# Deaths from infection in Romania: the rate rose by more than 60% in six years, against 8% in 18 other EU countries For the same age structure, Romanian death certificates gave an infection (pneumonia, sepsis or C. difficile) as the cause of death 63% more often in 2023 than in 2017: from 50.1 to 81.5 deaths per 100,000 people. In the 18 EU countries with data for every year, the rate rose by 8%. Deaths from all causes in Romania fell by 8%. The rise had begun before the pandemic: +24% by 2019. Almost four fifths of it is pneumonia. In 2017, Romania's rate was 1.6 times that of the comparison countries; in 2023, 2.5 times. ## At what age - Both sexes, aged 40–44: in 2023, 15 in every 100,000 people in Romania died with an infection (pneumonia, sepsis or C. difficile) recorded as the cause of death, against 11 in 2017. In the 18 comparison countries: 2.6. Romania's rate is 5.9 times as high. - Both sexes, aged 45–49: in 2023, 24 in every 100,000 people in Romania died with an infection (pneumonia, sepsis or C. difficile) recorded as the cause of death, against 18 in 2017. In the 18 comparison countries: 4.2. Romania's rate is 5.9 times as high. - Both sexes, aged 50–54: in 2023, 39 in every 100,000 people in Romania died with an infection (pneumonia, sepsis or C. difficile) recorded as the cause of death, against 28 in 2017. In the 18 comparison countries: 6.0. Romania's rate is 6.4 times as high. - Both sexes, aged 55–59: in 2023, 59 in every 100,000 people in Romania died with an infection (pneumonia, sepsis or C. difficile) recorded as the cause of death, against 47 in 2017. In the 18 comparison countries: 9.6. Romania's rate is 6.2 times as high. - Both sexes, aged 60–64: in 2023, 93 in every 100,000 people in Romania died with an infection (pneumonia, sepsis or C. difficile) recorded as the cause of death, against 60 in 2017. In the 18 comparison countries: 17. Romania's rate is 5.5 times as high. - Both sexes, aged 65–69: in 2023, 151 in every 100,000 people in Romania died with an infection (pneumonia, sepsis or C. difficile) recorded as the cause of death, against 81 in 2017. In the 18 comparison countries: 31. Romania's rate is 4.9 times as high. - Both sexes, aged 70–74: in 2023, 207 in every 100,000 people in Romania died with an infection (pneumonia, sepsis or C. difficile) recorded as the cause of death, against 120 in 2017. In the 18 comparison countries: 56. Romania's rate is 3.7 times as high. - Both sexes, aged 75–79: in 2023, 332 in every 100,000 people in Romania died with an infection (pneumonia, sepsis or C. difficile) recorded as the cause of death, against 191 in 2017. In the 18 comparison countries: 98. Romania's rate is 3.4 times as high. - Both sexes, aged 80–84: in 2023, 499 in every 100,000 people in Romania died with an infection (pneumonia, sepsis or C. difficile) recorded as the cause of death, against 283 in 2017. In the 18 comparison countries: 207. Romania's rate is 2.4 times as high. - Both sexes, aged 85+: in 2023, 767 in every 100,000 people in Romania died with an infection (pneumonia, sepsis or C. difficile) recorded as the cause of death, against 434 in 2017. In the 18 comparison countries: 649. Romania's rate is 1.2 times as high. ## What is counted here, and where sepsis fits Sepsis is the body's runaway reaction to an infection: organs begin to fail. Worldwide, the condition most often behind sepsis deaths is lower respiratory infection, mostly pneumonia (Global Burden of Disease study, Rudd and colleagues, 2020). On a death certificate the doctor writes a chain of conditions, from the one that started it all to the one that led directly to death. Statistics keep only one: the condition that started the chain. Sepsis is usually a middle link: it comes from an infection, and under the rules of the International Classification of Diseases the cause kept in statistics should be the condition at the start. So the number of deaths recorded as "sepsis" says little about how many people die with sepsis. In Romania, 2,661 deaths in 2023 were recorded with sepsis as the underlying cause, 91% of them as "sepsis, unspecified organism". Between countries the figure varies tens of times over, because certificates are filled in differently. To compare like with like, the page counts three causes together: pneumonia, sepsis itself and C. difficile infection, often caught in hospital. ## How much, since when, and among whom The rate rose every year from 2017 to 2019, before the pandemic, by 24% in all. In 2020 and 2021 it rose further, then came down, but stayed far above its 2017 level: 81.5 in 2023, against 50.1. Under 65, the rate rose by 28%; at 65 and over, by 76%. Most deaths are in old age, but among adults the gap with the other countries is largest in middle age. Among children under 5 the ratio is higher still (12 times: 20.9 against 1.7 per 100,000), on 197 deaths in 2023; the page on infant pneumonia explains them. Eurostat separately publishes, from 2013, an age-standardised death rate for pneumonia, calculated independently. It points the same way: Romania's rate was 1.4 times the EU average in 2013 and 2.6 times in 2023. ## Romania and the other countries Of the 20 EU countries with data for 2017 and 2023, Romania and Latvia have the largest relative rises, practically equal: the rate was multiplied by 1.63 in Romania and by 1.58 in Latvia, where it stays much lower (35.9 per 100,000). Slovakia has the highest rate (101.3); Romania is second. 7 countries have no 2023 data yet in the WHO database (Belgium, Denmark, Germany, Greece, Ireland, Malta and Portugal), and Croatia has no 2022 data, so it appears in the 2017–2023 comparison but not among the countries with data for every year. The 18 countries with data for every year hold 69% of the EU population outside Romania. ## Disease, or the way certificates are filled in? Part of the rise may come from certificates rather than disease. An old person often dies with both heart disease and pneumonia; which becomes the underlying cause depends on how the doctor fills in the certificate. Over the same years, Romania's death rate from circulatory diseases fell by 114 per 100,000, more than infections rose (+31). Romania publishes only the underlying cause of death, without the other conditions on the certificate, so a shift between causes cannot be measured from these data. What can be said: the rise began before the pandemic, in 2023 the rate remained far above its 2017 level, and the rise also appears under 65, where heart disease causes far fewer deaths. Hospital admissions do not settle it either. From 2016 to 2019, hospital discharges with sepsis as the main diagnosis rose by 25% in Romania, but also in many other countries, sometimes by more (Slovakia +58%, Latvia +47%, Hungary +27%), while in others they fell (Netherlands −29%, Sweden −10%). Admission data do not separate changes in diagnosis and coding from changes in illness. ## How sepsis is recognised Sepsis is an emergency: every hour before treatment counts. The warning signs, what to say at the emergency department and what recovery looks like are explained at length in the guide Sepsis Clarity. If someone with an infection is getting worse fast, call 112 in Europe (999 in the UK). ## What these data do not say - They do not say how many people had sepsis. They count deaths where an infection is the recorded underlying cause, not every death in which an infection was present. - They do not say why the rate rose. Antibiotic resistance, hospital infections, flu, vaccination or the way certificates are filled in may all matter; these data do not separate them. - Comparisons with other countries depend on how doctors fill in certificates in each country. Grouping the three infections reduces this problem but does not remove it. - The latest year available for Romania in the WHO database is 2023. ## Method - Deaths: WHO Mortality Database, detailed ICD-10 codes, underlying cause of death, by sex and five-year age group, 2017–2023. The "infection" group: A40–A41 (sepsis), J12–J18 (pneumonia), A04.7 (C. difficile enterocolitis), fixed before the count. - Population: Eurostat (demo_pjangroup), the mean of 1 January of the year and 1 January of the next; where the second is missing (some Lithuanian age groups, 2024), 1 January of the year. Standardisation: 2013 European Standard Population, 18 age groups (0–4 … 85+). - "Comparison countries": the 18 EU countries with WHO and Eurostat data for every year 2017–2023, pooled (deaths and populations summed by age group). - Thresholds were fixed before the count: the headline uses the rise rounded down to ten (more than 60%); "the largest rise in the EU" would have been written only with a lead of at least 0.1 over the second country, and the lead over Latvia is 0.04. - Check: the age-standardised pneumonia rates computed here (40.0 and 64.6) are practically identical to those published by Eurostat (40.1 and 65.1). ## Questions ### How many people die of infections in Romania? In 2023, 14,868 deaths had pneumonia, sepsis or C. difficile as the underlying cause, against 9,087 in 2017. That is 6.1% of all deaths. ### Why are so few deaths recorded as sepsis? Coding rules say the recorded cause should be the condition that started the chain, and sepsis usually comes from another infection, most often in the lungs. In 2023, 2,661 deaths in Romania were recorded as sepsis. ### Did it rise because of the pandemic? The rate had already risen by 24% between 2017 and 2019, before COVID-19. These data do not establish the cause of the rise. Deaths recorded as COVID-19 are not included here. ### At what age is the gap with the other countries largest? Among adults, in middle age. At 50–64, Romania's rate is 5.9 times that of the comparison countries; over 85, 1.2 times. ## Sources - World Health Organization, WHO Mortality Database: detailed ICD-10 files (Morticd10, parts 5 and 6) and country list, February 2026 release. - Eurostat, population on 1 January by five-year age group and sex (demo_pjangroup). - Eurostat, standardised death rates by cause (hlth_cd_asdr2), pneumonia J12–J18. - Eurostat, hospital discharges by diagnosis per 100,000 inhabitants (hlth_co_disch2t), septicaemia A40–A41. - Eurostat, Revision of the European Standard Population (2013). - Rudd K.E. and colleagues, "Global, regional, and national sepsis incidence and mortality, 1990–2017", The Lancet 395 (2020): 200–211. - The patient and family guide Sepsis Clarity.