Mortality at a historically low level in France, cancers and circulatory diseases the leading causes of death

Mortality in France, caused primarily by cancers and circulatory diseases, reached a "historically low" level in 2023, essentially linked to the decline of Covid-19 , but the pandemic left its mark and territorial inequalities remained strong.

"The two leading causes of death remain tumors and diseases of the circulatory system," ahead of diseases of the respiratory system, shows a reference work by researchers from the French Public Health Agency, Inserm and the statistics department of the Ministry of Health (Drees) published Tuesday.

"After three years of high mortality due to the Covid-19 pandemic and a resurgence in mortality linked to respiratory diseases in 2022," 2023 saw a "lower mortality rate than in 2019," explains Elise Coudin, director of CépiDc (Inserm).

As in the vast majority of European countries, the mortality level was "historically low" in France, but it remained higher than expected if the pre-pandemic trend had continued until 2023. The decline compared to 2022 is explained "60% by the drop in mortality linked to Covid-19", which fell to ninth place among causes of death, as well as by drops in mortality from circulatory diseases and tumors.

Every year, these scientists examine the main causes of mortality , with a slight time lag. In 2023, more than 637,000 deaths were recorded.

Still the leading killer, among both men and women, cancers were responsible for just over a quarter of deaths (27%). Although declining, mortality due to tumors increased for certain cancers (pancreas, melanoma) and, in general, among women over 85.

In second place, cardio-neurovascular diseases (myocardial infarction, stroke, heart failure, etc.) caused just over a fifth of deaths and represented the leading cause of mortality among those aged 85 and over.

"Slightly increasing" in 2023, deaths caused by respiratory diseases other than Covid (pneumonia, chronic diseases, winter flu in particular) have returned to pre-Covid levels since 2022. While they have decreased slightly over one year, deaths from endocrine, digestive, and genitourinary diseases have remained on an upward trend for several years.

This trend is potentially linked "to shocks induced by the pandemic (delayed care, difficulties in accessing care, changes in behavior, or even in the provision of care)," the researchers judge, without knowing whether these are "one-off effects that are slow to resolve or structural shocks."

Another lesson: mortality due to accidents , particularly falls and transport accidents, has increased again, while the suicide rate (13.6 per 100,000) has decreased. For the second year in a row, mortality due to external causes (accidents, suicides, etc.) was "significantly" higher than its pre-pandemic trend.

Geographically, mortality is much higher in the overseas departments and regions and, to a lesser extent, in the north and east of France. "Mortality is 89% higher in Mayotte compared to the national average, 37% in French Guiana, and 17% in Hauts-de-France," Vianney Costemalle, head of the Drees (Department of Economic and Social Affairs) population health office, told AFP.

Conversely, mortality is significantly lower in the Île-de-France region (-15% compared to the national average). These disparities may be linked to "behavioral, economic, environmental, territorial, and access to care" factors, summarizes Vianney Costemalle.

Mortality is also higher in rural areas outside the influence of cities and lower in large urban areas, particularly for cardio-neurovascular diseases and external causes.

In 2023, more than half of deaths (53%) occurred in healthcare facilities and almost a quarter at home (24%).