Under-5 Mortality Trends and Leading Causes of Death in Children Under 5 Years Old Between 2016 and 2020 in Greece. A Nationwide Population Based Study

Objectives To examine recent trends and cause-specific patterns of under-5 mortality in Greece and to identify demographic and regional variations using ICD-10–based national data. Study Design Nationwide population-based retrospective study. Methods We conducted a nationwide analysis of all under-5 deaths recorded by the Hellenic Statistical Authority (ELSTAT) from 2016 to 2020. Neonatal mortality rate (NMR), infant mortality rate (IMR), and under-5 mortality rate (U5MR) were calculated per 1,000 live births. Causes of death were analyzed using individual ICD-10 codes, and age-, sex-, and region-specific patterns were examined. Mortality trends were contextualized using data from the World Health Organization (WHO), United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME), and Eurostat. Results A total of 1,877 under-5 deaths were recorded, 58.3% of which occurred during the neonatal period. Mortality declined steadily, with U5MR decreasing by 22.9%, from 4.97 to 3.82 per 1,000 live births. Deaths were predominantly attributed to perinatal (P00-P96) and congenital anomaly (Q00-Q99) ICD-10 categories (>70%). Mortality was higher among males (56%) and concentrated in regions hosting major tertiary hospitals. In 2020, Greece’s U5MR ranked in the mid-range among EU countries. Conclusions Despite declining under-5 mortality, preventable neonatal causes remain prominent in Greece. Strengthening perinatal and neonatal care and targeted prevention strategies are essential to further improve outcomes and align with leading European countries.