Excess mortality in England, week ending 20 November 2020

Experimental Statistics

Generated on 2020-11-30

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 10,035 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.

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

0-14

Figure 3: Weekly excess deaths by date of registration, Males, 0-14.

15-44

Figure 4: Weekly excess deaths by date of registration, Males, 15-44.

45-64

Figure 5: Weekly excess deaths by date of registration, Males, 45-64.

65-74

Figure 6: Weekly excess deaths by date of registration, Males, 65-74.

75-84

Figure 7: Weekly excess deaths by date of registration, Males, 75-84.

85+

Figure 8: Weekly excess deaths by date of registration, Males, 85+.

Total

Figure 9: Weekly excess deaths by date of registration, Males, Total.

The trend in excess deaths for males by age group is shown in Figures 3 to 9, which allows the extent of the excess each week to be compared over time and between age groups.

Figure 10: Cumulative excess deaths (A) and the ratio of registered deaths to expected deaths (B) by age group, males, England.

Figure 10A for males can be used to compare the cumulative total of excess deaths since 20 March 2020 between age groups.

Figure 10B 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	1,107	1,198	-*	−91	4	-
15-44	6,273	5,430	1.16	843	389	46.1%
45-64	27,907	21,664	1.29	6,243	3,720	59.6%
65-74	36,768	29,749	1.24	7,019	5,877	83.7%
75-84	60,543	49,787	1.22	10,756	11,780	>100%+
85+	61,233	51,734	1.18	9,499	11,634	>100%+
Total	193,831	159,562	1.21	34,269	33,404	97.5%
* 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

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

0-14

Figure 11: Weekly excess deaths by date of registration, Females, 0-14.

15-44

Figure 12: Weekly excess deaths by date of registration, Females, 15-44.

45-64

Figure 13: Weekly excess deaths by date of registration, Females, 45-64.

65-74

Figure 14: Weekly excess deaths by date of registration, Females, 65-74.

75-84

Figure 15: Weekly excess deaths by date of registration, Females, 75-84.

85+

Figure 16: Weekly excess deaths by date of registration, Females, 85+.

Total

Figure 17: Weekly excess deaths by date of registration, Females, Total.

The trend in excess deaths for females by age group is shown in Figures 11 to 17, which allows the extent of the excess each week to be compared over time and between age groups.

Figure 18: Cumulative excess deaths (A) and the ratio of registered deaths to expected deaths (B) by age group, females, England.

Figure 18A for females can be used to compare the cumulative total of excess deaths since 20 March 2020 between age groups.

Figure 18B 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	856	937	-*	−81	2	-
15-44	3,543	2,987	1.19	556	256	46.0%
45-64	17,846	14,667	1.22	3,179	1,953	61.4%
65-74	25,275	21,318	1.19	3,957	3,163	79.9%
75-84	50,394	43,134	1.17	7,260	8,019	>100%+
85+	89,339	76,671	1.17	12,668	13,480	>100%+
Total	187,253	159,714	1.17	27,539	26,873	97.6%
* 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

Asian

Figure 19: Weekly excess deaths by date of registration, Males, 0-14.

Black

Figure 20: Weekly excess deaths by date of registration, Males, 15-44.

Mixed

Figure 21: Weekly excess deaths by date of registration, Males, 45-64.

Other

Figure 22: Weekly excess deaths by date of registration, Males, 65-74.

White

Figure 23: Weekly excess deaths by date of registration, Males, 75-84.

The trend in excess deaths for males is shown in Figures 19 to 23, which allows the extent of the excess each week to be compared over time and between ethnic groups.

Figure 24: Cumulative excess deaths (A) and the ratio of registered deaths to expected deaths (B) by ethnic group, males, England.

Figure 24A for males can be used to compare the cumulative total of excess deaths since 20 March 2020 between ethnic groups.

Figure 24B 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	7,471	4,625	1.62	2,846	2,328	81.8%
Black	4,196	2,369	1.77	1,827	1,308	71.6%
Mixed	886	610	1.45	277	168	60.7%
Other	2,604	1,886	1.38	718	675	94.1%
White	172,590	145,218	1.19	27,372	27,501	>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

Asian

Figure 25: Weekly excess deaths by date of registration, Females, Asian.

Black

Figure 26: Weekly excess deaths by date of registration, Females, Black.

Mixed

Figure 27: Weekly excess deaths by date of registration, Females, Mixed.

Other

Figure 28: Weekly excess deaths by date of registration, Females, Other.

White

Figure 29: Weekly excess deaths by date of registration, Females, White.

The trend in excess deaths for females is shown in Figures 25 to 29, which allows the extent of the excess each week to be compared over time and between ethnic groups.

Figure 30: Cumulative excess deaths (A) and the ratio of registered deaths to expected deaths (B) by ethnic group, females, England.

Figure 30A for females can be used to compare the cumulative total of excess deaths since 20 March 2020 between ethnic groups.

Figure 30B 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	5,386	3,689	1.46	1,698	1,320	77.8%
Black	3,224	2,072	1.56	1,152	775	67.3%
Mixed	782	496	1.58	286	138	48.2%
Other	2,247	1,256	1.79	991	445	44.9%
White	170,022	147,367	1.15	22,655	23,143	>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

Quintile 1 - most deprived

Figure 31: Weekly excess deaths by date of registration, Quintile 1 - most deprived.

Quintile 2

Figure 32: Weekly excess deaths by date of registration, Quintile 2.

Quintile 3

Figure 33: Weekly excess deaths by date of registration, Quintile 3.

Quintile 4

Figure 34: Weekly excess deaths by date of registration, Quintile 4.

Quintile 5 - least deprived

Figure 35: Weekly excess deaths by date of registration, Quintile 5 - least deprived.

The trend in excess deaths among deprivation quintiles is shown in Figures 31 to 35, which allows the extent of the excess each week to be compared over time and between deprivation quintiles.

Figure 36: Cumulative excess deaths (A) and the ratio of registered deaths to expected deaths (B) by deprivation quintile, England

Figure 36A can be used to compare the cumulative total of excess deaths since 20 March 2020 between deprivation quintiles.

Figure 36B 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	81,047	65,619	1.24	15,428	14,570	94.4%
Quintile 2	76,550	63,877	1.20	12,673	12,797	>100%*
Quintile 3	77,617	65,877	1.18	11,740	11,516	98.1%
Quintile 4	75,592	64,675	1.17	10,917	11,294	>100%*
Quintile 5 - Least Deprived	70,278	59,533	1.18	10,745	10,100	94.0%
* the total excess was less than the number of deaths with a mention of COVID-19, indicating fewer deaths from other causes than expected

Region

North East

Figure 37: Weekly excess deaths by date of registration, North East.

North West

Figure 38: Weekly excess deaths by date of registration, North West.

Yorkshire and The Humber

Figure 39: Weekly excess deaths by date of registration, Yorkshire and The Humber.

East Midlands

Figure 40: Weekly excess deaths by date of registration, East Midlands.

West Midlands

Figure 41: Weekly excess deaths by date of registration, West Midlands.

East of England

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

London

Figure 43: Weekly excess deaths by date of registration, London.

South East

Figure 44: Weekly excess deaths by date of registration, South East.

South West

Figure 45: Weekly excess deaths by date of registration, South West.

The trend in excess deaths by region is shown in Figures 37 to 45, which allows the extent of the excess each week to be compared over time and for selected regions.

Figure 46: Cumulative excess deaths (A) and the ratio of registered deaths to expected deaths (B) by region, England.

Figure 46A can be used to compare the cumulative total of excess deaths since 20 March 2020 between regions.

Figure 46B 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	21,634	17,844	1.21	3,790	3,819	>100%*
North West	56,791	45,626	1.24	11,165	11,242	>100%*
Yorkshire and the Humber	39,992	33,315	1.20	6,677	6,775	>100%*
East Midlands	34,188	29,143	1.17	5,045	5,052	>100%*
West Midlands	43,320	35,152	1.23	8,168	7,073	86.6%
East of England	42,674	37,055	1.15	5,619	5,709	>100%*
London	41,411	31,877	1.30	9,534	9,209	96.6%
South East	60,872	52,612	1.16	8,260	8,076	97.8%
South West	40,202	36,652	1.10	3,550	3,322	93.6%
* 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

Ischaemic heart diseases

Figure 47: Weekly excess deaths by date of registration, ischaemic heart diseases, England.

Stroke (cerebrovascular diseases)

Figure 48: Weekly excess deaths by date of registration, cerebrovascular diseases, England.

Other circulatory diseases

Figure 49: Weekly excess deaths by date of registration, other circulatory diseases, England.

Cancer

Figure 50: Weekly excess deaths by date of registration, cancer, England.

Acute respiratory infections (including flu/pneumonia)

Figure 51: Weekly excess deaths by date of registration, acute respiratory infections, England.

Chronic lower respiratory diseases

Figure 52: Weekly excess deaths by date of registration, chronic lower respiratory diseases, England.

Other respiratory diseases

Figure 53: Weekly excess deaths by date of registration, other respiratory diseases, England.

Dementia and Alzheimer’s disease

Figure 54: Weekly excess deaths by date of registration, dementia and Alzheimer’s, England.

Diseases of the urinary system

Figure 55: Weekly excess deaths by date of registration, diseases of the urinary system, England.

Cirrhosis and other liver disease

Figure 56: Weekly excess deaths by date of registration, cirrhosis and other liver diseases, England.

Parkinson’s disease

Figure 57: Weekly excess deaths by date of registration, Parkinson’s disease, England.

Other causes (excluding COVID-19)

Figure 58: 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 47 to 58 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 59: Cumulative excess deaths (A) and the ratio of registered deaths to expected deaths (B) by underlying cause of death, England

Figure 59A 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 59B 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	33,980	31,678	1.07	2,302	566	24.6%
Cerebrovascular Diseases	17,997	16,684	1.08	1,313	399	30.4%
Other Circulatory Diseases	28,957	27,417	1.06	1,540	490	31.8%
Cancer	91,791	92,123	-*	−332	1,270	-
Acute Respiratory Infections	12,952	14,899	0.87	−1,947	10	-
Chronic Lower Respiratory Diseases	16,025	17,668	0.91	−1,643	235	-
Other Respiratory Diseases	5,184	6,538	0.79	−1,354	83	-
Dementia and Alzheimer's	43,086	40,408	1.07	2,678	929	34.7%
Diseases of the Urinary System	5,220	4,698	1.11	522	158	30.3%
Cirrhosis and Other Liver Diseases	5,880	5,359	1.10	521	140	26.9%
Parkinson's Disease	4,581	4,757	-*	−176	92	-
All Other Causes (Excl. COVID-19)	60,361	57,952	1.04	2,409	835	34.7%
* registered deaths were not significantly different from expected deaths for the time period

Deaths with a Mention of Specific Causes

Dementia and Alzheimer’s disease

Figure 60: Weekly excess deaths by date of registration, all mentions of dementia and Alzheimer’s disease, England.

Acute respiratory infections (including flu/pneumonia)

Figure 61: Weekly excess deaths by date of registration, all mentions of acute respiratory infections, England.

Diabetes Mellitus

Figure 62: Weekly excess deaths by date of registration, all mentions of diabetes mellitus, England.

Figures 60 to 62 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 63: Weekly excess deaths by date of registration, own home, England.

Care home (nursing or residential)

Figure 64: Weekly excess deaths by date of registration, care home (nursing or residential), England.

Hospital (acute or community, not psychiatric)

Figure 65: Weekly excess deaths by date of registration, hospital (acute or community, not psychiatric), England.

Hospice

Figure 66: Weekly excess deaths by date of registration, hospice, England.

Other places

Figure 67: Weekly excess deaths by date of registration, other places, England.

Figures 63 to 67 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 68: Cumulative excess deaths (A) and the ratio of registered deaths to expected deaths (B), by place of death, England.

Figure 68A 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 68B 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)	93,406	70,129	1.33	23,277	16,473	70.8%
Home	108,038	79,829	1.35	28,209	2,903	10.3%
Hospice	16,577	19,656	0.84	−3,079	851	-
Hospital (Acute or Community, not Psychiatric)	153,282	141,619	1.08	11,663	39,607	>100%*
Other Places	9,781	8,329	1.17	1,452	443	30.5%
* 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.

Links to historic reports

• excess-mortality-in-england-week-ending-13-Nov-2020.html
• excess-mortality-in-england-week-ending-06-Nov-2020.html
• excess-mortality-in-england-week-ending-30-Oct-2020.html
• excess-mortality-in-england-week-ending-23-Oct-2020.html
• excess-mortality-in-england-week-ending-16-Oct-2020.html
• excess-mortality-in-england-week-ending-09-Oct-2020.html
• excess-mortality-in-england-week-ending-02-Oct-2020.html
• excess-mortality-in-england-week-ending-25-Sep-2020.html
• excess-mortality-in-england-week-ending-18-Sep-2020.html
• excess-mortality-in-england-week-ending-11-Sep-2020.html
• excess-mortality-in-england-week-ending-04-Sep-2020.html
• excess-mortality-in-england-week-ending-28-Aug-2020.html
• excess-mortality-in-england-week-ending-21-Aug-2020.html
• excess-mortality-in-england-week-ending-14-Aug-2020.html
• excess-mortality-in-england-week-ending-07-Aug-2020.html
• excess-mortality-in-england-week-ending-31-Jul-2020.html
• excess-mortality-in-england-week-ending-24-Jul-2020.html
• excess-mortality-in-england-week-ending-17-Jul-2020.html
• excess-mortality-in-england-week-ending-10-Jul-2020.html
• excess-mortality-in-england-week-ending-03-Jul-2020.html

Code repository

The code used to create this report is stored here.