Pooling European all-cause mortality: Methodology and findings for the seasons 2008/2009 to 2010/2011

J. Nielsen, A. Mazick, N. Andrews, M. Detsis, T. M. Fenech, V. M. Flores, A. Foulliet, B. Gergonne, H. K. Green, C. Junker, B. Nunes, J. O'Donnell, A. Oza, A. Paldy, R. Pebody, A. Reynolds, T. Sideroglou, B. E. Snijders, F. Simon-Soria, H. UphoffL. Van Asten, M. J. Virtanen, F. Wuillaume, K. Molbak

Research output: Contribution to journalArticle

8 Citations (Scopus)


Several European countries have timely all-cause mortality monitoring. However, small changes in mortality may not give rise to signals at the national level. Pooling data across countries may overcome this, particularly if changes in mortality occur simultaneously. Additionally, pooling may increase the power of monitoring populations with small numbers of expected deaths, e.g. younger age groups or fertile women. Finally, pooled analyses may reveal patterns of diseases across Europe. We describe a pooled analysis of all-cause mortality across 16 European countries. Two approaches were explored. In the 'summarized' approach, data across countries were summarized and analysed as one overall country. In the 'stratified' approach, heterogeneities between countries were taken into account. Pooling using the 'stratified' approach was the most appropriate as it reflects variations in mortality. Excess mortality was observed in all winter seasons albeit slightly higher in 2008/09 than 2009/10 and 2010/11. In the 2008/09 season, excess mortality was mainly in elderly adults. In 2009/10, when pandemic influenza A(H1N1) dominated, excess mortality was mainly in children. The 2010/11 season reflected a similar pattern, although increased mortality in children came later. These patterns were less clear in analyses based on data from individual countries. We have demonstrated that with stratified pooling we can combine local mortality monitoring systems and enhance monitoring of mortality across Europe.

Original languageEnglish
Pages (from-to)1996-2010
Number of pages15
JournalEpidemiology and Infection
Issue number9
Publication statusPublished - Sep 2013


  • Influenza
  • methodology
  • mortality
  • pooling
  • surveillance

ASJC Scopus subject areas

  • Epidemiology
  • Infectious Diseases

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    Nielsen, J., Mazick, A., Andrews, N., Detsis, M., Fenech, T. M., Flores, V. M., Foulliet, A., Gergonne, B., Green, H. K., Junker, C., Nunes, B., O'Donnell, J., Oza, A., Paldy, A., Pebody, R., Reynolds, A., Sideroglou, T., Snijders, B. E., Simon-Soria, F., ... Molbak, K. (2013). Pooling European all-cause mortality: Methodology and findings for the seasons 2008/2009 to 2010/2011. Epidemiology and Infection, 141(9), 1996-2010. https://doi.org/10.1017/S0950268812002580