Excess mortality within England: 2023 data - statistical commentary
Updated 18 April 2024
Applies to England
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New for this release
The Office for Health Improvement and Disparities (OHID) has released a new version of its excess mortality report, previously published as Excess mortality in England and English regions. The new report, which is titled Excess mortality within England: post-pandemic method, will not measure the impact of the COVID-19 pandemic on mortality, but will instead measure the level of excess mortality given that the pandemic has occurred. Excess deaths can either be expressed in absolute terms (number higher than expected) or in relative terms (percentage higher than expected).
The new report provides a method for ongoing monitoring of mortality and the methodology is closely aligned to the revised approach adopted by the Office for National Statistics (ONS) to produce national estimates of excess mortality for the UK. Measuring excess mortality: a guide to the main reports summarises the approach used for both reports. The ONS report provides the headline figures. The new OHID report focuses on comparing excess mortality within England by geography and cause of death.
Excess deaths are normally defined as the difference between the actual number of deaths registered in a particular period and the estimated number of deaths expected in that period.
The new report includes a revised baseline to estimate numbers of expected deaths. Throughout the pandemic, expected deaths were based on the trend in mortality rates in the 5 years immediately preceding the pandemic (2015 to 2019). The new baseline is a rolling 5-year period, so, for example, estimates for December 2023 are based on mortality rates from January 2018 to December 2022.
The new report also incorporates revised population estimates and projections based on the 2021 Census. There have also been some other changes to how the data is analysed and presented. These are explained in Changes to OHID’s reporting of excess mortality in England.
Introduction
The new OHID report presents excess mortality for regions and local authorities within England, for various population subgroups and by cause of death. OHID’s new and previous reports both include estimates of excess mortality in England from January to December 2023. This summary compares the results presented in the previous and new reports for 2023.
Figure 1 shows the trends in death rates from 2015 to 2022. The pre-pandemic (2015 to 2019) trend, shown by the orange line, was downward. Therefore we expected this trend to continue, had there been no pandemic, as shown by the dotted orange line. This baseline was used for the previous report.
When the pandemic and revised population estimates are accounted for, the recent trend (2018 to 2022), shown by the turquoise line, is almost flat. The flatter gradient leads to higher expected deaths and therefore lower excess deaths. This baseline is used for the new report. The months which were most adversely affected by COVID-19 (March, April, May, November, December 2020, and January and February 2021) have been excluded from the monthly rates used to establish the trend between 2018 and 2022. In Figure 1 they are indicated by the dotted blue line.
Figure 1: Directly age standardised monthly mortality rates, England, 2015 to 2023
Difference between 2015 to 2019 trend and 2018 to 2022 trend.
Main findings
The new report estimates that there were 10,890 excess deaths in England in 2023 (2% higher than expected), compared with what would be expected based on 2018 to 2022 trends, after accounting for the pandemic and revised population estimates.
The previous report estimated that there were 26,976 excess deaths in England in 2023 (5% higher than expected), compared with what would have been expected if the pandemic had not occurred. This is lower than 2022, when the previous report shows 30,587 excess deaths. Excess deaths were higher in the first 2 years of the pandemic: 70,718 in 2020 (from 21 March) and 43,102 in 2021.
Detailed findings
Estimates by month
Figure 2 shows how the 2 assumptions about recent trends lead to different expected and excess deaths during 2023. Excess deaths are the difference between registered deaths (the blue line) and expected deaths (the turquoise and orange lines). The bigger the gap between the registered and expected lines, the bigger the excess. If the expected line is higher than the registered deaths line, the excess is negative, which means there were fewer deaths than expected.
Early in 2023, the new report indicates higher excess deaths than the previous report (as there is a bigger gap between the turquoise and blue lines). However, in the second half of 2023, the new report indicates negative excess deaths whereas the previous report showed excess deaths.
Figure 2: Registered and expected deaths, England, 2023
Difference between previous report and new report with different baselines
Table 1 shows the number of excess deaths for months in 2023 using the previous and new reports. Months from the previous report are approximated from the published weekly estimates.
In the first 6 months of 2023, the new report estimates that there were 21,503 excess deaths in England, with deaths 8% higher than expected. This compares with 18,531 excess deaths in the previous report, with deaths 7% higher than expected. The highest excess in both reports was in January, when there were 9,336 more deaths than expected in the new report and 6,789 in the previous report.
In the second half of 2023, from July to December, the new report shows 10,613 fewer deaths than expected (4% lower than expected). This is in contrast to the previous report, which indicated that there were 8,445 excess deaths in the second half of 2023 (3% higher than expected).
Table 1: Excess deaths for months in 2023 in England (January to December) from both reports
| 2023 | Excess deaths from new report | Approximate monthly excess deaths from previous report |
|---|---|---|
| January | 9,336 | 6,789 |
| February | 1,799 | 1,395 |
| March | 2,476 | 1,293 |
| April | 2,882 | 2,034 |
| May | 3,545 | 3,968 |
| June | 1,465 | 3,053 |
| July | –1,214 | 914 |
| August | –819 | 1,845 |
| September | –1,464 | 1,695 |
| October | –3,288 | 823 |
| November | –1,242 | 2,526 |
| December | –2,586 | 642 |
| Total | 10,890 | 26,976 |
Estimates by sex and age group
In 2023, the new report estimates 5,828 (2%) excess deaths in females and 5,064 (2%) in males. The previous report estimated slightly more excess deaths in males than females, but for both sexes deaths were 5% higher than expected.
Table 2 summarises the estimates by age from the new and previous reports. Both reports show that the number of excess deaths was highest in those age 85 and over in 2023. However, the 2 reports differ in their assessment of the relative excess mortality by age. There have been some substantial changes to the populations by age group which, along with the change in baseline, have resulted in the differences seen.
The new report estimates the highest relative excess mortality for the whole of 2023 in those aged under 25 and those aged over 85 (6% and 5% higher than expected respectively). The numbers of deaths in the under 25 age group are relatively small. Excess figures in this age group may be influenced by delays in registration since a high proportion of these deaths are referred to the coroner service, which has been disrupted by the pandemic.
The new report shows a smaller relative excess for those aged 75 to 84 and no excess for those aged 65 to 74, while those aged 25 to 74 experienced negative excess. The previous report indicated that the greatest relative excess was in age groups under 65.
Table 2: Excess deaths by age group in 2023 in England (January to December) from both reports
| Age group | Excess deaths from new report | Approximate excess deaths from previous report |
|---|---|---|
| 0 to 24 | 328 (+6%) | 546 (+11%) |
| 25 to 49 | –675 (–3%) | 1,819 (+9%) |
| 50 to 64 | –1,153 (–2%) | 6,768 (+13%) |
| 65 to 74 | –326 (0%) | 3,674 (+5%) |
| 75 to 84 | 2,107 (+1%) | 5,802 (+4%) |
| 85 and over | 10,609 (+5%) | 8,337 (+4%) |
| Total | 10,890 (+2%) | 26,976 ( +5%) |
Estimates by region
The new report shows the estimates of relative excess for 2023 are similar for most regions. The exceptions are London, which had only 37 excess deaths overall, and Yorkshire and The Humber, which saw lower relative excess deaths than the other regions outside London. In fact, London experienced similar levels of negative excess to the rest of the country in the second half of 2023, but had lower excess in the first half of the year.
However, the relative positions of the regions are similar in the new report to those published in the previous report.
Estimates by cause of death
The previous report presented analysis primarily based on mentions of causes of death on the death certificate. This was because it was designed to monitor mortality in a period when COVID-19 was responsible for many deaths and, as a new cause, it disrupted the patterns of deaths from other causes. Now that levels of COVID-19 mortality are lower and more stable, the new report presents analysis by underlying cause of death – the disease that initiated the chain of events leading directly to the death.
The groups of causes presented in the new report are not all the same as in the previous report. Some causes included in the previous report, including heart failure, diseases of the urinary system and diabetes, are much more likely to be mentioned on the death certificate as contributing to the death, than they are to be identified as the underlying cause. As the number of deaths from these causes is much smaller when looking at only the underlying cause, they have not been included in the new report, to help ensure the robustness of the analysis presented. The causes included in the new report are selected because they are of particular interest in terms of excess deaths. These causes may be changed as mortality patterns and priorities change.
The new report shows that the underlying cause group resulting in the largest excess in 2023 was influenza and pneumonia (Table 3). There was a large excess in January 2023 (2,688 excess deaths; 123% higher than expected) with consistent excess through the rest of the year. The previous report gave heart failure as the cause with the largest relative excess, but this could have included many people who had heart failure, but the underlying cause was flu or pneumonia, so the figures are not comparable.
For most causes (flu and pneumonia being the only clear exception) the pattern of excess deaths through the year is similar to that for all causes: higher excess at the start of the year, reducing through the year and for many cases resulting in negative excess by the end of the year. For this reason, estimates of excess deaths by underlying cause are shown for the first and second halves of 2023 separately in Table 3. Note that the causes in the table do not sum to the total: some causes are missing, and cerebrovascular diseases and ischaemic heart diseases are subsets of circulatory diseases.
There were particularly high excess deaths in January 2023 for circulatory diseases (including cerebrovascular diseases (stroke) and ischaemic heart diseases), chronic lower respiratory diseases and dementia and Alzheimer’s. It is likely that the high levels of flu circulating contributed to the increase in deaths from these causes.
Table 3: Excess deaths by underlying cause of death in England in 2023, from new OHID report
| Jan to June 2023 excess deaths | Jan to June 2023 relative excess | July to Dec 2023 excess deaths | July to Dec 2023 relative excess | Total 2023 excess deaths | Total 2023 relative excess | |
|---|---|---|---|---|---|---|
| Cancer | 2,045 | +3% | –452 | –1% | 1,593 | +1% |
| Chronic lower respiratory diseases | 3,940 | +30% | 1,423 | +12% | 5,363 | +22% |
| Circulatory diseases | 5,192 | +8% | –2,953 | –5% | 2,239 | +2% |
| Cerebrovascular diseases | 1,272 | +9% | –41 | 0% | 1,231 | +5% |
| Ischaemic heart diseases | 1,779 | +6% | –1,972 | –7% | -193 | 0% |
| Cirrhosis and other liver diseases | 229 | +4% | –426 | –8% | -197 | –2% |
| Dementia and Alzheimer’s | 4,218 | +14% | 609 | +2% | 4,827 | +8% |
| Influenza and pneumonia | 5,656 | +68% | 2,135 | +32% | 7,791 | +52% |
The new report gives lower estimates of excess (2,239 or +2% over the whole year) from circulatory diseases in 2023 than the previous model (14,881 or +6%). However, only around half of those deaths with circulatory disease on the death certificate have it as the underlying cause, so these figures are not comparable. The monthly pattern of excess for circulatory disease in the new report follows that for all causes.
Excess deaths from cancer, (considered to be the underlying cause in most people who die with cancer) are more consistent between the 2 reports. The new report gives a relatively small positive excess (1,593 or +1%) and the previous report a relatively small negative excess (–1,527 or –1%).
Methodology
A detailed description of the methodology can be found in the methodology document. A description of the changes in method between the previous and the new version of the report can be found in Changes to OHID’s reporting of excess mortality in England.
The change that most significantly affects the estimates, other than the updated baseline described above, is the availability of new population estimates and projections from ONS. The previous model was based on pre-2021 Census population estimates and projections, whereas the new model uses the latest estimates and projections, which have been updated using data from the 2021 Census.
Feedback
For enquiries or feedback relating to excess mortality within England, email statistics@dhsc.gov.uk - please mark the email subject as ‘Excess mortality reports feedback’.