20 January 2023

Nearly 5,000 extra deaths in 2022 with symptoms of ‘old age and frailty’

20 January 2023

Summer heatwaves and low levels of flu last winter are among factors that may have contributed to almost 5,000 more deaths than usual in England in 2022 where symptoms included old age and frailty, new figures suggest.

Health experts warned that “urgent” action is needed to halt the trend, which also shows the total number of deaths has been above average for eight months in a row.

There were 4,756 extra deaths registered last year in England where the underlying cause was given as “symptoms, signs and ill-defined conditions” – a definition used to cover people who are frail or elderly.

Deaths in this category were 37% above average – making it the leading cause of excess death in England in 2022, according to the Office for National Statistics (ONS).

The mortality rate for this category, 31.5 deaths per 100,000 people, is “statistically significantly” higher than the five-year average of 24.6 per 100,000.

Heart diseases were the second leading cause of excess death in England in 2022 (2,383 excess deaths, 5% above average), followed by “heart failure and complications, and ill-defined heart disease” (1,789 excess deaths, 23% above average).

The jump in excess deaths where the symptoms include old age or frailty might be linked to the low numbers of flu and pneumonia deaths last winter.

Professor David Spiegelhalter, of Cambridge University, said the figures showed that across 2022 there was a “substantial excess in the broad category ‘symptoms, signs and ill-defined conditions’, with around 4,700 excess deaths, an increase of over a third.

“But this was almost exactly compensated for by a large overall deficit of around 4,700 in ‘influenza and pneumonia’, which caused few deaths last winter.

“It is possible that some of the older people would otherwise have been taken earlier by flu.”

The figures for this winter are likely to show a different picture, with the country having experienced its worst flu season for a decade.

Deaths that took place at the end of December 2022 are still being registered, so it is too soon to see the full impact of the surge in flu cases in the run-up to Christmas.

But the ONS data already shows that influenza and pneumonia was the leading cause of excess mortality in England last month, with 574 extra deaths registered – 26% above average.

The mortality rate for flu and pneumonia in December was 56.5 per 100,000 people – “statistically significantly higher” than the five-year average of 48.2 per 100,000.

The ONS report also provides fresh evidence of the effect of last year’s heatwaves, with 638 excess deaths recorded as taking place on July 19 – when temperatures in the UK topped 40C for the first time – and a further 496 excess deaths on July 20.

“Heat is very dangerous,” said Professor Spiegelhalter, with the figures showing “a big spike during the record hottest days of July”.

During the four days from August 12 to 15, when temperatures climbed to the mid-30s, 1,120 excess deaths took place.

Across the whole of 2022, the number of registered deaths in England were 6.3% above average.

The overall mortality rate for the year, which adjusts for population size and age structure, was 0.7% lower than usual – but this is due to deaths in early 2022 running below average, because of high levels of Covid-19 mortality in early 2021.

Greg Ceely, ONS head of health surveillance analysis, said: “We can see that the number of registered deaths remained above average in December, continuing the pattern for the latter part of the year. This was partly driven by an increase in deaths from respiratory diseases, influenza and pneumonia.

“It’s important to consider that death registration numbers alone can only tell us so much, however. When we adjust for changes in population size and age structure over time, we see a different picture; the age-standardised mortality rate for the year was below average for both England and Wales.

“We will continue to investigate and monitor the data to further understand trends in mortality.”

The ONS uses a five-year average of 2016 to 2019 plus 2021 to calculate the number of excess deaths in 2022.

Veena Raleigh, senior fellow at the health charity The King’s Fund, said the figures “should not lead to complacency”, adding that mortality in 2022 “should have fallen sharply after the heavy loss of life from Covid-19 in 2020 and 2021. Instead of which, it remains higher than in some pre-pandemic years, including 2019, the most recent.

“Moreover, since May 2022 the monthly mortality rate has in fact been higher than the pre-pandemic average – a trend that shows no sign of abating. The outlook is therefore not promising.

“Halting and reversing this trend requires contributory drivers, such as unmet health care needs during the pandemic and unprecedented pressures on NHS services, to be addressed urgently.”

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