You asked
Please would it be possible for clarification (via a freedom of information request) on the following points, in relation to the following heading section in your 2020 spreadsheets pertaining to death records:
'Total deaths, all ages'
'Note: Deaths could possibly be counted in both causes presented. If a death had an underlying respiratory cause and a mention of COVID-19 then it would appear in both counts'
Deaths by cause
Deaths where the underlying cause was respiratory disease (ICD-10 J00-J99)
Deaths where COVID-10 mentioned on the death certificate (ICD-10 U07.1 and U07.2)
You state that multiple codes have been used on death records, how many death records does this pertain to (if this is something you cannot answer, please could you provide me with a contact for someone who does have this information)?
The way data is currently being presented may grossly overestimate total deaths from respiratory causes, if not grossly then will most certainly make it impossible for any accurate calculations for death rates for respiratory infection. This is therefore highly critical to assess. I want to quantify the real number of total deaths from respiratory infections, which is impossible to do given the current methods for recording data.
My second query is to determine whether total deaths by all causes has been accurately recorded. How do you quantify total number of deaths, and have you removed duplicate coding in the calculations used? EG; if the PT has a recorded death statistic for BOTH COVID-19 and an underlying respiratory disease, have you disregarded multiples to ensure only one code is used to count the total deaths?
We said
Thank you for your request.
Our mortality data comes from the information collected at death registration. All of the conditions mentioned on the death certificate are coded using the International Classification of Diseases, Tenth Revision (ICD-10). From all of these causes an underlying cause of death is selected using ICD-10 coding rules. The underlying cause of death is defined by WHO as:
a) the disease or injury that initiated the train of events directly leading to death, or
b) the circumstances of the accident or violence that produced the fatal injury
Information on how the medical certificate of cause of death (MCCD) is completed is available here.
Latest provisional weekly deaths are available in the provisional weekly deaths publication. This publication provides:
- Total number of deaths from all causes – this is literally a count of every death registered. A death is only counted once no matter how many conditions are mentioned on the certificate.
- Number of deaths due to respiratory disease (ICD-10 J00-J99).
- Number of deaths involving COVID-19 (ICD-10 U07.1 and U07.2)
- Number of deaths due to COVID-19 (see the excel chart data file, under Figure 2).
The term 'due to' means the disease or condition was the underlying cause of death. 'Involving' or 'mentioned' means the disease or condition was recorded anywhere on the death certificate, either as the underlying cause of death or as a contributory factor.
Although COVID-19 is a respiratory disease, it is currently coded to emergency ICD codes U07.1 and U07.2. Therefore, a death due to COVID-19 would be included in the COVID-19 mentions category but not the respiratory disease category, because the latter is based on underlying cause.
A death due to respiratory disease (i.e. J00-J99 was recorded as the underlying cause of death) that also mentioned COVID-19 as a contributory factor, would be counted in both categories.
In many cases, several diseases or conditions are listed on the death certificate. At present, we are not able to tell you overall how many deaths in 2020 mentioned contributory causes as data are still provisional. Provisional mortality data for 2020 are only released via our weekly and monthly mortality analysis publications under special measures with a provisional caveat. Given the current situation with the COVID-19 pandemic, we have increased our output of provisional data to aid specialist modelling work and to provide further information alongside our weekly deaths publication. These can be found via the following links, which may be of use to you:
Monthly mortality analysis, England and Wales (July to September)
Monthly mortality analysis, England and Wales (March to June)
We have not undertaken analysis specifically on the number of death certificates where multiple codes appear. In order to fulfil this request, we would need to create a bespoke analysis. Under the Freedom of Information Act 2000, Public Authorities are not obligated to create information in order to respond to requests. We therefore consider this to be information not held.