06/2025
External causes of death: understanding for action
In this number...
Information on causes of death among the population has enormous potential as a tool for public health decision-making. The analyses and research work carried out with the data provided by the Death Statistics according to cause of death allow the health system to be strengthened in order to be able to act in those situations in which avoidable deaths may occur, either by implementing prevention programmes or by the application of appropriate treatments.
In the particular case of external causes of death, most are preventable. Knowledge of their pattern and incidence enables public administrations to act towards preventing them. A clear example can be found in the campaigns and initiatives to prevent road accidents, which have led to a significant decrease in the number of road fatalities in recent decades.
Specific suicide prevention initiatives are now in place, such as official plans, specialised resources and care services such as the 024 hotline. In this sense, the Death Statistics by cause of death aims to be up to the task of providing quality information that will help the different monitoring systems to mitigate this problem.
In this INE Figures, our main aim is to present information on the primary external causes of death during 2024 and their patterns over the last few years. To complement this sensitive information of social interest, we also wanted to set aside a space to learn more about the illnesses suffered by people who opted for euthanasia.
Sources: INE (Death statistics by cause of death)
Introduction: causes of death from disease and external causes
What did people die of in 2024?
In 2024, 436,118 persons passed away in Spain, six fewer than the previous year. Of them, 220,090 were men and 216,028 were women.
Tumours and diseases of the circulatory system accounted for more than half of the deaths. Although tumours were the leading cause of death, the number of deaths due to this disease in 2024 was very similar to the previous year. However, deaths due to illnesses of the circulatory system fell by 2.0%.
On the other hand, 50,132 people lost their lives due to a disease of the respiratory system, the third leading cause of death. The number of deaths from such illnesses was higher than in 2023 (6.7% more).
Not all deaths are due to disease
Approximately 5% of deaths each year are due to external causes, such as people who die in road accidents, falls, drowning, etc. or commit suicide.
The impact of an ageing population, with more people who are very old, frail and have more health problems, helps to explain why accidental falls are again, for the second year running, the leading external cause of death. In 2024 there were 4,450 deaths and three out of four were over 75 years old.
The second cause is suicide. In 2024, 3,953 people opted to end their life, 4.0% fewer than 2023.
Mortality attributed to natural disasters
Heat, cold and flooding as main causes
One of the indicators of the United Nations Sustainable Development Goals is the number of people killed by natural disasters. Knowing this indicator helps to bolster resilience to climate-related risks and natural disasters in all countries.
In the last decade, 1,084 people died in Spain due to natural disasters. The main causes were exposure to excessive heat (55.8% of deaths), flooding (23.1%) and exposure to excessive cold (16.0%).
However, the evolution of this indicator has varied over time, with half of all natural disaster fatalities in the last decade being concentrated in the years 2022 and 2024. Specifically, in 2022 there were 152 deaths (86.2% due to exposure to excessive heat) and in 2024, 342 people died from natural disasters (66.4% were flood victims).
People who lost their lives in the Valencia flash flooding
The flash flooding caused by the storms of 29 October 2024 claimed the lives of 227 people, 136 men and 91 women. Approximately half were under 65 years of age. The victims also included very old people: one in five of those killed was a person aged 85 or over.
Among all the victims, 73 died as a result of being trapped in their homes and 12 in a residence, most of whom were older people.
The increase in fatalities due to accidental falls
Accidental falls as the leading external cause of death
A notable increase in the number of deaths due to accidental falls in recent years has meant that for the second year in a row it has become the leading cause of external death, surpassing the number of suicides.
Six out of ten people who died were over 80 years old, mostly men
Many of those who died from accidental falls were older people. Six out of ten were over 80 years old.
By sex, 53.9% were men and 46.1% were women. This percentage difference varies according to age, being much more pronounced in younger age groups and even inverting at very advanced ages, where the percentage of women who die from this cause exceeds that of men.
Specifically, more than 80% of the people who died from accidental falls under 50 years of age were men, while this percentage stood at 35.7% among those over 90 years of age.
This is explained by the fact that there are more women than men in Spain at older ages. If instead of absolute data we analyse the relative data, we observe that the male mortality rate due to accidental falls is higher than the female rate in all age groups, reaching its maximum in men aged 90, who have a rate of 233.9 deaths per 100,000 inhabitants, while the rate for women of the same age stands at 178.8.
Suicides, the beginning of a downward trend?
Decline in cases by 2024
Suicide deaths began a worrying upward trend during 2020-2022, coinciding with the pandemic and post-pandemic periods, reaching over 4,000 deaths per year. Data for 2023 and 2024 point to the possible start of a downward trend.
Despite this, suicide is the second leading external cause of death in Spain, with a rate of 8.1 deaths per 100,000 inhabitants in 2024, which means a total of 3,953 deaths by suicide in the last year, down by 4.0% with respect to 2023. This phenomenon predominantly affects men (approximately 75% of cases).
The age group in which suicide is most frequent is between 45 and 60 years of age, in both men and women. One in three people who took their own lives in 2024 were in this age group.
The pattern of mortality in recent years shows that May, July and August are the months with the highest number of suicides.
Rise in adolescents and slight improvement in young people: an area of care that remains essential
In 2024, 90 adolescents under the age of 20 took their own lives, 14 more than the previous year. This is the highest figure recorded in recent years, surpassing even the 87 deaths in 2022.
Thus, 2022 and 2024 were the periods with the highest incidence, while in the other recent years the number of suicides in this very young group stood around 75 cases.
In 2024, 120 young people between the ages of 20 and 24 also took their own lives.
Small municipalities, with the highest suicide rates
In terms of municipality size, the data indicate that rural areas and small municipalities have higher suicide rates than large cities. In areas with less than 10,000 inhabitants, the suicide rate is 9.3 cases per 100,000 inhabitants, while in provincial capitals the rate is 7.5 cases. The lowest rate is in municipalities with more than 100,000 inhabitants that are not provincial capitals (7.2).
Employment status and education level, what were they like?
The death statistics by cause of death provide socio-demographic information on the persons who die. In the specific case of people who committed suicide, in 20231 it is known that 42.2% of those aged between 16 and 67 were working, 15.5% were unemployed and 13.7% were unable to work due to permanent disability.
In terms of level of education, 36.1% of the people who took their own lives had lower secondary education as the highest level of education they attained, 15.3% had some kind of university education and 13.5% had primary education.
1. Data for 2024 are not available. The information on education level and employment status corresponds to the previous year.
Traffic fatalities
70% reduction in fatalities in three decades
Over the last 30 years, traffic fatalities in Spain have declined dramatically.
The year 1998 saw the highest number of traffic fatalities during this period, with more than 6,000 victims, while in the year 2024 the number of fatalities stood at 1,853, a decrease of approximately 70% in three decades.
This development is due to a number of factors, including improved infrastructure, the generalisation of vehicle safety systems, advertising campaigns and increased vigilance, as well as social awareness of road safety. The data have made it possible to assess the impact of each of the prevention measures adopted.
Despite the notable decrease, if we focus on the data for the last decade, with the exception of the years 2020 and 2021 when the mobility restriction due to the pandemic led to a lower incidence, we see that the number of road traffic fatalities remained practically stable, and in 2024 there was even an increase in fatalities of 1.4% compared to the previous year.
Mostly men
In 2024, the months with the highest number of traffic fatalities were August and July, with 187 and 177 deaths respectively, while February was the month with the lowest number, with 129 deaths.
Eight out of 10 people who died in traffic accidents were men, 43.1% of whom were aged between 40 and 64. Mortality among women was more frequent at older ages, where four out of 10 were over 65.
Pedestrians, motorcyclists and cyclists account for half of all fatalities
Although the majority of those killed in road accidents were car occupants (38.0%), fatalities also included cyclists, motorcyclists and pedestrians hit by vehicles. Annually, these account for half of all road fatalities.
Specifically, in 2024, 501 people lost their lives in motorbike accidents, over half of whom were between 40 and 64 years old, and 88 cyclists also died, eight out of 10 of whom were over 40 years old.
One in two pedestrians who die in road accidents is over 65 years of age
Half of the pedestrians killed each year are aged 65 and over, more men than women. In 2024, 383 people lost their lives as pedestrians, 54% of whom were aged 65 or over. In this age group, three out of five were men.
Diseases behind euthanasia
Three years after the passing of the law, we wanted to dedicate this space to learn about the illnesses suffered by the people who opted for euthanasia.
Euthanasia was regulated in 2021
Organic Law 3/2021 of 24 March on euthanasia regulation was approved in March 2021. Following its approval and publication in the Official State Gazette, it came into force on 25 June 2021.
The “Euthanasia Best Practices Manual”, published by the Ministry of Health, explains how to certify the death of a patient who has opted for the provision of assistance in dying. The certificate must state this fact in addition to the person's "serious and incurable illness" or "serious, chronic and disabling condition".
This guideline provides information1 through the medical death certificates about the illness of the persons who requested euthanasia, as well as their age and sex.
1. The data may be underestimated if the certifying physician has not followed the directive set out by the Ministry of Health and euthanasia was not reported on the death certificate.
Which people have received assistance in dying?
From the entry into force of the Law until December 2024, certifying physicians reported that 1,046 people ended their lives with this procedure. Although many of the patients were between 65 and 79 years old (43.3%), 31.2% were under 65 years old and 25.5% were over 80 years old. The number of people opting for euthanasia has progressively increased since the law's implementation, reaching 403 cases during the year 2024.
Since its implementation, diseases of the nervous system have been the most prevalent among those who have opted for euthanasia. Some 45% had some form of these diseases, namely the 161 people had amyotrophic lateral sclerosis (ALS), 54 with Parkinson's and 53 with multiple sclerosis.
After diseases of the nervous system, the most frequent diagnosis among those who asked for assistance to die were tumours (311 deaths). The type of tumour was wide-ranging, but the most numerous were bronchial and lung tumours (42 people) and brain tumours (36).
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