Official Statistics

INteractive Health Atlas of Lung conditions in England (INHALE): March 2023 update

Published 7 March 2023

Applies to England

New in this update

New mortality data has been added to the INHALE profile

This bulletin includes new and updated data for 3 indicators in the INHALE profile for the single year place of death indicators which can be used to support service planning and service distribution for end of life care for people with chronic obstructive pulmonary disease (COPD):

• percentage of COPD deaths that occur in hospital, all ages
• percentage of COPD deaths that occur at home, all ages
• percentage of COPD deaths that occur in care homes, all ages

Data for the percentage of COPD deaths in ‘hospices’ and ‘other places’ has not been captured here due to small numbers but are included in the denominator.

On 1 July 2022, 42 integrated care boards (ICBs) were established to replace sustainability and transformation partnerships (STPs). ICBs have a legal responsibility to commission health services that meet their population needs and must follow statutory guidance for palliative and end of life care. At the same time, 106 sub-integrated care board locations (SICBLs) were established replacing clinical commissioning groups (CCGs). The mortality place of death indicators have been calculated for the new 2022 SICBL geographies. Trend data has been recalculated and adjusted to take into account the changes in cause of death coding software and ICD-10 coding making data comparable to the most recent 2021 data.

Due to the potential impact of coronavirus (COVID-19) on mortality data, indicators are now being presented in views for both 3-year up to 2017 to 2019 and single year up to 2021 where numbers allow.

The impact of COVID-19 on cause of death for people living with COPD, their risk of contracting COVID-19, changes in admissions to hospital and community provision of end of life care and peoples’ personal choices about place of care and death should be considered when interpreting the data presented in this bulletin.

Due to improvements in the classification of communal establishments used to classify a place of death, some values may have changed from previously published numbers.

These place of death indicators are based on the total number of deaths with COPD listed as the underlying cause of death.

Main findings

This update shows:

• the total number of deaths from COPD, as the underlying cause, dropped during the 2 years (2020 and 2021) of the COVID-19 pandemic. There were 27,195 deaths in 2019, 23,650 deaths in 2020 and 21,701 deaths in 2021

• these reductions are due in part to COVID-19 displacing COPD as the underlying cause of death in people living with COPD

• within the context of the reduced numbers of deaths from COPD as the underlying cause there were changes also in the proportion of people dying in hospital, home and care home in 2020 and 2021

• this in part reflects displacement of cause of death by COVID-19 and in part changes in hospital admissions and patient choice during 2020 and 2021 compared with 2019

• after a large drop in the percentage of people dying from COPD in hospital in 2020 as compared with 2019 there was a small but significant increase from 52.5% in 2020 to 54.7% in 2021. However, because of a reduction in total number of deaths from COPD as the underlying cause, the actual number of people dying in hospital decreased from 16,260 in 2019 to 12,407 in 2020 to 11,869 deaths in 2021

• the percentage of people dying from COPD at home has increased from 25.2% in 2019 to 30.7% in 2020 and 31.3% in 2021. However, the actual number of people dying at home from COPD decreased from 7,272 in 2020 to 6,789 deaths in 2021, returning to a similar number seen in 2019 of 6,856

• the number of people dying from COPD as the underlying cause in care homes has reduced each year from 3,345 in 2019, to 3,249 in 2020 and 2,411 deaths in 2021. After an increase in the percentage of people dying from COPD in care home in 2020 compared with 2019, the percentage of people dying from COPD in a care home decreased significantly from 13.7% in 2020 to 11.1% in 2021

Summary

The number of deaths where COPD is the underlying cause has decreased since 2018. In 2019 there were 27,195 deaths. This decreased to 23,650 deaths (a 3,545 decrease) in 2020. In 2021, a further decrease (of 1,949) to 21,701 deaths.

Table 1: number and percentage of COPD deaths by place of death, England

Calendar year	Hospital	Home	Care home
2019	16,260 (59.8%)	6,856 (25.2%)	3,345 (12.3%)
2020	12,407 (52.5%)	7,272 (30.7%)	3,249 (13.7%)
2021	11,869 (54.7%)	6,789 (31.3%)	2,411 (11.1%)

Percentage of COPD deaths, all ages, occurring in hospital

Between 2012 and 2019 the steady reduction in the percentage of people who died in hospital from COPD mirrored the reduction in percentage of deaths in hospital from all causes although a significantly greater percentage of people died from COPD in hospital than from all causes throughout the period.

From 2019 to 2020, there was a greater decrease in the percentage of COPD deaths occurring in hospital, a 7.3 % decrease, than for deaths from all causes occurring in hospital, a 3.0% decrease all hospital deaths.

The percentage of COPD deaths occurring in hospital remains lower than the pre COVID-19 value. There is a difference of 5.1% between 2019 (59.8%) and 2021 (54.7%) in the percentage of COPD deaths occurring in hospital. The equivalent decrease for deaths from all causes occurring in hospital is less than 1% (2019 44.9%, 2021 44%).

Figure 1: trend chart of percentage of COPD deaths and deaths from all causes that occur in hospital for England

Percentages of COPD deaths, all ages, occurring at home

Between 2012 and 2019 there has been a steady increase in the percentage of people who died at home from COPD mirroring the increase in percentage of deaths at home from all causes.

The percentage of deaths from all causes which occurred at home increased rapidly between 2019 to 2021 but this increase was greater for COPD. In 2019 there was a difference of 0.8% between the percentage of COPD deaths occurring at home (25.2%) and deaths from all causes occurring at home (24.4%). This difference had increased to 3.3% in 2020 and was 2.6% in 2021.

Figure 2: trend chart of percentage of COPD deaths and deaths from all causes that occur at home for England

Percentage of COPD deaths, all ages, occurring in care homes

Over the past decade there has been a lower percentage of deaths from COPD in care homes than for all causes.

There were 838 fewer COPD deaths in care homes in 2021 than in 2020 in England. This represents a statistically significant decrease of 2.6% (13.7% in 2020, 11.1% in 2021). In the same time period there was a larger statistically significant decrease in deaths from all causes occurring in a care home of 3.5% (23.7% in 2020, 20.2% in 2021).

Figure 3: trend chart of percentage of COPD deaths and deaths from all causes that occur in care homes for England

Background and further information

Respiratory disease continues to be a major cause of disability and premature mortality in England.

The INHALE respiratory disease profile provides a useful resource relating to one of the leading causes of death in England. The profile contains data for sub-integrated care board locations, CCGs, lower tier local authorities and upper tier local authorities.

Further details about the profile methodology are available within the definitions section of the online version of the INHALE profile.

Responsible statistician, product lead: Liz Rolfe, Julia Verne.

For queries relating to this document, please contact: healthcare.variation@dhsc.gov.uk.

Additional resources:

• All deaths by place of death indicators in end of life care profiles

• Home becomes the most common place of death for cancer patients during the COVID-19 pandemic, a descriptive analysis in England