From June 11 to October 29 , what were the chances of English men and women dying from any cause? The same as last year. Surprising but true.

9 November 2020 By Paul Martin

Figures for “excess deaths” have risen again since then and are likely to rise further during the winter months, as Covid-19 cases increase.

These findings, based on collating all the death certificates, appear astounding, as the public perception is that life had become much more dangerous and precarious.

It was — but only during the period in April and May.

There were 54,833 more deaths in total in that period than would have been expected had it been a ‘normal’ time.    

Since mid-June till October 9 there were in fact slightly fewer deaths than in previous years — about one per cent less than average in each week.

There was then an excess of deaths in the following two weeks, making the number of excess deaths overall exactly nil.

There was a similar pattern for the 6.632 million people in UK (i.e. England, Scotland, Wales and Northern Ireland) aged between 65 to 74.

Strangely, the excess deaths from heart attacks rose significantly, compared with the previous average from the period over the previous five years. But the cancer figure was somewhat lower than ‘average’.

This may be because the average lifespan of someone diagnosed with cancer is now close to six years – whereas heart attack patients will often die extremely rapidly or have a much lower chance of survival, if there is a delay in calling emergency services, or if they were not collected by ambulance quickly.

Here are some of PUBLIC HEALTH ENGLAND‘s figures:

https://fingertips.phe.org.uk/static-reports/mortality-surveillance/excess-mortality-in-england-latest.html

Figure 1: Weekly excess deaths by date of registration, England.

All Persons

Weekly excess deaths by date of registration, England.

Age Group Males

Figure 3: Weekly excess deaths, by date of registration and age group, males, England.

The trend in excess deaths for males by age group is shown in Figure 3, which allows the extent of the excess each week to be compared over time and between age groups.

Figure 4: Cumulative excess deaths (A) and the ratio of registered deaths to expected deaths (B) by age group, males, England.

Figure 4A for males can be used to compare the cumulative total of excess deaths since 20 March 2020 between age groups.

Figure 4B compares the cumulative total of excess deaths among males with the number which would have been expected based on the modelled estimates for earlier years. Where the ratio of observed to expected is less than 1, this is shown in grey. The proportion of the excess where COVID-19 was mentioned on the death certificate is shown in yellow.

Table 1 – Males
Age group (years)Registered deathsExpected deathsRatio registered / expectedExcess deathsCOVID-19 deathsCOVID-19 deaths as % excess
0-14920987*−674
15-445,1394,4711.1566834852.1%
45-6423,12217,8421.305,2803,20560.7%
65-7430,47024,4931.245,9774,83981.0%
75-8450,32040,9301.239,3909,790>100%+
85+51,03742,5161.208,5219,859>100%+
Total161,008131,2391.2329,76928,04594.2%
* registered deaths were not significantly different from expected deaths for the time period + the total excess was less than the number of deaths with a mention of COVID-19, indicating fewer deaths from other causes than expected

Why ratios are important

Ratios can be useful for comparing between groups when the expected number is very different between groups.

For example, if group A had 5 excess deaths and group B had 10, it could appear that the impact was twice as high in group B. However, if the expected number of deaths was 1 in group A and 5 in group B, and the registered numbers of deaths were 6 and 15 respectively, then the ratios would show that group A experienced 6 times the number of deaths compared to expected, while group B experienced 3 times the number expected. Therefore, the actual relative impact is higher in group A.

The ratios presented in this report are relative to historical trends within each group, and not in relation to another group. For example, in the ethnicity section the ratio for the Asian group is the ratio between deaths in this group registered in 2020 and the estimate of expected deaths in the Asian group based on the preceding 5 years. It is not the ratio between the Asian group and another ethnic group.

Age Group Females

Figure 5: Weekly excess deaths, by date of registration and age group, females, England.

The trend in excess deaths for females by age group is shown in Figure 5, which allows the extent of the excess each week to be compared over time and between age groups.

Figure 6: Cumulative excess deaths (A) and the ratio of registered deaths to expected deaths (B) by age group, females, England.

Figure 6A for females can be used to compare the cumulative total of excess deaths since 20 March 2020 between age groups.

Figure 6B shows the ratio of the observed to the expected deaths by age group among females since 20 March 2020. This chart can be used to compare the relative excess mortality between age groups.

Table 2 – Females
Age group (years)Registered deathsExpected deathsRatio registered / expectedExcess deathsCOVID-19 deathsCOVID-19 deaths as % excess
0-14721771*−502
15-442,8842,4601.1742421550.7%
45-6414,78612,0791.222,7071,67461.8%
65-7420,94117,5521.193,3892,63977.9%
75-8441,77135,4741.186,2976,715>100%+
85+74,71963,0931.1811,62611,55699.4%
Total155,822131,4281.1924,39422,80193.5%
* registered deaths were not significantly different from expected deaths for the time period + the total excess was less than the number of deaths with a mention of COVID-19, indicating fewer deaths from other causes than expected

Ethnic Group Males

Figure 7: Weekly excess deaths, by date of registration and ethnic group, males, England.

The trend in excess deaths for males is shown in Figure 7, which allows the extent of the excess each week to be compared over time and between ethnic groups.

Figure 8: Cumulative excess deaths (A) and the ratio of registered deaths to expected deaths (B) by ethnic group, males, England.

Figure 8A for males can be used to compare the cumulative total of excess deaths since 20 March 2020 between ethnic groups.

Figure 8B shows the ratio of the observed to the expected deaths by ethnic group among males since 20 March 2020. This chart can be used to compare relative excess mortality between ethnic groups.

Table 3 – Males
Ethnic groupRegistered deathsExpected deathsRatio registered / expectedExcess deathsCOVID-19 deathsCOVID-19 deaths as % excess
Asian6,2413,7871.652,4541,94279.1%
Black3,6681,9391.891,7291,24472.0%
Mixed7514991.5025215762.4%
Other2,2271,5451.4468262791.9%
White143,325118,8731.2124,45223,84197.5%

Ethnic Group Females

Figure 9: Weekly excess deaths, by date of registration and ethnic group, females, England.

The trend in excess deaths for females is shown in Figure 9, which allows the extent of the excess each week to be compared over time and between ethnic groups.

Figure 10: Cumulative excess deaths (A) and the ratio of registered deaths to expected deaths (B) by ethnic group, females, England.

Figure 10A for females can be used to compare the cumulative total of excess deaths since 20 March 2020 between ethnic groups.

Figure 10B shows the ratio of the observed to the expected deaths by ethnic group among females since 20 March 2020. This chart can be used to compare relative excess mortality between ethnic groups.

Table 4 – Females
Ethnic groupRegistered deathsExpected deathsRatio registered / expectedExcess deathsCOVID-19 deathsCOVID-19 deaths as % excess
Asian4,4753,0211.481,4541,11876.9%
Black2,7751,6971.641,07872967.6%
Mixed6644061.6425813250.9%
Other1,9321,0291.8890441646.0%
White141,452120,6931.1720,75920,23997.5%

Ethnicity coding

Ethnicity is not collected at death registration, so these estimates were made by linking death records to hospital records to find the ethnicity of the deceased. This approach has some limitations. Ethnicity is supposed to be self-reported by the patient in hospital records, but this may not always be the case. Patients may also report different ethnicities in different episodes of care. For this analysis the most recent reported ethnic group was used. Population estimates have been used to calculate mortality rates to estimate the expected numbers of deaths, and these were based on the 2011 Census. This may lead to a mismatch between ethnicity reported in hospital records and self-reported ethnicity in the census. It appears, for example, that more people are assigned to the ‘Other’ group in hospital records than in the 2011 Census.

Deprivation

Figure 11: Weekly excess deaths, by date of registration and deprivation quintile, England

The trend in excess deaths among deprivation quintiles is shown in Figure 11, which allows the extent of the excess each week to be compared over time and between deprivation quintiles.

Figure 12: Cumulative excess deaths (A) and the ratio of registered deaths to expected deaths (B) by deprivation quintile, England

Figure 12A can be used to compare the cumulative total of excess deaths since 20 March 2020 between deprivation quintiles.

Figure 12B shows the ratio of the observed to the expected deaths by deprivation quintile since 20 March 2020. This chart can be used to compare relative excess mortality between deprivation quintiles.

Table 5
Deprivation quintileRegistered deathsExpected deathsRatio registered / expectedExcess deathsCOVID-19 deathsCOVID-19 deaths as % excess
Quintile 1 – Most Deprived66,76353,9891.2412,77411,55790.5%
Quintile 263,51152,5511.2110,96010,80798.6%
Quintile 364,73254,1941.1910,5389,87293.7%
Quintile 463,06153,2051.199,8569,74598.9%
Quintile 5 – Least Deprived58,76348,9731.209,7908,86590.6%

Region

Figure 13: Weekly excess deaths by date of registration, North East.

The trend in excess deaths by region is shown in Figures 13 to 21, which allows the extent of the excess each week to be compared over time and for selected regions.

Figure 22: Cumulative excess deaths (A) and the ratio of registered deaths to expected deaths (B) by region, England.

Figure 22A can be used to compare the cumulative total of excess deaths since 20 March 2020 between regions.

Figure 22B shows the ratio of the observed to the expected deaths by region since 20 March 2020. This chart can be used to compare relative excess mortality between regions.

Table 6
RegionRegistered deathsExpected deathsRatio registered / expectedExcess deathsCOVID-19 deathsCOVID-19 deaths as % excess
North East17,76014,6831.213,0772,97196.6%
North West45,97037,5421.228,4288,39799.6%
Yorkshire and the Humber32,60627,4111.195,1955,05197.2%
East Midlands28,34523,9751.184,3704,08293.4%
West Midlands36,02528,9231.257,1026,04685.1%
East of England35,83530,4811.185,3545,18596.8%
London35,52926,2231.359,3068,66193.1%
South East51,40843,2781.198,1307,50292.3%
South West33,35230,1531.113,1992,95192.2%

Deaths by Underlying Cause

Figure 23: Weekly excess deaths by date of registration, ischaemic heart diseases, England.

The trend in excess deaths for selected underlying causes of death (UCOD) is shown in Figures 23 to 34 which allow the extent of the excess to be compared over time for each cause. For each cause, the number of excess deaths without COVID-19 mentioned on the certificate (shown in the white part of the column) may be due to an increase in deaths from this cause during the period of the pandemic, but may also reflect under-reporting of deaths involving COVID-19.

Figure 35: Cumulative excess deaths (A) and the ratio of registered deaths to expected deaths (B) by underlying cause of death, England

Figure 35A shows the total cumulative excess deaths by UCOD since 20 March 2020. The chart can be used to compare the number of excess deaths for each UCOD.

This chart can be used to compare the cumulative total of excess deaths since 20 March 2020 between underlying causes.

Figure 35B shows the ratio of the observed to the expected deaths by UCOD since 20 March 2020. This chart can be used to compare relative excess mortality between underlying causes of death.

Table 7
Underlying cause of deathRegistered deathsExpected deathsRatio registered / expectedExcess deathsCOVID-19 deathsCOVID-19 deaths as % excess
Ischaemic Heart Diseases27,99326,1571.071,83642823.3%
Cerebrovascular Diseases14,92813,7401.091,18832026.9%
Other Circulatory Diseases23,98022,5361.061,44437926.3%
Cancer75,81976,065*−246959
Acute Respiratory Infections10,85412,2580.89−1,40410
Chronic Lower Respiratory Diseases13,34514,6010.91−1,256180
Other Respiratory Diseases4,3525,3670.81−1,01571
Dementia and Alzheimer’s36,14932,8211.103,32877223.2%
Diseases of the Urinary System4,3203,8621.1245811725.6%
Cirrhosis and Other Liver Diseases4,8094,4001.0940910224.9%
Parkinson’s Disease3,8023,848*−4672
All Other Causes (Excl. COVID-19)49,72747,6931.042,03468433.6%
* registered deaths were not significantly different from expected deaths for the time period

Figure 39: Weekly excess deaths by date of registration, own home, England.

Figures 39 to 43 show the weekly total excess registered deaths by place of death since week ending 27 March 2020. These charts can be used to understand the trend in excess deaths by place of death. This analysis should be interpreted as excess deaths within each place of death compared to what would have been expected based on data over the past five years.

Figure 44: Cumulative excess deaths (A) and the ratio of registered deaths to expected deaths (B), by place of death, England.

Figure 44A shows the total cumulative excess deaths in each place of death since 20 March 2020. The chart can be used to compare the numbers of excess deaths in each place of death. This chart can be used to compare the cumulative total of excess deaths since 20 March 2020 between places of death.

Figure 44B shows the ratio of the observed to the expected deaths in each place of death since 20 March 2020. This chart can be used to compare relative excess mortality between places of death.

Table 8
Place of deathRegistered deathsExpected deathsRatio registered / expectedExcess deathsCOVID-19 deathsCOVID-19 deaths as % excess
Care Home (Nursing or Residential)80,26557,2601.4023,00514,99965.2%
Home89,26365,6441.3623,6192,42110.3%
Hospice13,89216,2720.85−2,380746
Hospital (Acute or Community, not Psychiatric)125,330116,8441.078,48632,275>100%*
Other Places8,0806,8711.181,20940533.5%
* the total excess was less than the number of deaths with a mention of COVID-19, indicating fewer deaths from other causes than expected

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