Generated on 2020-08-10

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 2,259 excess deaths and this was nearly three and a half times (3.35 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
0-14 121 103 -* 18 0 0.0%
15-44 530 528 -* 2 111 >100%+
45-64 2,737 1,557 1.76 1,180 970 82.2%
65-74 2,695 1,517 1.78 1,178 966 82.0%
75-84 4,140 2,386 1.74 1,754 1,563 89.1%
85+ 4,080 2,778 1.47 1,302 1,407 >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 79 81 -* −2 2 -
15-44 302 286 -* 16 64 >100%+
45-64 1,473 1,041 1.42 432 439 >100%+
65-74 1,681 1,139 1.48 542 511 94.2%
75-84 3,345 2,180 1.53 1,165 1,002 86.0%
85+ 5,719 3,959 1.44 1,760 1,467 83.3%

* 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 2,024 937 2.16 1,087 920 84.7%
Black 1,749 691 2.53 1,058 806 76.1%
Mixed 166 104 1.60 62 59 95.8%
Other 943 502 1.88 441 409 92.7%
White 9,018 6,220 1.45 2,798 2,812 >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 1,406 757 1.86 650 528 81.3%
Black 1,338 656 2.04 682 487 71.3%
Mixed 145 88 1.65 57 51 89.7%
Other 777 364 2.13 412 263 63.9%
White 8,564 6,381 1.34 2,184 2,145 98.2%



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 4,852 3,131 1.55 1,721 1,605 93.2%
Quintile 2 8,151 5,182 1.57 2,969 2,691 90.6%
Quintile 3 5,845 3,818 1.53 2,027 1,894 93.5%
Quintile 4 4,633 3,167 1.46 1,466 1,420 96.8%
Quintile 5 - Least Deprived 3,421 2,297 1.49 1,124 892 79.3%

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 629 428 1.47 201 166 82.5%
Barnet 1,368 863 1.58 505 457 90.6%
Bexley 950 714 1.33 236 235 99.4%
Brent 1,115 626 1.78 489 486 99.4%
Bromley 1,220 918 1.33 302 345 >100%*
Camden 559 420 1.33 139 160 >100%*
Croydon 1,403 900 1.56 503 496 98.7%
Ealing 1,148 704 1.63 444 409 92.1%
Enfield 1,218 731 1.67 487 390 80.0%
Greenwich 859 560 1.54 299 226 75.5%
Hackney 671 410 1.64 261 231 88.4%
Hammersmith and Fulham 535 328 1.63 207 170 82.0%
Haringey 755 435 1.73 320 272 85.1%
Harrow 965 538 1.79 427 397 92.9%
Havering 1,163 827 1.41 336 276 82.1%
Hillingdon 1,013 713 1.42 300 315 >100%*
Hounslow 803 548 1.47 255 236 92.4%
Islington 559 389 1.44 170 152 89.5%
Kensington and Chelsea 384 296 1.30 88 125 >100%*
Kingston Upon Thames 542 385 1.41 157 131 83.6%
Lambeth 847 506 1.67 341 290 85.1%
Lewisham 852 539 1.58 313 294 94.1%
Merton 694 426 1.63 268 203 75.7%
Newham 840 484 1.74 356 308 86.5%
Redbridge 989 616 1.61 373 313 83.9%
Richmond Upon Thames 594 434 1.37 160 152 95.2%
Southwark 740 479 1.55 261 252 96.4%
Sutton 722 521 1.39 201 179 89.1%
Tower Hamlets 572 386 1.48 186 187 >100%*
Waltham Forest 789 501 1.57 288 250 86.8%
Wandsworth 785 529 1.48 256 215 84.0%
Westminster 619 402 1.54 217 184 84.8%

* 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 6
Underlying cause of death Registered deaths Expected deaths Ratio registered / expected Excess deaths COVID-19 deaths COVID-19 deaths as % excess
Ischaemic Heart Diseases 1,954 1,797 1.09 157 49 31.2%
Cerebrovascular Diseases 982 876 1.12 106 52 49.0%
Other Circulatory Diseases 1,920 1,759 1.09 161 54 33.4%
Cancer 4,950 5,071 -* −121 115 -
Acute Respiratory Infections 798 834 -* −36 4 -
Chronic Lower Respiratory Diseases 965 985 -* −20 26 -
Other Respiratory Diseases 306 339 -* −33 9 -
Dementia and Alzheimer's 2,678 1,915 1.40 763 85 11.1%
Diseases of the Urinary System 350 273 1.28 77 19 24.8%
Cirrhosis and Other Liver Diseases 325 297 -* 28 8 28.5%
Parkinson's Disease 233 230 -* 3 12 >100%+
All Other Causes (Excl. COVID-19) 3,458 3,201 1.08 257 86 33.4%

* 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

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 7
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) 5,285 2,504 2.11 2,781 1,395 50.2%
Home 7,095 4,400 1.61 2,695 680 25.2%
Hospice 988 1,176 0.84 −188 112 -
Hospital (Acute or Community, not Psychiatric) 12,841 8,982 1.43 3,859 6,242 >100%*
Other Places 693 534 1.30 159 73 45.9%

* 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.