Monthly mortality analysis, England and Wales: November 2022

• In November 2022, there were 47,611 deaths registered in England, 4,083 deaths (9.4%) above the November five-year average (2016 to 2019, and 2021) and there were 3,112 deaths registered in Wales, 166 deaths (5.6%) above the November average.
• The leading cause of death in both England and Wales in November 2022 was dementia and Alzheimer's disease (11.8% of all deaths in England and 11.1% of all deaths in Wales).
• Coronavirus (COVID-19) was the eighth leading cause of death in November 2022 in England (accounting for 2.6% of all deaths) and the ninth leading cause of death in Wales (2.5% of all deaths).
• Accounting for population size and age structure, the year-to-date (January to November) age-standardised mortality rate (ASMR) in 2022 in both England (943.1 deaths per 100,000 people) and Wales (1,017.1 deaths per 100,000 people) was significantly lower than most years since our data time series began in 2001.
• Deaths were above average in both England and Wales (9.4% and 5.6% above average, respectively) in November 2022; the ASMR was also above expected to a lesser extent in England (2.1%), but below expected in Wales (0.6% below average).
• Year-to-date deaths were above average in both England and Wales (5.6% and 3.9% above average, respectively), but below average for the year-to-date ASMR (1.3% and 2.1% below average, respectively).

There were 47,611 deaths registered in England in November 2022, based on provisional data. This was 565 less deaths than in November 2021 and 4,083 more deaths (9.4%) than the five-year average (2016 to 2019, and 2021).

In Wales, the provisional number of deaths registered in November 2022 was 3,112. This was 230 fewer deaths than in November 2021 and 166 more deaths (5.6%) than the five-year average for November.

The five-year average for 2022 has been provided for 2016 to 2019, and 2021. This moves our five-year average along by a year, but does not include the exceptionally high number of deaths seen in 2020. This is so that deaths in 2022 are compared with a five-year average that is up to date (rather than 2015 to 2019) while still being close to representing a usual (non-coronavirus (COVID-19) pandemic) year. For more information, see our blog, Understanding excess deaths during a pandemic.

Age-standardised mortality rates (ASMRs) are used for comparisons over time rather than numbers of deaths, because ASMRs account for changes to the population size and age structure.

Since the beginning of our time series in 2001, mortality rates have generally been decreasing for the month of November.

In England, the highest mortality rate for the month of November was in 2001, at 1,227.9 deaths per 100,000 people. This was statistically significantly higher than the November ASMR for most other years in the data time series. The lowest mortality rate for November was in 2014 at 904.0 deaths per 100,000 people. This was significantly lower than the November ASMR in all other years in the data time series.

In 2022, the November ASMR for England was 1,010.1 deaths per 100,000 people. This was significantly lower than the mortality rates for both November 2021 (1,042.6 deaths per 100,000 people) and November 2020 (1,060.4 deaths per 100,000 people), both of which fell within the coronavirus pandemic. This suggests deaths in colder months may be returning to rates seen before the coronavirus pandemic, however, the November 2022 rate was still significantly higher than November 2019 (947.7 deaths per 100,00 people).

In Wales, the highest mortality rate for November was in 2003 (1,306.9 deaths per 100,000 people), which was statistically significantly higher than most other years in the data time series. Like England, the lowest ASMR was in 2014 (942.5 deaths per 100,000 people). This was significantly lower than the November ASMR in most other years in the data time series.

In November 2022, the ASMR in Wales was 1,084.2 deaths per 100,000 people. Similar to England, this was significantly lower than both the November 2021 (1,183.5 deaths per 100,000 people) and November 2020 (1,214.2 deaths per 100,000 people) mortality rate. However, the November 2022 rate was not significantly different than the November ASMRs for 2016 to 2019, indicating a return to pre-coronavirus-pandemic mortality rates within colder months.

These patterns in ASMRs over time were similar in both males and females (Figure 1).

The doctor certifying a death can list all causes in the chain of events that led to the death, and pre-existing conditions that may have contributed to the death. Using this information, we determine an underlying cause of death. More information on this process can be found in our User guide to mortality statistics.

For more information on our definition of coronavirus (COVID-19) deaths, see Section 11: Measuring the data.

The first deaths involving COVID-19 were registered in England and Wales in March 2020. Since then, COVID-19 was the underlying cause of death in most deaths that involved COVID-19 (84.7% in England, 83.5% in Wales).

The proportion of deaths due to COVID-19 (of all deaths involving COVID-19) decreased between October and November 2022 in both England (from 65.6% to 64.8%) and Wales (from 70.1% to 65.8%) (Figure 2).

Figure 2: The proportion of deaths due to COVID-19, when COVID-19 was mentioned anywhere on the death certificate, decreased in both England and Wales in November 2022 compared with October 2022

Percentage of deaths involving COVID-19 that were due to COVID-19, England and Wales, deaths registered in March 2020 to November 2022

Notes:

1. Figures are for deaths registered rather than deaths occurring in each period.
2. Figures for 2022 are based on provisional mortality data.
3. Figures exclude non-residents.
4. Deaths "due to COVID-19" include only deaths where COVID-19 was the underlying cause of death, whereas deaths “involving COVID-19” include deaths where COVID-19 was mentioned anywhere on the death certificate. For more information on our definitions of COVID-19 deaths, see the Measuring the data section.
5. Because of small numbers, the proportions for May 2021 and June 2021 in Wales should be interpreted with caution.

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Of the 47,611 deaths registered in November 2022 in England, 2.6% (1,239 deaths) were due to COVID-19. This was lower than the number of deaths registered in October 2022 that were due to COVID-19 (1,512 deaths, 3.3% of all deaths). Including all deaths involving COVID-19 (1,912 deaths), this percentage increased to 4.0% of all deaths in England.

In Wales, 2.5% of the 3,112 deaths registered in November 2022 were due to COVID-19 (79 deaths). This was lower than the number of deaths registered in October 2022 that were due to COVID-19 (103 deaths, 3.5%). Including all deaths involving COVID-19 (120 deaths), this percentage increased to 3.9% of all deaths in Wales in November 2022.

Mortality rates for deaths due to COVID-19

The age-standardised mortality rate (ASMR) for deaths due to COVID-19 in England statistically significantly decreased to 26.1 deaths per 100,000 people in November 2022, from 31.0 deaths per 100,000 people in October 2022.

In Wales, the ASMR also decreased to 27.4 deaths per 100,000 people in November 2022, compared with 34.6 deaths per 100,000 people in October 2022, however this change was not significant.

These patterns in ASMRs were similar for males and females in England and in Wales. More information on mortality rates by sex is available in our accompanying dataset.

The 10 most common underlying causes of death registered in November 2022, compared with the five-year average for November (2016 to 2019, and 2021), for England and Wales, respectively, are shown in Figures 4 and 5. Causes of death are based on our leading causes of death groupings.

In England, dementia and Alzheimer's disease remained the leading cause of death in November 2022 (for the 17th consecutive month), with 117.6 deaths per 100,000 people (5,608 deaths). Coronavirus (COVID-19) remained the eighth leading cause of death in November 2022, at 26.1 deaths per 100,000 people (1,239 deaths). The COVID-19 mortality rate was statistically significantly lower than the top seven leading causes of death, and significantly higher than all causes ranked 10th and lower.

In England in November 2022, mortality rates for 4 of the 10 leading causes of death were significantly lower than the five-year average. The mortality rate for symptoms, signs, and ill-defined (35.0 deaths per 100,000 people) was statistically significantly higher (34.6% higher) than the five-year average in England for the 17th consecutive month. This leading cause group includes mostly deaths with a code for "old age" but is also used for causes such as "frailty".

In Wales, the leading cause of death was also dementia and Alzheimer's disease (for the fourth consecutive month), with 118.3 deaths per 100,000 people (344 deaths). COVID-19 was the ninth leading cause of death in November 2022 at 27.4 deaths per 100,000 (79 deaths), decreasing from the seventh leading cause in October 2022. This was statistically significantly lower than the top six leading causes of death.

In Wales in November 2022, all of the top 10 leading causes of death were not significantly different than the five-year average.

Leading causes of death registered in the year-to-date

In the first 11 months (January to November) of 2022, the leading cause of death in England was dementia and Alzheimer's disease (106.7 deaths per 100,000 people). In Wales, the year-to-date leading cause of death was ischaemic heart diseases (111.7 deaths per 100,000 people).

In England, the year-to-date COVID-19 mortality rate remained the sixth leading cause of death (38.2 deaths per 100,000 people). This was statistically significantly lower than the top five leading causes of death, and significantly higher than all causes ranked lower.

In Wales, deaths due to COVID-19 also remained the sixth leading cause of death in the year-to-date (39.2 deaths per 100,000 people). This was significantly lower than the top five leading causes of death, and significantly higher than all leading causes ranked eighth and lower.

More information on the 2022 year-to-date leading causes of death is available in Tables 12a and 12b of our accompanying dataset. More in-depth analysis of leading causes of death is available in our annual publication, based on finalised mortality data.

There were 491,005 deaths registered in England and 32,260 in Wales during the first 11 months (January to November) of 2022.

To gain a better idea of year-to-year differences in mortality rates, we calculated year-to-date age-standardised mortality rates (ASMRs) based on deaths registered in January to November of each year from 2001 to 2022 (Figure 6).

For England, the year-to-date ASMR for 2022 (943.1 deaths per 100,000 people) was statistically significantly lower than most years since our data time series started in 2001, except for 2019 (915.4 deaths per 100,000 people) and 2014 (933.6 deaths per 100,000 people), which were significantly lower than 2022.

For Wales, the year-to-date ASMR for 2022 was 1,017.1 deaths per 100,000 people. This was statistically significantly lower than most years since our data time series began, except for 2019 (992.7 deaths per 100,000 people), which was significantly lower than 2022, and 2017 (1,038.7 deaths per 100,000 people), 2014 (1,000.6 deaths per 100,000 people) and 2011 (1,029.8 deaths per 100,000 people), which were not significantly different to 2022.

Excess deaths presented in this bulletin are the difference between the observed deaths within a period compared with the five-year average (2016 to 2019, and 2021) for the same period. Most of this article makes comparisons with observed deaths in 2022 to the five-year average, however this section compares excess mortality for the number of deaths and age-standardised mortality rates (ASMRs), and explains why there are differences between these.

Because mortality rates take into account the population size and age structure at a given period, it is not unusual for excess mortality rates to be lower than excess deaths. This is because while deaths may be higher than what we would expect, it may not be when relative to the population. For example, if the population was larger in the observed period than the average population was in the years making up the five-year average, then the deaths per 100,000 people could be lower.

However, it is important to note here that the ASMRs for both 2021 and 2022 use population projections, based on 2018-population estimates. This means the projections do not currently take into account major events that would have affected the population, such as the coronavirus (COVID-19) pandemic. Once revised population estimates are applied in the ASMR calculation, which takes into account the census, there may be changes to the mortality rates; we will update rates in due course.

Since the beginning of 2022, excess mortality rates have been proportionally lower than excess deaths in England (Figure 7). This was the case regardless of whether deaths or ASMRs were below or above average. For example, in January 2022, deaths were 10.2% below average and ASMRs were 16.2% below what we would expect.

The number of deaths increased to be above what we would expect in England in March 2022 (2.5% above average). However, the ASMR continued to be below what we would expect (4.3% below average). By May 2022, excess deaths and excess mortality rates for that month were both above what we would expect, at 15.6% and 7.9% above average, respectively. Both deaths and ASMRs have continued to be above what we would expect in the following months, increasing and decreasing in similar patterns.

In England, in November 2022, excess deaths were 9.4% above what we would expect, with excess mortality rates continuing to be lower at 2.1% above average. However, when looking at the excess mortality in the year-to-date (January to November 2022), deaths were 5.6% above what we would expect, whereas ASMRs were 1.3% below expected.

There are different ways of measuring excess mortality and these numbers will differ from those published elsewhere that use a different method, for example the Office for Health Improvement and Disparities’ (OHID) excess deaths measure. This is because the figures here are based on the average of five years, whereas the OHID measure looks at the trend seen between 2015 and 2019, as well as accounting for population, deprivation and ethnicity. The Office for National Statistics (ONS) and OHID are currently working together to review their excess mortality measures.

Similar trends were recorded in Wales, with both deaths and ASMRs lower than what we would expect in January 2022 (11.0% and 15.9% respectively), and deaths increasing above what we would expect in March 2022, with ASMRs remaining below what we would expect (4.5% above average and 1.3% below average, respectively). By May 2022, both deaths and ASMRs were above what we would expect for that month, at 12.4% and 5.5% above average, respectively.

In the following months, excess deaths were observed in all months, but excess mortality rates were only observed in three of the six months in Wales. This was the case in November 2022, where deaths were 5.6% above average, compared with ASMRs at 0.6% below what we would expect.

When considering excess mortality in the year-to-date in Wales, deaths were 3.9% above what we would expect, whereas ASMRs were 2.1% below expected.

This section is based on the date a death occurred, rather than the date of registration used in the previous sections, to monitor current mortality trends. Further information can be found in Section 11: Measuring the data.

In England, 39,263 deaths occurred in November 2022 (and were registered by 7 December 2022). This was 3,685 fewer deaths than the five-year average (2016 to 2019, and 2021) for November (8.6% lower). In November 2022, of all deaths that occurred, 872 deaths (2.2%) were due to coronavirus (COVID-19). This is just over half the number of deaths due to COVID-19 occurring in October 2022 (1,725 deaths).

In Wales, 2,640 deaths occurred in November 2022 (and were registered by 7 December 2022). This was 249 fewer deaths than the five-year average (8.6% lower). Of all deaths that occurred in November 2022, 49 deaths (1.9%) were due to COVID-19. This was over half the number of deaths due to COVID-19 that occurred in October 2022 (115 deaths).

The first death due to COVID-19 occurred on 30 January 2020 in England and 15 March 2020 in Wales. Figures 9 and 10 show the trends in COVID-19 death occurrences from March 2020 onwards for England and Wales, respectively.

Figure 9: In England, the number of deaths due to COVID-19 occurring in November 2022 was approximately half that of October 2022

Number of deaths occurring on each day from March 2020 to November 2022, five-year average and range, England

Notes:

1. Figures are for deaths occurring on each day rather than deaths registered, registered up to 7 December 2022. Death occurrences will increase as more deaths are registered, particularly for later dates.
2. Figures for 2022 (including deaths that occurred in previous years but were registered in 2022) are based on provisional mortality data.
3. Figures exclude non-residents.
4. "COVID-19" includes only deaths where COVID-19 was the underlying cause.
5. This chart includes deaths from 1 March 2020. Three deaths due to COVID-19 occurred prior to this in England (one death in January 2020 and two deaths in February 2020), but are not included here.
6. For deaths occurring in 2020 and 2021, the five-year average consists of deaths occurring between 2015 to 2019, whereas for deaths occurring in 2022 the five-year average consists of deaths occurring between 2016 to 2019 and 2021.
7. The five-year average for 2022 has been provided for 2016 to 2019 and 2021, because of the impact of the coronavirus pandemic on deaths occurring in 2020. This provides an up-to-date comparison (rather than 2015 to 2019) of the number of deaths expected per day in a usual (non-coronavirus pandemic) year.

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Figure 10: In Wales, the number of daily deaths due to COVID-19 occurring in November 2022 was less than half that of October 2022

Number of deaths occurring on each day from March 2020 to November 2022, five-year average and range, Wales

Notes:

1. Figures are for deaths occurring on each day rather than deaths registered, registered up to 7 December 2022. Death occurrences will increase as more deaths are registered, particularly for later dates.
2. Figures for 2022 (including deaths that occurred in previous years but were registered in 2022) are based on provisional mortality data.
3. Figures exclude non-residents.
4. “COVID-19 deaths” include only deaths where COVID-19 was the underlying cause.
5. For deaths occurring in 2020 and 2021 the five-year average consists of deaths occurring between 2015 to 2019, whereas for deaths occurring in 2022 the five-year average consists of deaths occurring between 2016 to 2019 and 2021.
6. The five-year average for 2022 has been provided for 2016 to 2019 and 2021, because of the impact of the coronavirus pandemic on deaths occurring in 2020. This provides an up-to-date comparison (rather than 2015 to 2019) of the number of deaths expected per day in a usual (non-coronavirus pandemic) year.

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The number of death occurrences is incomplete because it is likely that more deaths need to be registered. Therefore, comparisons should be treated with caution.

Instances where the number of death occurrences on each day in November was below the range of the last five years are likely to be a result of when the data extract was created. Specifically, deaths that occurred towards the end of the month may not have been registered by the time the data extract was created. We would therefore expect the number of death occurrences to be higher in future releases.

Data on pre-existing conditions of people who died due to coronavirus (COVID-19) in England and Wales between January 2020 to September 2022 can be found in the accompanying dataset. Quarter 3 (July to Sept) 2022 analysis is available in our Monthly mortality analysis, England and Wales: September 2022 bulletin. We will publish analysis for Quarter 4 (Oct to Dec) 2022 in our December 2022 edition of this bulletin.

Age-specific mortality rates

Age-specific mortality rates are used to allow comparisons between specified age groups.

Age-standardised mortality rates

Age-standardised mortality rates (ASMRs) are used to allow comparisons between populations that may contain different proportions of people of different ages. The 2013 European Standard Population is used to standardise rates. In this bulletin, we have adjusted the monthly ASMRs to allow for comparisons with annual rates. For more information see Section 11: Measuring the data.

Coronaviruses

The World Health Organization (WHO) defines coronaviruses as "a large family of viruses that are known to cause illness ranging from the common cold to more severe diseases such as Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS)". Between 2001 and 2018, there were 12 deaths in England and Wales due to a coronavirus infection, with a further 13 deaths mentioning the virus as a contributory factor on the death certificate.

Coronavirus (COVID-19)

COVID-19 refers to the "coronavirus disease 2019" and is a disease that can affect the lungs and airways. It is caused by a type of coronavirus. Further information about coronavirus (COVID-19) disease is available from the WHO.

Pre-existing condition

A pre-existing condition is defined as any condition that either preceded the disease of interest (for example, COVID-19) in the sequence of events leading to death or was a contributory factor in the death but not part of the causal sequence.

More information on the pre-existing conditions methodology is available in our accompanying dataset, Pre-existing conditions of people who died due to COVID-19, England and Wales.

Registration delay

Mortality statistics are compiled from information supplied when deaths are certified and registered as part of civil registration, a legal requirement. According to the Births and Deaths Registration Act 1953, a death should be registered within five days unless it is referred to a coroner for investigation. Mortality statistics for a given time period can be based on occurrence (death date) or registration (registration date); registration delay is the difference between date of occurrence and date of registration.

Statistical significance

The term "significant" refers to statistically significant changes or differences. Significance has been determined using the 95% confidence intervals, where instances of non-overlapping confidence intervals between estimates indicate the difference is unlikely to have arisen from random fluctuation.

95% confidence intervals

A confidence interval is a measure of the uncertainty around a specific estimate. If a confidence interval is 95%, it is expected that the interval will contain the true value on 95 occasions if repeated 100 times. As intervals around estimates widen, the level of uncertainty about where the true value lies increases. The size of the interval around the estimate is strongly related to the number of deaths, prevalence of health states and the size of the underlying population. At a national level, the overall level of error will be small compared with the error associated with a local area or a specific age and sex breakdown. More information is available on our uncertainty pages.

This bulletin provides timely surveillance of mortality in England and Wales, based on the best available provisional data, including all-cause mortality and coronavirus (COVID-19) deaths.

Analysis contains deaths registered in November 2022 by age and sex, and includes deaths that occurred in November 2022 by date of death. Non-residents of England and Wales are excluded. In November 2022, there were 116 deaths of non-residents that were registered in England and Wales.

Data sources

This bulletin is based primarily on death registrations. Analysis by month of death registration is consistent with our weekly death registrations bulletin and allows for a more timely analysis than would be possible using death occurrences. There is a section on death occurrences for surveillance of recent mortality trends. Death occurrences show the number of deaths that occurred within a calendar period and give a better indication of exactly when deaths were at their highest. This allows mortality to be related to other factors such as weather patterns.

A provisional extract of death registrations and death occurrences data is taken on the first working day after the eighth of the month, to allow time for deaths to be registered. For more detail on the data sources used, see our methodology article.

Definition of COVID-19 deaths

We use the term "due to COVID-19" when referring only to deaths with an underlying cause of death of COVID-19. When considering all the deaths that had COVID-19 mentioned anywhere on the death certificate, whether as an underlying cause or not, we use the term "involving COVID-19". The International Classification of Diseases (ICD-10) codes used to define COVID-19 are:

1. U07.1: COVID-19, virus identified

2. U07.2: COVID-19, virus not identified

3. U09.9: post-COVID condition, unspecified (this cannot be assigned to the underlying cause of death so is not included in the "deaths due to COVID-19" definition)

4. U10.9: multisystem inflammatory syndrome associated with COVID-19, unspecified

Our definition of COVID-19 (regardless of whether it was the underlying cause or mentioned elsewhere on the death certificate) includes some cases where the certifying doctor suspected the death involved COVID-19 but was not certain (U07.2). For example, a doctor may have clinically diagnosed COVID-19 based on symptoms but this diagnosis may not have been confirmed with a test, so they may write "suspected COVID-19" on the death certificate. Of the 162,058 deaths due to COVID-19, 4,157 (2.6%) were classified as "suspected" COVID-19. Including all 191,757 deaths involving COVID-19, "suspected" COVID-19 was recorded on 4,794 deaths (2.5%) of all deaths involving COVID-19 in England and Wales (excluding non-residents). For more information on the ICD-10 definition of COVID-19, see our methodology article.

There are several ICD-10 codes not included in our definitions of deaths due to COVID-19 and deaths involving COVID-19. These are:

1. U08.9: personal history of COVID-19, unspecified

2. U11.9: need for immunisation against COVID-19, unspecified

3. U12.9: COVID-19 vaccines causing adverse effects in therapeutic use, unspecified

Tables 13 and 14 of our accompanying dataset provide figures of each COVID-19 ICD-10 code registered since March 2020. Our figures usually consist of first registrations only. On occasion, and after further investigation, a death can be reregistered as a different cause of death. For transparency of our statistics, these tables include re-registrations as well as initial registrations. All the other figures remain as first registration only.

Monthly mortality rates

To calculate monthly mortality rates that are comparable with annual rates, adjustments must be made to annual population estimates to account for the time covered. Our methodology article provides more detail on how this is calculated.

Acknowledgement

We would like to thank Becca Smith, Andreas Christofi, Anisah Saib, Sion Ward and Paul Brown for their valued contribution to this bulletin.

Provisional data are used

Provisional death registrations and death occurrences data are used in this bulletin. This enables timely analysis to be completed to monitor mortality trends. However, as the data for 2022 are provisional, they are subject to change.

Data coverage, timeliness, and registration delays

Mortality data give complete population coverage. They ensure the estimates are of high precision and representative of the underlying population at risk. However, because of registration delays, monthly death occurrence data are always somewhat incomplete. This is especially true for deaths that occurred towards the end of the month.

More quality and methodology information on strengths, limitations, appropriate uses and how the data were created is available in our Mortality statistics in England and Wales Quality and Methodology Information and our User guide to mortality statistics.