applied in a given standard population.
The European Standard Population as reported by WHO and Eurostat have been used in this report.

Methodology used to develop Figures 6 and 7: Causes of death in males and females in Malta compared with the EU average The methodology applied for these graphs was adopted from the Joint Assessment Framework (JAF).
The EU average was taken as the mean, which is taken as 0 in the graphs, while the dark grey bars represent the best performing EU country, and the light grey bars represent the worst performing EU country.

The EU average (un-weighted) was calculated from the data available on Eurostat database for the 28 EU countries.
The values for each indicator are standardised, the score being calculated using the following method: Standardised score indicator x = [(value of indicator x – EU average of x)/standard deviation across EU MS of x]*10 The interpretation of the standardised scores was the same as that used in the JAF report.

The standardised score for Malta for each indicator is interpreted with respect to the EU average.
Standardised scores between -7 and 7 are defined as around the EU average (0) and the bars are shaded in white.

Standardised scores from -7 to -13 (bars coloured in light green) are better (+) than the EU average and standardised scores smaller than -13 (bars coloured in dark green) are considerably better (++) than the EU average.
Conversely, standardised scores from 7 to 13 (bars coloured in orange) are worse (-) than the EU average and standardised scores larger than 13 (bars coloured in red) are considerably worse (- -) than the EU average.
Malta National Mortality Registry Page | 18 Annual Mortality Report 2019 Malta National Mortality Registry Page | 19 Deaths 2019 in residentsAge GroupsMTL1*Cause of deathSex0-45-1415-2425-3435-4445-5455-6465-7475-84>85TotalAll causesT36773445107294775112312603688All malesM15332228601904806054631869All femalesF214412174710429551879718191001Certain infectious and parasitic diseases (A00-B99)M0001012681028F30000000612211003Diarrhoea and gastroenteritis of presumed infectious origin (A09)M00000000101F000000000001004Other intestinal infectious diseases (A01-A08)M00000001001F000000000001005Respiratory TuberculosisM00000001001F000000000001011Meningococcal InfectionM00000000000F200000000021012Septicaemia (A40-A41)M000000126918F10000000512181020Human immunodeficiency virus disease (HIV)M00010101104F000000000001025Remainder of certain infectious and parasitic diseases (A21-A32, A38, A42-A49,M00000011013 A65-A79, A81, A83-A89, B00-B04, B06-B09, B25-B49, B58-B64, B66-B94, B99)F000000001011026Neoplasms (C00-D48)M01134178318216460515F012752457139133764441027Malignant neoplasm of lip, oral cavity and pharynx (C00-C14)M000001444114F000001004381028Malignant neoplasm of oesophagus (C15)M000011455117F000000101351029Malignant neoplasm of stomach (C16)M00000051013129F0000011483171030Malignant neoplasm of colon, rectum and anus (C18-C21)M00011252016752F0001055101312461031Malignant neoplasm of liver and intrahepatic bile ducts (C22)M0010005714229F0010000930131032Malignant neoplasm of pancreas (C25)M00000272012344F000010816105401033Malignant neoplasm of larynx (C32)M00000133108F000000000001034Malignant neoplasm of trachea, bronchus and lung (C33-C34)M00000416452914108F00002341595381035Malignant neoplasm of skin (C43)M00000026008F000000140161036Malignant neoplasm of breast (C50)M00000000000F00011616222310791037Malignant neoplasm of cervix uteri (C53)F000001221171038Malignant neoplasm of other and unspecified parts of uterus (C54-C55)F0000002744171039Malignant neoplasm of ovary (C56)F000214416103401040Malignant neoplasm of prostate
 (C61)M00000119211446 Annual Mortality Report 2019 Malta National Mortality Registry Page | 20 Deaths 2019 in residentsAge GroupsMTL1*Cause of deathSex0-45-1415-2425-3435-4445-5455-6465-7475-84>85Total1041Malignant neoplasm of bladder (C67)M0000001710725F000000021031042Malignant neoplasm of meninges, brain and other parts of central nervous M010120450013F0001014250131043Non-Hodgkin's lymphoma (C82-C85)M000100267016F0000002444141044Multiple myeloma and malignant plasma cell neoplasms (C90)M000000127111F000000002241045Leukaemia (C91-C95)M000001432010F0100001354141046Remainder of malignant neoplasms (C17, C23-C24, C26-C31, C37-C41, C44-C49, M000004182722677F0012016222615731047Remainder of neoplasms (D00-D48)M00000013138F000001014171048Diseases of the blood and blood-forming organs and certainM00000013206disorders involving the immune mechanism (D50-D89)F000000000111049Anaemias (D50-D64)M00000002002F000000000111050Remainder of diseases of the blood and blood-forming organs and certain M00000011204F000000000001051Endocrine, nutritional and metabolic diseases (E00-E88)M10011213283520101F00001182635521231052Diabetes mellitus (E10-E14)M0000121323332092F00001072432471111054Remainder of endocrine, nutritional and metabolic diseases (E00-E07, E15-E34, M10010005209E50-E88)F0000011235121055Mental and behavioural disorders (F01-F99)M00001114363780F000000011411021541056Mental and behavioural disorders due to psychoactive substance use (F10-F19)M00001000102F000000000001057Remainder of mental and behavioural disorders (F01-F09, F20-F99)M00000114353778F000000011411021541058Diseases of the nervous system (G00-G98)M210011523162069F01110269710371059Meningitis ( G00, G03)M10000000001F000000000001060Alzheimer's disease (G30)M00000020013F000000111251061Remainder of diseases of the nervous system (G04-G25, G31-G98)M110011323161965F0111025868321063Diseases of the ear and mastoid processM00000000000F000000001011064Diseases of the circulatory system (I00-I99)M100322557157211172628F10025726621843306171065Acute rheumatic
rheumatic fever and chronic rheumatic heart diseases (I00-M00000000000I09)F00000000303 Annual Mortality Report 2019 Malta National Mortality Registry Page | 21 Deaths 2019 in residentsAge GroupsMTL1*Cause of deathSex0-45-1415-2425-3435-4445-5455-6465-7475-84>85Total1066Hypertensive diseases (I10-I14)M000000111811F00000020725341067Ischaemic heart diseases (I20-I25)M00010214110813496401F0001321632851422811068Other heart diseases (I26-I51)M1002216243135102F10001061544731401069Cerebrovascular diseases (I60-I69)M000002818402795F00011411240801391070Atherosclerosis (I70)M00000002024F000000003691071Remainder of diseases of the circulatory system (I71-I99)M000001145415F0000011324111072Diseases of the respiratory system (J00-J98) M20020410458987239F000013123631262171073Influenza (J10-J11)M100100124312F0000000028101074Pneumonia (J12-J18)M100103516263688F000001162548811075Other acute lower respiratory infections (J20-J22)M00000001161936F000000061439591076Chronic lower respiratory diseases (J40-J47)M000000119301868F000001051010261077Remainder of diseases of the respiratory system (J00-J06, J30-J39, J60-J98)M00000137131135F000011061221411078Diseases of the digestive system (K00-K92)M00001249142151F0000143131428631079Gastric and duodenal ulcer (K25-K27)M00000000134F000000011131080Diseases of the liver (K70-K76)M000002342213F0000121422121081Remainder of diseases of the digestive system (K00-K22, K28-K66, K80-K92)M00001015111634F000002281125481082Diseases of the skin and subcutaneous tissue (L00-L98)M00000002305F000000001671083Diseases of the musculoskeletal system and connective tissue (M00-M99)M00000002215F001000034081084Diseases of the genitourinary system (N00-N98)M00000134122141F000001021830511085Glomerular and renal tubulo-interstitial diseases (N00-N15)M00000000000F000000000111086Remainder of diseases of the genito-urinary system (N17-N98)M00000134122141F000001021829501092Certain conditions originating in the perinatal period (P00-P96)M50000000005F13000000000131093Congenital malformations, deformations and chromosomal
 abnormalities M40001021109(Q00-Q99)F310003210010 Annual Mortality Report 2019 Malta National Mortality Registry Page | 22 Deaths 2019 in residentsAge GroupsMTL1*Cause of deathSex0-45-1415-2425-3435-4445-5455-6465-7475-84>85Total1094Symptoms, signs and abnormal clinical and laboratory findings, not M000130330111elsewhere classified (R00-R99)F1000110224111095External causes of morbidity and mortality (V01-Y89)M01211146611121376F01023114920411096Transport accidents (V01-V99)M000130152012F010111000151097Falls (W00-W19)M0001001271324F00000001514201098Accidental drowning and submersion (W65-W74)M00021010105F000010000011099Exposure to smoke, fire and flames (X00-X09)M00000001001F000000001011100Accidental poisoning and exposure to noxious substances (X40-M00010100002X49)F000000000001101Intentional self-harm (X60-X84)M002383211020F000000010011102Assault (X85-Y09)M00001100002F000100010021103All other external causes (W20-W64, W75-W99, X10-X39, X50-X59, Y10-Y89)M010311121010F000010113511* Mortality tabulation list 1