Excess mortality in England post COVID-19 pandemic - in full
THE LANCET implications for secondary prevention
Excess mortality in England post COVID-19 pandemic:
implications for secondary prevention
Jonathan Pearson-Stuttard,a ,b ,∗ Sarah Caul,c Stuart McDonald,a ,d Emily Whamond,e and John N. Newtone ,f
a
Lane Clark & Peacock LLP, London, UK
b
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK
c
Office for National Statistics, Newport, UK
d
Continuous Mortality Investigation Ltd, London, UK
e
Department of Health and Social Care, London, UK
f
European Centre for Environment and Human Health, University of Exeter Medical School, Penryn, UK
Many countries, including the UK, have continued to
experience an apparent excess of deaths long after the
peaks associated with the COVID-19 pandemic in 2020
and 2021.1,2 Numbers of excess deaths estimated in this
period are considerable. The UK Office for National
Statistics (ONS) has calculated that there were 7.2% or
44,255 more deaths registered in the UK in 2022 based
on comparison with the five-year average (excluding
2020).1 This persisted into 2023 with 8.6% or 28,024
more deaths registered in the first six months of the year
than expected. 1 The Continuous Mortality Investigation
(CMI) found a similar excess (28,500 deaths) for the
same period using different methods.3 Several methods
can be used to estimate excess deaths, each with limi-
tations which should be considered in interpretation,
however the overall trends tend to be consistent across
the various methods.
The causes of these excess deaths are likely to be
multiple and could include the direct effects of Covid-19
infection,1 acute pressures on NHS acute services result-
ing in poorer outcomes from episodes of acute illness,4
and disruption to chronic disease detection and manage-
ment.5 Further analysis by cause and by age- and sex-group
may help quantify the relative contributions of these
causes.
Since July 2020, the Office for Health Improve-
ment and Disparities (OHID) has published estimates
of excess mortality based on a Poisson regression
model for England week by week, overall and
decomposed by age, ethnicity, region and cause. 6 This
model finds that in the period from week ending 3rd
June 2022 to 30th June 2023, excess deaths for all
causes were relatively greatest for 50–64 year olds
(15% higher than expected), compared with 11%
higher for 25–49 and < 25 year olds, and about 9%
higher for over 65 year old groups. While the median
age of these groups has changed since 2020, age-
standardised mortality analysis breaking down death
rates by sex find clearer age differences still. The age-
standardised CMI found similar patterns with the
largest relative excess deaths for 2022 observed in
young (20–44 years) and middle-aged (45–64 years)
adults. 7 These findings should be interpreted carefully
because of greater than usual delay in registration of
deaths in the latter part of 2022. 8
Several causes, including cardiovascular diseases,
show a relative excess greater than that seen in deaths
from all-causes (9%) over the same period (week ending
3rd June 2022–30th June 2023), namely: all cardiovas-
cular diseases (12%), heart failure (20%), ischaemic
heart diseases (15%), liver diseases (19%), acute respi-
ratory infections (14%), and diabetes (13%). 6
For middle-aged adults (50–64) in this 13-month
period, the relative excess for almost all causes of
death examined was higher than that seen for all ages.
Deaths involving cardiovascular diseases were 33%
higher than expected, while for specific cardiovascular
diseases, deaths involving ischaemic heart diseases were
44% higher, cerebrovascular diseases 40% higher and
heart failure 39% higher. Deaths involving acute respi-
ratory infections were 43% higher than expected and for
diabetes, deaths were 35% higher. Deaths involving liver
diseases were 19% higher than expected for those aged
50–64, the same as for deaths at all ages. 9
Looking at place of death, from 3rd June 2022 to 30th
June 2023 there were 22% more deaths in private
homes than expected compared with 10% more in
hospitals, but there was no excess in deaths in care
homes and 12% fewer deaths than expected in hospices.
For deaths involving cardiovascular diseases the relative
excess in private homes was higher than all causes at
27%. Deaths in hospital were 8% higher and deaths in
care homes only 3% higher.9
The greatest numbers of excess deaths in the acute
phase of the pandemic were in older adults. The pattern
now is one of persisting excess deaths which are most
prominent in relative terms in middle-aged and younger
adults, with deaths from CVD causes and deaths in
private homes being most affected. Timely and granular
analyses are needed to describe such trends and so to
inform prevention and disease management efforts.
Leveraging such granular insights has the potential to
*Corresponding author. Lane Clark & Peacock LLP, London, UK.
E-mail address: jonathan.pearson-stuttard@lcp.uk.com (J. Pearson-
Stuttard).
© 2023 The Author(s). Published by Elsevier Ltd. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/
licenses/by-nc-nd/4.0/).
The Lancet Regional
Health - Europe
2024;36: 100802
Published Online 1
December 2023
https://doi.org/10.
1016/j.lanepe.2023.
100802
www.thelancet.com Vol 36 January, 2024 1
Comment
mitigate what seems to be a continued and unequal
impact on mortality, and likely corresponding impacts
on morbidity, across the population.
Contributors
All authors contributed to the design of the paper, JP-S wrote the first
draft, SC, SM and JN drafted additional sections, all authors reviewed
and commented on drafts.
Declaration of interests
JP-S is Partner at Lane Clark & Peacock LLP, Chair of the Royal Society
for Public Health and reports personal fees from Novo Nordisk and
Pfizer Ltd outside of this submitted work. SM is Partner at Lane Clark &
Peacock LLP and deputy Chair of the Continuous Mortality Investiga-
tion. All other authors declare no competing interests.
References
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2 Alicandro G, La Vecchia C, Islam N, et al. A comprehensive anal-
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during 2020. Eur J Epidemiol. 2023. https://doi.org/10.1007/
s10654-023-01044-x.
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pandemic on cardiovascular disease prevention and management.
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