Excess mortality in England, week ending 26 February 2021

Experimental Statistics

Generated on 2021-03-08

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 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, 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 2020 there were 10,004 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

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 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	1,568	1,773	0.88	−205	5	-
15-44	9,031	8,003	1.13	1,028	811	78.9%
45-64	41,775	31,767	1.32	10,008	7,900	78.9%
65-74	54,768	43,635	1.26	11,133	12,058	>100%*
75-84	90,102	73,158	1.23	16,944	22,890	>100%*
85+	92,815	75,870	1.22	16,945	23,888	>100%*
Total	290,059	234,206	1.24	55,853	67,552	>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

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 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	1,226	1,387	0.88	−161	6	-
15-44	5,182	4,397	1.18	785	543	69.2%
45-64	26,581	21,493	1.24	5,088	4,427	87.0%
65-74	37,678	31,267	1.21	6,411	7,073	>100%*
75-84	74,879	63,300	1.18	11,579	16,384	>100%*
85+	134,219	111,920	1.20	22,299	28,452	>100%*
Total	279,765	233,765	1.20	46,000	56,885	>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	12,428	6,815	1.82	5,613	5,109	91.0%
Black	6,298	3,511	1.79	2,787	2,251	80.8%
Mixed	1,362	901	1.51	461	365	79.2%
Other	4,066	2,723	1.49	1,343	1,335	99.3%
White	259,862	215,039	1.21	44,823	57,022	>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	8,798	5,506	1.60	3,292	2,980	90.5%
Black	4,951	3,043	1.63	1,907	1,437	75.3%
Mixed	1,233	736	1.67	497	284	57.1%
Other	3,314	1,946	1.70	1,369	863	63.0%
White	255,662	217,329	1.18	38,332	50,018	>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	120,462	96,140	1.25	24,322	28,403	>100%*
Quintile 2	114,821	93,605	1.23	21,216	26,507	>100%*
Quintile 3	116,403	96,513	1.21	19,890	24,524	>100%*
Quintile 4	113,002	94,749	1.19	18,253	23,529	>100%*
Quintile 5 - Least Deprived	105,136	87,296	1.20	17,840	21,474	>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