Mortality in France, caused primarily by cancers and circulatory diseases, reached a "historically low" level in 2023, mainly 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.
Every year, these scientists examine the leading causes of death, with a slight time lag. In 2023, more than 637,000 deaths were recorded.
"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," Elise Coudin, director of CépiDc (Inserm), told AFP.
As in the vast majority of European countries, the mortality level was "historically low" in France, but it remained higher than that 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 the causes of death –, says Ms. Coudin, as well as by drops in mortality from circulatory system diseases and tumors.
– Cancers in the lead –
Still the leading killer, among both men and women, cancers were responsible for just over a quarter of deaths (27%).
Although declining, mortality from tumors has increased for certain cancers (pancreas, melanoma) and, in general, among women over 85 years of age.
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 illnesses other than Covid (pneumonia, chronic diseases, winter flu in particular) have returned to pre-Covid levels since 2022. They had declined sharply in 2020 and 2021, at the height of the pandemic.
Although they have decreased slightly over the past 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.
– Regional disparities –
For the second year in a row, mortality from external causes (accidents, suicides, etc.) was "significantly" higher than its pre-pandemic trend.
Regarding infant mortality, "more than half of deaths in children under one year old are due to a condition originating in the perinatal period," ahead of congenital malformations and chromosomal abnormalities, explains Anne Fouillet, epidemiologist at Public Health France.
Geographically, mortality is much more marked in the overseas departments and regions and, to a lesser extent, in the north and east of mainland France.
"Mortality is 89% higher in Mayotte than the national average, 37% in French Guiana, and 17% in Hauts-de-France," Vianney Costemalle, head of the Drees population health office, told AFP.
Conversely, mortality is significantly lower in Île-de-France (-15% compared to the national average).
These disparities can be linked to "behavioral, economic, environmental, territorial, and access to care" factors, summarizes Mr. 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 establishments and almost a quarter at home (24%).
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