Generated on 2021-02-17

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, South East.‎

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

The trend in total excess deaths by week, in South East, 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 1,548 excess deaths and this was nearly two times (1.87 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, South East.

Figure 2: Cumulative deaths since 21 March 2020, by date of registration, South East.

The trend in the total cumulative number of excess deaths in South East 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, South East.

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

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 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
0-14 205 253 -* −48 0 -
15-44 1,115 1,082 -* 33 86 >100%+
45-64 5,447 4,684 1.16 763 883 >100%+
65-74 7,598 6,423 1.18 1,175 1,528 >100%+
75-84 13,336 11,033 1.21 2,303 3,151 >100%+
85+ 15,478 12,252 1.26 3,226 3,699 >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, South East.

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

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 observed 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
0-14 151 197 0.76 −46 1 -
15-44 652 598 -* 54 54 >100%+
45-64 3,621 3,156 1.15 465 521 >100%+
65-74 5,258 4,652 1.13 606 860 >100%+
75-84 10,900 9,576 1.14 1,324 2,200 >100%+
85+ 22,730 17,936 1.27 4,794 4,739 98.9%

* 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, South East.

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

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 observed 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 983 644 1.53 339 326 96.1%
Black 282 208 1.36 74 81 >100%*
Mixed 161 121 1.33 40 41 >100%*
Other 489 264 1.85 225 136 60.4%
White 39,785 33,562 1.19 6,223 8,032 >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, South East.

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

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 observed 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 678 514 1.32 164 191 >100%*
Black 229 158 1.44 70 47 66.5%
Mixed 141 102 1.39 39 28 70.5%
Other 460 183 2.52 277 101 36.5%
White 40,340 34,215 1.18 6,125 7,324 >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, South East.

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

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 observed 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 7,320 6,156 1.19 1,164 1,609 >100%*
Quintile 2 13,174 10,874 1.21 2,300 2,884 >100%*
Quintile 3 17,742 14,855 1.19 2,887 3,569 >100%*
Quintile 4 21,050 17,577 1.20 3,473 4,237 >100%*
Quintile 5 - Least Deprived 27,205 22,457 1.21 4,748 5,423 >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, South East.

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

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 observed 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
Bracknell Forest 801 647 1.24 154 162 >100%*
Brighton and Hove 2,117 1,827 1.16 290 382 >100%*
Buckinghamshire 4,612 3,843 1.20 769 961 >100%*
East Sussex 6,912 5,800 1.19 1,112 1,505 >100%*
Hampshire 13,266 11,416 1.16 1,850 2,357 >100%*
Isle of Wight 1,819 1,573 1.16 246 234 95.1%
Kent 16,508 13,269 1.24 3,239 4,028 >100%*
Medway 2,570 1,991 1.29 579 718 >100%*
Milton Keynes 1,969 1,606 1.23 363 483 >100%*
Oxfordshire 5,639 4,864 1.16 775 954 >100%*
Portsmouth 1,684 1,510 1.12 174 330 >100%*
Reading 1,281 960 1.34 321 287 89.3%
Slough 978 722 1.36 256 282 >100%*
Southampton 1,879 1,589 1.18 290 322 >100%*
Surrey 11,251 8,904 1.26 2,347 2,436 >100%*
West Berkshire 1,309 1,075 1.22 234 215 92.0%
West Sussex 9,365 8,081 1.16 1,284 1,483 >100%*
Windsor and Maidenhead 1,286 1,113 1.16 173 296 >100%*
Wokingham 1,245 1,053 1.18 192 287 >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 underlying 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 underlying cause of death, South East.

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

Figure 9A shows the total cumulative excess deaths by UCOD since 21 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 21 March 2020 between underlying causes.

Figure 9B shows the ratio of the observed to the expected deaths by UCOD since 21 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 6,674 6,424 1.04 250 178 71.1%
Cerebrovascular Diseases 4,068 3,818 1.07 250 139 55.5%
Other Circulatory Diseases 7,282 6,723 1.08 559 211 37.8%
Cancer 19,886 20,433 0.97 −547 508 -
Acute Respiratory Infections 2,746 3,760 0.73 −1,014 2 -
Chronic Lower Respiratory Diseases 3,275 3,981 0.82 −706 88 -
Other Respiratory Diseases 1,077 1,442 0.75 −365 28 -
Dementia and Alzheimer's 9,678 9,893 -* −215 310 -
Diseases of the Urinary System 1,198 1,035 1.16 163 41 25.2%
Cirrhosis and Other Liver Diseases 1,167 1,027 1.14 140 55 39.4%
Parkinson's Disease 1,102 1,185 -* −83 39 -
All Other Causes (Excl. COVID-19) 12,490 12,378 -* 112 275 >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

Place of Death

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

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

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 observed 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) 23,586 18,109 1.30 5,477 5,539 >100%*
Home 22,334 16,673 1.34 5,661 789 13.9%
Hospice 4,915 5,918 0.83 −1,003 364 -
Hospital (Acute or Community, not Psychiatric) 33,460 29,415 1.14 4,045 10,881 >100%*
Other Places 2,196 1,879 1.17 317 149 47.0%

* 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.

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.

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 Underlying cause of death is between I20-I25
Cerebrovascular diseases Underlying cause of death is between I60-I69
Other circulatory diseases Underlying cause of death begins with I (excluding I20-I25 and I60-I69)
Cancer Underlying cause of death is between C00-C97
Acute respiratory infections Underlying cause of death is between J00-J22
Chronic lower respiratory diseases Underlying cause of death is between J40-J47
Other respiratory diseases Underlying cause of death begins with J (excluding J00-J22 and J40-J47)
Dementia and Alzheimer’s Underlying cause of death is one of F01, F03, or G30
Diseases of the urinary system Underlying cause of death is between N00-N39
Cirrhosis and other liver diseases Underlying cause of death is between K70-K76
Parkinson’s disease Underlying cause of death is G20
All other causes (excl. COVID-19) All other underlying causes of death (excluding COVID-19)

Back to underlying cause of death section

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