Generated on 2021-10-18

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 throughout the pandemic 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 week through the pandemic. Excess deaths are estimated by week and in total since 21 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. Please note, some of the figures in this report have been rounded, though the differences displayed are based on unrounded data.

All Persons

Weekly excess deaths by date of registration, North West.‎

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

The trend in total excess deaths by week, in North West, 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 24 April 2020 there were 1,557 excess deaths and this was two times (2 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 21 March 2020, by date of registration, North West.

Figure 2: Cumulative deaths since 21 March 2020, by date of registration, North West.

The trend in the total cumulative number of excess deaths in North West since 21 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, North West.

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

Figure 3A for males can be used to compare the cumulative total of excess deaths since 21 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 registered 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
0-24 611 694 0.88 −83 8 -
25-49 3,376 2,883 1.17 493 317 64.3%
50-64 9,375 7,381 1.27 1,994 1,421 71.3%
65-74 13,182 11,292 1.17 1,890 2,311 >100%*
75-84 20,334 17,005 1.20 3,329 4,351 >100%*
85+ 17,723 15,964 1.11 1,759 3,778 >100%*
Total 64,601 55,218 1.17 9,383 12,186 >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



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, North West.

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

Figure 4A for females can be used to compare the cumulative total of excess deaths since 21 March 2020 between age groups.

Figure 4B shows the ratio of the registered to the expected deaths by age group among females since 21 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
0-24 430 446 -* −16 10 -
25-49 2,132 1,745 1.22 387 222 57.4%
50-64 6,010 5,054 1.19 956 840 87.9%
65-74 9,359 7,929 1.18 1,430 1,471 >100%+
75-84 17,405 14,781 1.18 2,624 3,063 >100%+
85+ 26,229 24,026 1.09 2,203 4,472 >100%+
Total 61,565 53,981 1.14 7,584 10,078 >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, North West.

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

Figure 5A for males can be used to compare the cumulative total of excess deaths since 21 March 2020 between ethnic groups.

Figure 5B shows the ratio of the registered to the expected deaths by ethnic group among males since 21 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 1,812 1,231 1.47 580 669 >100%*
Black 606 365 1.66 241 181 75.1%
Mixed 188 173 -+ 15 39 >100%*
Other 414 353 1.17 60 89 >100%*
White 60,801 52,421 1.16 8,380 11,154 >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

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



Ethnic Group Females

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

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

Figure 6A for females can be used to compare the cumulative total of excess deaths since 21 March 2020 between ethnic groups.

Figure 6B shows the ratio of the registered to the expected deaths by ethnic group among females since 21 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 1,293 923 1.40 370 397 >100%*
Black 409 277 1.47 131 90 68.5%
Mixed 166 135 -+ 31 24 79.0%
Other 300 185 1.62 115 59 51.4%
White 58,690 51,808 1.13 6,883 9,473 >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

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



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, North West.

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

Figure 7A can be used to compare the cumulative total of excess deaths since 21 March 2020 between deprivation quintiles.

Figure 7B shows the ratio of the registered to the expected deaths by deprivation quintile since 21 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 45,056 37,847 1.19 7,209 8,201 >100%*
Quintile 2 24,219 20,803 1.16 3,416 4,533 >100%*
Quintile 3 18,749 16,579 1.13 2,170 3,232 >100%*
Quintile 4 21,233 18,871 1.13 2,362 3,616 >100%*
Quintile 5 - Least Deprived 16,909 15,100 1.12 1,809 2,682 >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

Upper Tier Local Authority

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

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

Figure 8A can be used to compare the cumulative total of excess deaths since 21 March 2020 between Upper Tier Local Authorities.

Figure 8B shows the ratio of the registered to the expected deaths by Upper Tier Local Authority since 21 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
Blackburn with Darwen 2,361 1,930 1.22 431 509 >100%*
Blackpool 3,167 2,756 1.15 411 504 >100%*
Bolton 4,718 3,934 1.20 784 876 >100%*
Bury 3,343 2,745 1.22 598 653 >100%*
Cheshire East 6,676 6,206 1.08 470 1,091 >100%*
Cheshire West and Chester 5,880 5,283 1.11 597 1,033 >100%*
Cumbria 10,075 8,542 1.18 1,533 1,569 >100%*
Halton 2,034 1,891 1.08 143 324 >100%*
Knowsley 2,776 2,375 1.17 401 480 >100%*
Lancashire 21,996 19,278 1.14 2,718 3,621 >100%*
Liverpool 8,199 6,751 1.21 1,448 1,572 >100%*
Manchester 6,349 5,158 1.23 1,191 1,172 98.4%
Oldham 3,836 3,210 1.19 626 804 >100%*
Rochdale 3,703 3,068 1.21 635 733 >100%*
Salford 3,845 3,273 1.17 572 707 >100%*
Sefton 5,918 4,937 1.20 981 988 >100%*
St. Helens 3,477 3,018 1.15 459 597 >100%*
Stockport 4,797 4,279 1.12 518 810 >100%*
Tameside 4,030 3,524 1.14 506 825 >100%*
Trafford 3,466 3,052 1.14 414 611 >100%*
Warrington 3,405 3,066 1.11 339 603 >100%*
Wigan 5,636 5,029 1.12 607 1,111 >100%*
Wirral 6,479 5,558 1.17 921 1,071 >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

Deaths by cause

See ICD10 references for the details of the ICD10 codes for each cause in this section.

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

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

Figure 9A shows the total cumulative excess deaths with mention of specific causes anywhere on the death certificate since 21 March 2020. The chart can be used to compare the number of excess deaths for each cause.

This chart can be used to compare the cumulative total of excess deaths since 21 March 2020 between causes.

Figure 9B shows the ratio of the registered to the expected deaths by cause of death since 21 March 2020. This chart can be used to compare relative excess mortality between causes mentioned anywhere on the death certificate.

Table 7
Cause of death mentioned on death certificate Registered deaths Expected deaths Specific cause deaths (underlying cause) COVID-19 deaths (underlying cause) Excess deaths Ratio registered / expected
Ischaemic Heart Diseases 22,873 19,990 12,126 2,654 2,883 1.14
Cerebrovascular Diseases 10,914 9,574 5,806 1,238 1,340 1.14
Other Circulatory Diseases 39,996 34,184 8,541 6,174 5,812 1.17
Heart Failure 14,400 12,799 1,837 1,804 1,601 1.13
Cancer 34,804 33,751 29,735 1,927 1,053 1.03
Acute Respiratory Infections 28,235 21,148 4,339 10,917 7,087 1.34
Chronic Lower Respiratory Diseases 17,020 14,896 5,891 3,682 2,124 1.14
Other Respiratory Diseases 8,845 9,754 1,773 1,253 −909 0.91
Dementia and Alzheimer's 21,586 19,129 13,144 4,000 2,457 1.13
Diseases of the Urinary System 15,268 12,839 1,603 2,729 2,429 1.19
Cirrhosis and Other Liver Diseases 4,710 4,122 2,559 339 588 1.14
Diabetes 14,349 10,142 1,244 3,550 4,207 1.41
Parkinson's Disease 2,243 1,992 1,214 389 251 1.13

Table 7 shows the number of registered deaths with a cause of death mentioned anywhere on the death certificate, the number expected, the excess deaths and the ratio of registered/expected deaths. It also breaks down the number of registered deaths with that cause registered on the death certificate by the number where the cause was the underlying cause and the number where COVID-19 was the underlying cause.

Place of Death

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

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

Figure 10A shows the total cumulative excess deaths in each place of death since 21 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 21 March 2020 between places of death.

Figure 10B shows the ratio of the registered to the expected deaths in each place of death since 21 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) 25,198 22,393 1.13 2,805 4,239 >100%*
Home 35,497 26,896 1.32 8,601 1,145 13.3%
Hospice 4,689 6,475 0.72 −1,786 261 -
Hospital (Acute or Community, not Psychiatric) 57,834 50,516 1.14 7,318 16,507 >100%*
Other Places 2,948 2,544 1.16 404 112 27.7%

* 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.

PHE produces other estimates of excess mortality using the daily General Register Office model and the EuroMOMO model. These are reviewed in this blog.

Updates to Excess Mortality Methodology, December 2020

Several changes to the models were introduced in the regional report from January 2020:

The methodology document has been updated to reflect these changes.

ICD10 references

Cause description ICD10 reference
Ischaemic heart diseases All mentions of I20-I25
Cerebrovascular diseases All mentions of I60-I69
Other circulatory diseases All mentions beginning with I (excluding I20-I25 and I60-I69)
Heart failure All mentions of I11.0, I25.5, I42.0, I42.9, I50.0, I50.1, I50.9
Cancer All mentions of C00-C97
Acute respiratory infections All mentions of J00-J22
Chronic lower respiratory diseases All mentions of J40-J47
Other respiratory diseases All mentions beginning with J (excluding J00-J22 and J40-J47)
Dementia and Alzheimer’s All mentions of F01, F03, or G30
Diseases of the urinary system All mentions of N00-N39
Cirrhosis and other liver diseases All mentions of K70-K76
Diabetes All mentions of E10-E14
Parkinson’s disease All mentions of G20

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