Excess deaths mystery: why thousands more people than expected are dying across England

Thousands more people died in England this autumn than expected, with health experts unable to give a definitive cause for the phenomenon.

Almost 26,000 ‘excess’ deaths have been recorded by the Office for National Statistics (ONS) so far this year - that is, deaths above the previous five-year average. In the most recent 10 weeks, covering the period up to 4 November, more than 10,000 extra deaths were registered.

Health experts say there is no single answer to explain why this is happening, but point to likely factors such as previous Covid infection leaving people at higher risk of heart attacks and stroke, as well as worsening ambulance response times and NHS treatment backlogs.

Despite having a tremendous impact on the health of the nation in recent years, figures from the ONS show Covid itself is now only the 12th most common cause of death. However, the knock-on effects of the pandemic are being keenly felt across the under-strain health system.

Excess deaths are the difference between the number of deaths registered and the number that would normally have been expected based on data from previous years. The analysis is based on the average number of deaths in pre-Covid years (2016, 2017, 2018, 2019) as well as 2021. 2020 is not included because of the unusually high number of deaths recorded during the height of the pandemic.

What do health researchers say?

Sarah Scobie, deputy director of research at the Nuffield Trust, said there is no single answer to explain why excess deaths are so high.

"More work is needed to understand the reasons behind recent continuing and persistent levels of excess deaths,” she said. “At present, it is very difficult to put it down to one single thing. Covid-19 continues to be a contributor to higher-than-average excess deaths we are recording, but it is becoming difficult to meaningfully compare to the five-year average for other conditions given Covid deaths were not included in this total then.

“An increase in health problems such as risk of heart attacks and stroke following Covid may be a factor. Access to services given the extreme pressure on ambulance and emergency services and declining performance in response times may also be having an impact."

A report published this month by the British Heart Foundation looked into why there was an above-average number of deaths from heart disease. It found that while Covid-19 infection was likely a significant factor in a rise in deaths from heart disease during the first year of the pandemic, it is no longer a driving force in these deaths. The report instead lays the blame at “significant and widespread disruption to heart care services”, from poor ambulance response times to a backlog for vital treatment.

The charity’s associate medical director, Dr Sonya Babu-Narayan, said: “Far too many people continue to face long waits for time-sensitive heart care, putting them at higher risk of becoming more unwell the longer they wait, with potentially devastating consequences.”

What are people dying of?

Dementia and Alzheimer’s disease was the leading cause of death in England in September, representing one in nine deaths (11.4%). Out of the ten most common causes of death, it also accounted for the most excess deaths, at 370. Undiagnosed illnesses, which usually account for a high proportion of deaths and are often linked to old age and frailty, had the second highest number of excess deaths during September, with 311 in total. Heart disease came third, with 244 more deaths than expected.

Covid-19 didn’t make the top ten causes of death, ranking 12th, or 1.8% of all deaths that month.

Which are the worst affected regions of England?

The figures also show wide regional disparities in excess deaths across England. The South East, England’s most populated region, recorded the greatest number of excess deaths in the 10 weeks to 4 November with 2,048 more people dying than expected. The South West recorded the second highest number of excess deaths, at 1,288, followed by the East of England with 1,146.

The North East and North West both recorded the lowest number of excess deaths in the 10 weeks to 4 November with the regions registering 384 and 351 excess deaths respectively. You can see how deaths have changed over time in your local region using the interactive chart below.

Are more men or women dying, and where are they dying?

Men have been dying at a greater rate than women. The number of male excess deaths in the nine months to September 2022 totalled 12,026, nearly three times greater than female excess deaths which had 4,735 in total, ONS data shows.

And more people have been dying at home than in any other setting. Data for 2022 so far, to 4 November, shows excess deaths registered at home totalled 25,253, while hospital excess deaths totalled 1,256. In the last 10 weeks 5,876 excess deaths have been registered in homes, more than half of all excess deaths in the period, the data shows.