Generated on 2020-11-16

Introduction

Monitoring excess mortality provides understanding of the impact of COVID-19 during the course of the pandemic and beyond. Excess mortality in this report is defined as the number of deaths in 2020 which are above the number expected based on mortality rates in earlier years.

In this report the expected number of deaths is modelled using five years of data from preceding years to estimate the number of deaths we would expect on each day in 2020. Excess deaths are estimated by week and in total since 20 March 2020, based on the date each death was registered rather than when it occurred. Excess deaths are presented by age, sex, Upper Tier Local Authority, ethnic group, level of deprivation, cause of death and place of death.

All Persons

Weekly excess deaths by date of registration, London.

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

The trend in total excess deaths by week, in London, since week ending 27 March 2020 is shown in Figure 1. Numbers above each of the columns show the total number of excess deaths and how these compare with the expected number based on modelled estimates for 2015 to 2019. For example, in week ending 17 April there were 2,251 excess deaths and this was nearly three and a half times (3.34 times higher) the expected number of deaths in this week. When fewer deaths than expected occur in a week, the column is coloured grey.

Excess deaths where COVID-19 was mentioned on the death certificate are shown in orange. If the number of deaths is not shown in the orange part of the column, that means the total excess was less than the number of deaths with a mention of COVID-19, indicating fewer deaths from other causes than expected in these weeks.

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 other causes during the period of the pandemic but may also reflect under-reporting of deaths involving COVID-19.

Cumulative deaths since 20 March 2020, by date of registration, London.

Figure 2: Cumulative deaths since 20 March 2020, by date of registration, London.

The trend in the total cumulative number of excess deaths in London since 20 March 2020 is shown in Figure 2.

Age Group Males

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

Figure 3: Cumulative excess deaths (A) and the ratio of registered deaths to expected deaths (B) by age group, males, London.

Figure 3A for males can be used to compare the cumulative total of excess deaths since 20 March 2020 between age groups.

Figure 3B 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 negative, 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 deaths Expected deaths Ratio registered / expected Excess deaths COVID-19 deaths COVID-19 deaths as % excess
0-14 207 176 -* 31 0 0.0%
15-44 906 899 -* 7 116 >100%+
45-64 3,990 2,655 1.50 1,335 989 74.1%
65-74 3,936 2,589 1.52 1,347 1,027 76.3%
75-84 5,814 4,071 1.43 1,743 1,641 94.2%
85+ 5,794 4,751 1.22 1,043 1,493 >100%+

* 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

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

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

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

Figure 4B 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 deaths Expected deaths Ratio registered / expected Excess deaths COVID-19 deaths COVID-19 deaths as % excess
0-14 126 137 -* −11 1 -
15-44 506 486 -* 20 68 >100%+
45-64 2,254 1,775 1.27 479 454 94.7%
65-74 2,557 1,943 1.32 614 539 87.8%
75-84 4,869 3,720 1.31 1,149 1,051 91.5%
85+ 8,270 6,750 1.23 1,520 1,546 >100%+

* 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

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

Figure 5: Cumulative excess deaths (A) and the ratio of registered deaths to expected deaths (B) by ethnic group, males, London.

Figure 5A for males can be used to compare the cumulative total of excess deaths since 20 March 2020 between ethnic groups.

Figure 5B 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 group Registered deaths Expected deaths Ratio registered / expected Excess deaths COVID-19 deaths COVID-19 deaths as % excess
Asian 2,814 1,630 1.73 1,185 988 83.4%
Black 2,336 1,202 1.94 1,135 822 72.5%
Mixed 245 180 1.36 64 62 96.8%
Other 1,398 872 1.60 526 427 81.2%
White 13,359 10,817 1.23 2,542 2,917 >100%*

* 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 Females

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

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

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

Figure 6B 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 group Registered deaths Expected deaths Ratio registered / expected Excess deaths COVID-19 deaths COVID-19 deaths as % excess
Asian 1,996 1,315 1.52 682 556 81.5%
Black 1,882 1,139 1.65 743 497 66.8%
Mixed 202 152 1.33 50 52 >100%*
Other 1,144 633 1.81 511 273 53.5%
White 12,879 11,085 1.16 1,794 2,243 >100%*

* the total excess was less than the number of deaths with a mention of COVID-19, indicating fewer deaths from other causes than expected



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

Cumulative excess deaths (A) and the ratio of registered deaths to expected deaths (B) by deprivation quintile, London.

Figure 7: Cumulative excess deaths (A) and the ratio of registered deaths to expected deaths (B) by deprivation quintile, London.

Figure 7A can be used to compare the cumulative total of excess deaths since 20 March 2020 between deprivation quintiles.

Figure 7B 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 quintile Registered deaths Expected deaths Ratio registered / expected Excess deaths COVID-19 deaths COVID-19 deaths as % excess
Quintile 1 - Most Deprived 6,969 5,342 1.30 1,627 1,678 >100%*
Quintile 2 11,859 8,843 1.34 3,016 2,832 93.9%
Quintile 3 8,488 6,516 1.30 1,972 1,994 >100%*
Quintile 4 6,901 5,404 1.28 1,497 1,489 99.5%
Quintile 5 - Least Deprived 5,012 3,920 1.28 1,092 932 85.3%

* the total excess was less than the number of deaths with a mention of COVID-19, indicating fewer deaths from other causes than expected

Upper Tier Local Authority

Cumulative excess deaths (A) and the ratio of registered deaths to expected deaths (B) by Upper Tier Local Authority, London.

Figure 8: Cumulative excess deaths (A) and the ratio of registered deaths to expected deaths (B) by Upper Tier Local Authority, London.

Figure 8A can be used to compare the cumulative total of excess deaths since 20 March 2020 between Upper Tier Local Authorities.

Figure 8B shows the ratio of the observed to the expected deaths by Upper Tier Local Authority since 20 March 2020. This chart can be used to compare relative excess mortality between Upper Tier Local Authorities.

Table 6
Upper Tier Local Authority Registered deaths Expected deaths Ratio registered / expected Excess deaths COVID-19 deaths COVID-19 deaths as % excess
Barking and Dagenham 928 729 1.27 199 185 92.9%
Barnet 1,950 1,474 1.32 476 469 98.6%
Bexley 1,421 1,217 1.17 204 255 >100%*
Brent 1,536 1,069 1.44 467 504 >100%*
Bromley 1,852 1,564 1.18 288 358 >100%*
Camden 845 717 1.18 128 166 >100%*
Croydon 1,987 1,536 1.29 451 505 >100%*
Ealing 1,677 1,202 1.40 475 434 91.3%
Enfield 1,721 1,247 1.38 474 401 84.5%
Greenwich 1,245 955 1.30 290 233 80.3%
Hackney 984 700 1.41 284 244 85.8%
Hammersmith and Fulham 794 559 1.42 235 176 75.0%
Haringey 1,077 743 1.45 334 286 85.7%
Harrow 1,304 918 1.42 386 409 >100%*
Havering 1,809 1,409 1.28 400 317 79.3%
Hillingdon 1,508 1,216 1.24 292 324 >100%*
Hounslow 1,224 935 1.31 289 258 89.2%
Islington 818 664 1.23 154 158 >100%*
Kensington and Chelsea 587 505 1.16 82 132 >100%*
Kingston Upon Thames 741 657 1.13 84 137 >100%*
Lambeth 1,197 863 1.39 334 299 89.6%
Lewisham 1,237 920 1.34 317 301 94.9%
Merton 1,022 726 1.41 296 209 70.6%
Newham 1,184 826 1.43 358 327 91.4%
Redbridge 1,480 1,050 1.41 430 362 84.2%
Richmond Upon Thames 870 741 1.17 129 155 >100%*
Southwark 1,086 817 1.33 269 255 94.7%
Sutton 1,084 889 1.22 195 182 93.4%
Tower Hamlets 851 660 1.29 191 202 >100%*
Waltham Forest 1,139 855 1.33 284 262 92.2%
Wandsworth 1,170 903 1.30 267 224 83.7%
Westminster 901 687 1.31 214 196 91.5%

* the total excess was less than the number of deaths with a mention of COVID-19, indicating fewer deaths from other causes than expected

Deaths by underlying cause

Cumulative excess deaths (A) and the ratio of registered deaths to expected deaths (B) by underlying cause of death, London.

Figure 9: Cumulative excess deaths (A) and the ratio of registered deaths to expected deaths (B) by underlying cause of death, London.

Figure 9A 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 9B 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 death Registered deaths Expected deaths Ratio registered / expected Excess deaths COVID-19 deaths COVID-19 deaths as % excess
Ischaemic Heart Diseases 3,305 3,038 1.09 267 57 21.3%
Cerebrovascular Diseases 1,585 1,491 -* 94 58 61.4%
Other Circulatory Diseases 3,074 2,984 -* 90 64 71.5%
Cancer 8,542 8,811 -* −269 133 -
Acute Respiratory Infections 1,255 1,341 -* −86 4 -
Chronic Lower Respiratory Diseases 1,490 1,599 -* −109 27 -
Other Respiratory Diseases 487 569 0.86 −82 12 -
Dementia and Alzheimer's 3,890 3,303 1.18 587 93 15.8%
Diseases of the Urinary System 550 467 1.18 83 22 26.6%
Cirrhosis and Other Liver Diseases 558 514 -* 44 10 22.9%
Parkinson's Disease 391 403 -* −12 12 -
All Other Causes (Excl. COVID-19) 5,772 5,492 1.05 280 103 36.8%

* registered deaths were not significantly different from expected deaths for the time period

Place of Death

Cumulative excess deaths (A) and the ratio of registered deaths to expected deaths (B), by place of death, London.

Figure 10: Cumulative excess deaths (A) and the ratio of registered deaths to expected deaths (B), by place of death, London.

Figure 10A 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 10B 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 death Registered deaths Expected deaths Ratio registered / expected Excess deaths COVID-19 deaths COVID-19 deaths as % excess
Care Home (Nursing or Residential) 6,906 4,321 1.60 2,585 1,429 55.3%
Home 11,114 7,557 1.47 3,557 700 19.7%
Hospice 1,653 2,024 0.82 −371 114 -
Hospital (Acute or Community, not Psychiatric) 18,397 15,166 1.21 3,231 6,606 >100%*
Other Places 1,159 925 1.25 234 76 32.5%

* the total excess was less than the number of deaths with a mention of COVID-19, indicating fewer deaths from other causes than expected

Comparisons to other measures of excess deaths in England

The Office for National Statistics also publishes a weekly report on excess deaths in England & Wales. The numbers reported by ONS are broadly in line with the overall excess death figures in this report but there are some differences as the ‘expected’ numbers in this report are not just the simple five-year average for 2015 to 2019, as used by ONS. As explained in the Methods, they are instead modelled estimates which adjust for factors such as the ageing of the population and the underlying trend in mortality rates from year to year. The ONS report also defines weeks as seven-day periods ending on a Friday. Excess deaths in this report were estimated only for weekdays, with deaths registered on a Saturday added to the preceding Friday each week.

EuroMOMO is a European mortality monitoring programme that aims to measure excess deaths related to seasonal influenza and other public health threats that uses a standardised methodology across 24 European countries. The methodology used by EuroMOMO is similar to that used by the PHE model, however, the EuroMOMO model looks at deaths by date of occurrence, and the PHE model looks at deaths by date of registration. Because there is a time lag between date of occurrence of death and date of registration, analysis of excess deaths by date of occurrence requires a delay correction, the reliability of which improves over time. These two models produce very similar results but with small differences due to the delay correction applied by EuroMOMO.

The PHE Daily GRO mortality model is used in PHE’s COVID-19 surveillance report for all-cause mortality. It uses a 5-year average to estimate expected deaths, similar to that used by the ONS but with a trend included. It looks at deaths by date of occurrence based on rapidly reported deaths from the General Register Office and uses a registration delay correction, the reliability of which improves over time. Overall, the excess deaths are similar in the COVID-19 surveillance report and this report, but may show some differences in specific weeks due to use of occurrence date compared with registration date, and in recent weeks due to the delay corrections.

Code repository

The code used to create this report is stored here.