Dutch travellers and expats have a greater chance of dying younger than people who stay in the Netherlands. Middle Eastern and African countries in particular are high-risk regions. Research by a hospital in Rotterdam shows that the main causes of death among Dutch people abroad are heart complaints and accidents, followed by cancer, infections and psychological problems.
 
The life expectancy of Dutch people abroad is much lower. In the Netherlands, the average age of death is 76.4, for Dutch nationals outside the country the age is 20 years younger (56.1 years old). Men in particular have a higher chance of dying early abroad. More than 70 percent of the Dutch fatalities outside the country are men.
 
"One possible reason why more Dutch men than women die abroad could be because they are less careful," says health expert Arina Groenheide. But she is unable to say why the average age of death is much lower for men when they live abroad. It is not because fewer elderly people or women go abroad. "For instance a large number of Dutch pensioners live outside the country or go to warm countries for the winter."
 
Middle East
According to the research, the risk of dying in Belgium is lowest (0.028 fatalities per 100,000) and highest in Kenya (12.18 per 100,000).
 
Ms Groenheide says Dutch nationals are almost 20 times more likely to die in the East Mediterranean area or in countries like Morocco, Egypt, Afghanistan and Jordan - than in Europe. "The chance of dying in Africa is more than 16 times higher, with infections being the main cause of death. In South Asia, people are nine times more likely to die. Here too, infections are also one of the main causes of death for compatriots." Generally heart failure and accidents are the main cause of death for Dutch people abroad.
 
No central registration
Initially Ms Groenheide turned to the Dutch embassies for these figures, but she soon realised that the Netherlands does not centrally register the causes of death of compatriots outside the country. So she sent questionnaires to family doctors. More than 1,800 filled them in.
 
Ms Groenheide: "Family doctors do not actually register the deaths of patients separately who die abroad. But as it is out of the ordinary for a patient to die abroad, they were able to answer our questions from their experience. The target group for our survey includes Dutch travellers, pensioners, people who spend the winters in warm countries and expats who leave the country for a couple of years and stay in contact with their doctors."
 
Travel advice
"The research means we can adjust the advice we give people for certain regions and countries. It makes it possible for us to better assess the risks to travellers and expats abroad, which is good," thinks Ms Groenheide. She recommends that the Netherlands follows the example of Great Britain and the United States and starts a central register of the causes of death of Dutch nationals abroad.
 
Medical risk
Anke van Nieuwenhuizen, spokesperson for the worldwide emergency organisation, SOS International, says the countries listed in the research are also on their list of high-risk countries. "But you shouldn't underestimate China or Russia. In countries like Nigeria, the local medical treatment is not always good enough, but the expat community is so large that there are organisations and structures which make up for this."
 
Ms Van Nieuwenhuizen thinks it is important to consider a person's health before departure, as well as the medical care available at his or her destination. Both factors play an important role. "For instance, it is not advisable for stable psychiatric patients to travel abroad. This includes people who are overworked and are told to 'take a break'." 
 
Note - the study did not compare the fatality figures of Dutch people abroad to the local life expectancy.

Photo: Patrick Rasenberg at Flickr