Excess mortality in England, week ending 18 September 2020

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, region, ethnic group, level of deprivation, cause of death and place of death.

All Persons

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

The trend in total excess deaths by week, in England, 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 there were 10,039 excess deaths and this was almost double (1.96 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.

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

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

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

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 deaths	Expected deaths	Ratio registered / expected	Excess deaths	COVID-19 deaths	COVID-19 deaths as % excess
0-14	819	885	-^*	−66	4	-
15-44	4,605	4,011	1.15	594	337	56.7%
45-64	21,048	16,004	1.32	5,044	3,152	62.5%
65-74	27,728	21,968	1.26	5,760	4,728	82.1%
75-84	45,938	36,683	1.25	9,255	9,583	>100%⁺
85+	46,783	38,098	1.23	8,685	9,685	>100%⁺
Total	146,921	117,647	1.25	29,274	27,489	93.9%
^* 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

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 deaths	Expected deaths	Ratio registered / expected	Excess deaths	COVID-19 deaths	COVID-19 deaths as % excess
0-14	642	692	-^*	−50	2	-
15-44	2,600	2,207	1.18	393	213	54.1%
45-64	13,393	10,834	1.24	2,559	1,640	64.1%
65-74	19,059	15,742	1.21	3,317	2,585	77.9%
75-84	38,196	31,798	1.20	6,398	6,586	>100%⁺
85+	68,456	56,573	1.21	11,883	11,388	95.8%
Total	142,346	117,845	1.21	24,501	22,414	91.5%
^* 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 group	Registered deaths	Expected deaths	Ratio registered / expected	Excess deaths	COVID-19 deaths	COVID-19 deaths as % excess
Asian	5,708	3,385	1.69	2,322	1,872	80.6%
Black	3,427	1,733	1.98	1,694	1,235	72.9%
Mixed	690	446	1.55	244	154	63.1%
Other	2,050	1,381	1.48	669	620	92.6%
White	130,475	106,240	1.23	24,236	23,530	97.1%

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 group	Registered deaths	Expected deaths	Ratio registered / expected	Excess deaths	COVID-19 deaths	COVID-19 deaths as % excess
Asian	4,112	2,701	1.52	1,411	1,088	77.1%
Black	2,573	1,517	1.70	1,055	724	68.6%
Mixed	595	363	1.64	232	130	56.2%
Other	1,758	920	1.91	838	413	49.3%
White	128,874	107,892	1.19	20,982	19,998	95.3%

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 quintile	Registered deaths	Expected deaths	Ratio registered / expected	Excess deaths	COVID-19 deaths	COVID-19 deaths as % excess
Quintile 1 - Most Deprived	60,878	48,405	1.26	12,473	11,233	90.1%
Quintile 2	57,988	47,114	1.23	10,874	10,614	97.6%
Quintile 3	59,074	48,586	1.22	10,488	9,676	92.3%
Quintile 4	57,669	47,699	1.21	9,970	9,620	96.5%
Quintile 5 - Least Deprived	53,658	43,904	1.22	9,754	8,760	89.8%

Region

North East

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

North West

Figure 14: Weekly excess deaths by date of registration, North West.

Yorkshire and The Humber

Figure 15: Weekly excess deaths by date of registration, Yorkshire and The Humber.

East Midlands

Figure 16: Weekly excess deaths by date of registration, East Midlands.

West Midlands

Figure 17: Weekly excess deaths by date of registration, West Midlands.

East of England

Figure 18: Weekly excess deaths by date of registration, East of England.

London

Figure 19: Weekly excess deaths by date of registration, London.

South East

Figure 20: Weekly excess deaths by date of registration, South East.

South West

Figure 21: Weekly excess deaths by date of registration, South West.

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

Region	Registered deaths	Expected deaths	Ratio registered / expected	Excess deaths	COVID-19 deaths	COVID-19 deaths as % excess
North East	16,142	13,165	1.23	2,977	2,858	96.0%
North West	42,029	33,661	1.25	8,368	8,074	96.5%
Yorkshire and the Humber	29,594	24,576	1.20	5,018	4,931	98.3%
East Midlands	25,808	21,494	1.20	4,314	4,027	93.3%
West Midlands	32,904	25,932	1.27	6,972	5,936	85.1%
East of England	32,788	27,325	1.20	5,463	5,150	94.3%
London	32,854	23,509	1.40	9,345	8,572	91.7%
South East	46,848	38,798	1.21	8,050	7,424	92.2%
South West	30,300	27,033	1.12	3,267	2,931	89.7%

Deaths by Underlying Cause

Ischaemic heart diseases

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

Stroke (cerebrovascular diseases)

Figure 24: Weekly excess deaths by date of registration, cerebrovascular diseases, England.

Other circulatory diseases

Figure 25: Weekly excess deaths by date of registration, other circulatory diseases, England.

Cancer

Figure 26: Weekly excess deaths by date of registration, cancer, England.

Acute respiratory infections (including flu/pneumonia)

Figure 27: Weekly excess deaths by date of registration, acute respiratory infections, England.

Chronic lower respiratory diseases

Figure 28: Weekly excess deaths by date of registration, chronic lower respiratory diseases, England.

Other respiratory diseases

Figure 29: Weekly excess deaths by date of registration, other respiratory diseases, England.

Dementia and Alzheimer’s disease

Figure 30: Weekly excess deaths by date of registration, dementia and Alzheimer’s, England.

Diseases of the urinary system

Figure 31: Weekly excess deaths by date of registration, diseases of the urinary system, England.

Cirrhosis and other liver disease

Figure 32: Weekly excess deaths by date of registration, cirrhosis and other liver diseases, England.

Parkinson’s disease

Figure 33: Weekly excess deaths by date of registration, Parkinson’s disease, England.

Other causes (excluding COVID-19)

Figure 34: Weekly excess deaths by date of registration, all other causes (excl. COVID-19), 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 death	Registered deaths	Expected deaths	Ratio registered / expected	Excess deaths	COVID-19 deaths	COVID-19 deaths as % excess
Ischaemic Heart Diseases	25,093	23,485	1.07	1,608	407	25.3%
Cerebrovascular Diseases	13,438	12,328	1.09	1,110	313	28.2%
Other Circulatory Diseases	21,652	20,202	1.07	1,450	367	25.3%
Cancer	67,931	68,042	-^*	−111	937	-
Acute Respiratory Infections	9,887	11,092	0.89	−1,205	9	-
Chronic Lower Respiratory Diseases	12,076	13,230	0.91	−1,154	167	-
Other Respiratory Diseases	3,920	4,820	0.81	−900	67	-
Dementia and Alzheimer's	33,000	29,333	1.12	3,667	755	20.6%
Diseases of the Urinary System	3,905	3,458	1.13	447	111	24.8%
Cirrhosis and Other Liver Diseases	4,265	3,937	1.08	328	95	29.0%
Parkinson's Disease	3,434	3,430	-^*	4	71	>100%⁺
All Other Causes (Excl. COVID-19)	44,718	42,723	1.05	1,995	656	32.9%
^* 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

Deaths with a Mention of Specific Causes

Dementia and Alzheimer’s disease

Figure 36: Weekly excess deaths by date of registration, all mentions of dementia and Alzheimer’s disease, England.

Acute respiratory infections (including flu/pneumonia)

Figure 37: Weekly excess deaths by date of registration, all mentions of acute respiratory infections, England.

Diabetes Mellitus

Figure 38: Weekly excess deaths by date of registration, all mentions of diabetes mellitus, England.

Figures 36 to 38 show weekly excess deaths where a specific cause was mentioned anywhere on the death certificate. These causes will have contributed to the death but not necessarily been the underlying cause.

Place of Death

Own home

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

Care home (nursing or residential)

Figure 40: Weekly excess deaths by date of registration, care home (nursing or residential), England.

Hospital (acute or community, not psychiatric)

Figure 41: Weekly excess deaths by date of registration, hospital (acute or community, not psychiatric), England.

Hospice

Figure 42: Weekly excess deaths by date of registration, hospice, England.

Other places

Figure 43: Weekly excess deaths by date of registration, other places, 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 death	Registered deaths	Expected deaths	Ratio registered / expected	Excess deaths	COVID-19 deaths	COVID-19 deaths as % excess
Care Home (Nursing or Residential)	74,613	51,192	1.46	23,421	14,853	63.4%
Home	80,764	58,816	1.37	21,948	2,368	10.8%
Hospice	12,490	14,591	0.86	−2,101	738	-
Hospital (Acute or Community, not Psychiatric)	114,148	104,937	1.09	9,211	31,542	>100%^*
Other Places	7,252	6,147	1.18	1,105	402	36.4%
^* 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.

Links to historic reports

Code repository

The code used to create this report is stored here

Excess mortality in England, week ending 18 September 2020

Experimental Statistics

What is an experimental statistic?

Introduction

All Persons

Age Group Males

Age Group Females

Ethnic Group Males

Ethnic Group Females

Deprivation

Region

North East

North West

Yorkshire and The Humber

East Midlands

West Midlands

East of England

London

South East

South West

Deaths by Underlying Cause

Ischaemic heart diseases

Stroke (cerebrovascular diseases)

Other circulatory diseases

Cancer

Acute respiratory infections (including flu/pneumonia)

Chronic lower respiratory diseases

Other respiratory diseases

Dementia and Alzheimer’s disease

Diseases of the urinary system

Cirrhosis and other liver disease

Parkinson’s disease

Other causes (excluding COVID-19)

Deaths with a Mention of Specific Causes

Dementia and Alzheimer’s disease

Acute respiratory infections (including flu/pneumonia)

Diabetes Mellitus

Place of Death

Own home

Care home (nursing or residential)

Hospital (acute or community, not psychiatric)

Hospice

Other places

Comparisons to other measures of excess deaths in England

Links to historic reports

Code repository