Trends in sudden death-attributed mortality across Europe, 2010–2020: a retrospective population-based analysis

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Background: Sudden death remains a major global cause of mortality, yet recent European trends are poorly characterized. We analyzed sudden death mortality across Europe from 2010 to 2020, assessing variations by age, sex, and region. Methods: We extracted sudden death-attributable mortality data from the World Health Organization (WHO) mortality dataset for 2010-2020. Age-adjusted mortality rates (AAMRs) were analyzed using joinpoint regression modeling, expressed as average annual percent change (AAPC) with 95% confidence intervals (CIs). A parallelism test compared trend differences across groups. Findings: From 2010 to 2020, there were 2,583,559 attributed sudden death (1,935,741 men and 647,818 women) in 26 European countries. Overall, the AAMR increased [AAPC: +2.9% (95% CI: 2.0-4.1), p < 0.001], with a significantly greater increase in women compared to men (p = 0.01). Regionally, AAMRs decreased in Western Europe [AAPC: -2.0% (95% CI: -2.1 to -0.1), p = 0.02], plateaued in Northern Europe [AAPC: -2.0% (95% CI: -4.7 to 0.8), p = 0.15], while increasing in Southern [+3.3% (95% CI: 1.5-8.2, p = 0.001] and Eastern Europe [AAPC: +3.4% (95% CI: 1.7-5.0), p < 0.001]. At the country level, substantial differences were observed, with Austria and Belgium showing the highest reduction of AAPC (-8.0% and -7.9%, respectively), contrasting with an increase in Spain and Germany (+3.3% and +2.8%, respectively). Interpretation: Rising sudden death mortality in Europe likely reflected evolving sex- and region-specific patterns, including the increasing cardiovascular risk burden among women and broader demographic changes across different parts of Europe. Equitable, multidisciplinary strategies are needed to curb this trend. Funding: None.

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