Excess mortality in England, week ending 25 December 2020

Notification

As we move further into winter, we have made improvements to the model used to estimate excess deaths. Adjustments have been made to account for changes in the pattern of death registrations over Christmas, to account for different seasonal patterns in death rates by age group, and different baseline trends by age group in each ethnic and deprivation group.

A limited version of the report will now be in place until late January while we make further refinements to the model to enable more accurate estimates of excess deaths for 2021. A full update to the methodological document will also be provided at that point.

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 week through the course of 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, region, ethnic group and level of deprivation.

All Persons

Weekly excess deaths by date of registration, England.&lrm;

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 2020 there were 10,003 excess deaths and this was nearly two times (1.92 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 21 March 2020, by date of registration, England.

The trend in the total cumulative number of excess deaths in England since 21 March 2020 is shown in Figure 2.

Age Group Males

0-14

Weekly excess deaths by date of registration, Males, 0-14.&lrm;

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+

Weekly excess deaths by date of registration, Males, 85+.&lrm;

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 21 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	1,262	1,440	0.88	−178	6	-
15-44	7,183	6,532	1.10	651	448	68.9%
45-64	32,064	25,467	1.26	6,597	4,421	67.0%
65-74	42,086	34,692	1.21	7,394	7,149	96.7%
75-84	69,262	57,319	1.21	11,943	14,344	>100%^*
85+	70,460	58,333	1.21	12,127	14,408	>100%^*
Total	222,317	183,784	1.21	38,533	40,776	>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

0-14

Weekly excess deaths by date of registration, Females, 0-14.&lrm;

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+

Weekly excess deaths by date of registration, Females, 85+.&lrm;

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 21 March 2020 between age groups.

Figure 18B 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	979	1,127	0.87	−148	2	-
15-44	4,069	3,590	1.13	479	301	62.8%
45-64	20,417	17,229	1.19	3,188	2,372	74.4%
65-74	28,884	24,858	1.16	4,026	3,896	96.8%
75-84	57,477	49,625	1.16	7,852	9,762	>100%^*
85+	102,244	86,249	1.19	15,995	16,497	>100%^*
Total	214,070	182,678	1.17	31,392	32,830	>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 Males

Asian

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

Black

Figure 20: Weekly excess deaths by date of registration, Males, Black.‎

Mixed

Figure 21: Weekly excess deaths by date of registration, Males, Mixed.‎

Other

Figure 22: Weekly excess deaths by date of registration, Males, Other.‎

White

Figure 23: Weekly excess deaths by date of registration, Males, White.‎

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 21 March 2020 between ethnic groups.

Figure 24B 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	8,805	5,381	1.64	3,423	2,861	83.6%
Black	4,695	2,775	1.69	1,920	1,408	73.3%
Mixed	1,018	716	1.42	303	201	66.5%
Other	2,971	2,149	1.38	823	754	91.6%
White	199,320	168,652	1.18	30,667	34,106	>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 21 March 2020 between ethnic groups.

Figure 30B 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	6,301	4,337	1.45	1,965	1,642	83.6%
Black	3,599	2,400	1.50	1,199	838	69.9%
Mixed	891	582	1.53	309	154	50.0%
Other	2,495	1,528	1.63	967	485	50.1%
White	195,605	169,724	1.15	25,881	28,527	>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 21 March 2020 between deprivation quintiles.

Figure 36B 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	93,014	75,589	1.23	17,425	17,869	>100%^*
Quintile 2	87,588	73,386	1.19	14,202	15,639	>100%^*
Quintile 3	88,747	75,517	1.18	13,230	13,978	>100%^*
Quintile 4	86,674	74,056	1.17	12,618	13,793	>100%^*
Quintile 5 - Least Deprived	80,364	68,163	1.18	12,201	12,327	>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

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 21 March 2020 between regions.

Figure 46B shows the ratio of the observed to the expected deaths by region since 21 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	24,865	20,463	1.22	4,402	4,692	>100%^*
North West	64,844	52,365	1.24	12,479	13,412	>100%^*
Yorkshire and the Humber	46,508	38,236	1.22	8,272	8,820	>100%^*
East Midlands	39,830	33,450	1.19	6,380	6,750	>100%^*
West Midlands	49,807	40,337	1.23	9,470	8,877	93.7%
East of England	48,576	42,562	1.14	6,014	6,779	>100%^*
London	46,558	36,632	1.27	9,926	10,337	>100%^*
South East	69,273	60,382	1.15	8,891	9,711	>100%^*
South West	46,126	42,033	1.10	4,093	4,228	>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

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.

Links to historic reports

Code repository

The code used to create this report is stored here.

Excess mortality in England, week ending 25 December 2020

Experimental Statistics

What is an experimental statistic?

Notification

Introduction

All Persons

Age Group Males

0-14

15-44

45-64

65-74

75-84

85+

Total

Age Group Females

0-14

15-44

45-64

65-74

75-84

85+

Total

Ethnic Group Males

Asian

Black

Mixed

Other

White

Ethnic Group Females

Asian

Black

Mixed

Other

White

Deprivation

Quintile 1 - most deprived

Quintile 2

Quintile 3

Quintile 4

Quintile 5 - least deprived

Region

North East

North West

Yorkshire and The Humber

East Midlands

West Midlands

East of England

London

South East

South West

Comparisons to other measures of excess deaths in England

Links to historic reports

Code repository