Deaths in private homes, from all causes, were one-third higher in 2020 than in the previous five years. There were around 167,000 deaths from all causes in private homes in England and Wales in 2020, compared with an average of 125,000 between 2015 and 2019.
The majority of deaths due to COVID-19 (where the coronavirus was the main cause) occurred in hospitals and care homes, while many deaths from other causes, such as breast cancer and prostate cancer, happened in private homes. Our analysis shows that many of these deaths at home were people who, in a non-pandemic year, may have typically died elsewhere such as in hospital.
Deaths in hospital were 4% above the five-year average. However, if deaths due to COVID-19 are excluded, then deaths in hospitals would have been 16% lower than the average.
Our first release of the finalised mortality data for 2020 shows that “excess deaths” from all causes were 14% above the five-year average in England and Wales, with the coronavirus (COVID-19) being the main reason for excess deaths.
Excess deaths are the difference between the number of deaths registered in 2020 and the five-year average (2015 to 2019). Using the average gives us a comparison of how many deaths we would expect in a "usual" year, before the COVID-19 pandemic.
There were almost 76,000 more deaths from all causes and in all locations (hospitals, care homes, private homes and elsewhere) in England and Wales in 2020 than the five-year average. COVID-19 was responsible for 97% of the excess, having not previously existed.
This analysis looks at England and Wales as a whole; trends for the two countries may differ and are shown separately in the charts and data tables.
Private homes and care homes bore the brunt of excess deaths in 2020
Deaths from all causes by place of death, England and Wales, deaths registered in 2020 and average for 2015 to 2019
More than half (around 41,000) of the 76,000 excess deaths, from all causes, in England and Wales in 2020 occurred in private homes. A further 25,000 occurred in care homes.
The contribution of COVID-19 to this increase in deaths in private homes is small, at just over 3,000. The increase of non-COVID-19 deaths in private homes is 30% above the five-year average.
Care homes recorded a 21% rise in deaths from all causes, with nearly 25,000 more than expected — almost 19,000 of them due to COVID-19. Excluding the coronavirus, other care home deaths were 5% up on the five-year average.
In hospitals, which were under significant pressure because of numbers of patients with the coronavirus, there were around 258,000 deaths from all causes, 10,000 (4%) more than the five-year average.
Deaths in hospital from causes other than COVID-19 fell by more than 40,000 (16%).
The most significant rise in deaths based on the previous five years was from "chronic rheumatic heart diseases", with just under 1,100 deaths registered in 2020, 36% higher when compared with 789 a year on average between 2015 and 2019.
"Cirrhosis and other diseases of the liver" caused almost 9,700 deaths, compared with an average of 8,300 between 2015 and 2019. Though deaths from this cause had generally been increasing over time prior to the pandemic, the rise between 2019 and 2020 was larger than seen in recent years. Proportionally, the biggest shift in deaths by this cause was in deaths in private homes, with nearly 2,400 in 2020 compared with an expected 1,800 (a rise of 31%). Analysis from Public Health England and academic studies has suggested that alcohol consumption in higher-risk drinkers increased during the COVID-19 pandemic, but more research is needed to fully understand the impact on mortality.
Increases in deaths from these causes were the highest above the expected range, using z-scores.
The z-scores are a more meaningful measure than percentage changes, which can be skewed by small numbers.
There were 8,000 fewer deaths in England and Wales than expected from "influenza and pneumonia", likely due in part to social distancing reducing the spread.
"Bronchitis, emphysema and other chronic obstructive pulmonary disease" and "renal failure" were the underlying causes of death that fell the farthest below what was expected based on their five-year averages.
Heart diseases caused significantly more deaths than normal during 2020
Causes of death, ranked by their deviation from the 2015 to 2019 average, England and Wales, deaths registered in 2020
- This chart shows the top and bottom 10 causes of death in terms of their z-score. A z-score of more than 1.96 means the cause was significantly higher in 2020 than in the five-year average, a z-score of less than -1.96 means the cause was significantly lower in 2020 than the five-year average. Other z-scores mean the cause was not statistically significantly different in 2020 than in the five-year average.
Breast cancer deaths ("malignant neoplasms of breast") were broadly in line with the 2015 to 2019 average. There were 10,385 deaths compared with an average of just over 10,200.
However, more breast cancer deaths were registered in private homes than in hospitals, compared with the five-year average.
There were just over 3,900 breast cancer deaths in private homes in England and Wales in 2020, compared with just over 2,800 in hospitals. This compares with an average of just under 2,900 deaths at home and 3,400 deaths in hospital per year between 2015 and 2019.
For prostate cancer ("malignant neoplasm of prostate"), 4,700 deaths out of a total of nearly 11,000 were in private homes in 2020 and just under 2,900 were in hospitals, compared with 3,300 in private homes and 3,600 in hospitals on average between 2015 and 2019.
"Parkinson’s disease" and "diabetes" deaths in private homes were up, by 66% for "Parkinson’s disease" (616 excess deaths) and by 60% for "diabetes" (894 excess deaths).
Deaths due to "influenza and pneumonia" in private homes were 8% below the five-year average.
Deaths at home for most causes were above the five-year average
Percentage of excess deaths registered in 2020 by underlying cause and percentage of excess deaths occurring in private homes, England and Wales, compared with the average for 2015 to 2019
- Not all locations are shown.
- This analysis uses deaths registered in each year. There is a delay between a death occurring and it being registered, with certain causes (such as external causes) taking much longer to be registered, particularly during the COVID-19 pandemic. For more information, see the About this article section.
There were more deaths (from all causes) in private homes in each month of 2020 than in a normal year, after the coronavirus pandemic struck in March.
While the peak in excess deaths in care homes during April 2020 was much higher than in private homes, deaths remained above average in private homes for the rest of the year. Deaths other than in private homes in England fell below the five-year average during July and August 2020 while in Wales this happened in August and September 2020.
Deaths in private homes remained above average even as mortality rates elsewhere returned to normal
Deaths from all causes by place of death, England and Wales, percentage difference between deaths registered in each month of 2020 and average for 2015 to 2019
In 2020, 89,000 people aged 85 years and over died in hospitals in England and Wales while 94,000 died in care homes and 50,000 in private homes.
The number of people aged 85 years and over dying in hospital was slightly below the five-year average during 2020. However, among this age group, almost 31,000 more people than expected died in private homes and care homes.
Deaths, from all causes, recorded in private homes among people aged 85 years and over were 43% above the five-year average in England and 38% above average in Wales during 2020. In care homes, the number of excess deaths came to 20% in England and 22% in Wales.
At the same time, deaths in hospital from all causes among those aged 85 years and over fell slightly, while deaths in age groups 45 to 64 years and 75 to 84 years increased in both England and Wales. Hospital deaths among the age group 65 to 74 years increased in England but not in Wales.
Deaths at home among people aged 85 years and over were 43% above average in 2020 in England and 38% above average in Wales
Percentage of deaths above the five-year average by age group and place of death, England and Wales, deaths registered in 2020
There were 258,000 deaths from all causes in hospitals in England and Wales in 2020, 10,000 (4%) up on the five-year average. Deaths due to the coronavirus (COVID-19) accounted for 1 in 5 of these.
While there were almost 33,000 deaths due to COVID-19 of females in England and Wales in 2020, fewer females died (of any cause) in hospital than the five-year average.
There were 118,000 female deaths in hospital from any cause in England and Wales, compared with almost 121,000 a year on average between 2015 and 2019, a fall of 2%. There were nearly 140,000 male deaths in hospital in 2020, 10% above the five-year average of 127,000, reflecting the higher number of male deaths due to COVID-19.
Males accounted for the largest share of excess deaths from any cause in England, at 18% above the five-year average compared with 11% for females. In Wales, male deaths were 14% above the average and female deaths were 10% above the average.
Deaths in private homes and care homes were up significantly for both males and females
Excess deaths registered in 2020, England and Wales, compared with 2015 to 2019 by place of death and sex
Deaths due to the coronavirus (COVID-19) were highest among the oldest age groups.
Overall excess deaths, the percentage above the average for the previous five years, followed a similar pattern. There was also a higher percentage of excess deaths among males than females from the ages of 45 to 49 years onwards in England.
However, the percentage of excess deaths in both England and Wales among those aged 65 to 69 years was the lowest of any age group above 40 to 44 years.
Excess deaths in England among those aged 65 to 69 years were 7% above the average for males and 2% above the average for females, compared with 1% above average for males and 2% below average for females in Wales.
Among the next age group down, 60 to 64 years, excess deaths were 18% above average for males and 14% above average for females in England while among the group aged 70 to 74 years they were 21% above average for males and 17% above average for females.
In Wales, deaths among males aged 60 to 64 years were 10% above average and for females 14% above average in 2020 while for those aged 70 to 74 years deaths were 15% above average for males and 18% above average for females.
Also in Wales, deaths of females aged 35 to 39 years were 47% higher than expected, with 105 registered in 2020 compared with a five-year average of around 71. Four deaths registered in 2020 in this age group, among males and females, were due to COVID-19.
Excess deaths were mostly higher for males than females among those aged 45 to 49 years and older
Percentage excess deaths by sex, England and Wales, compared with 2015 to 2019 average, deaths registered in 2020
- Deaths of those under 20 years grouped together due to small numbers.
More detailed information on excess deaths can be found in our accompanying dataset. In addition, more detailed analyses of excess deaths in England and Wales are produced by Public Health England and Public Health Wales.
About this article
In this article, “excess” deaths are defined as the difference between the number of deaths registered in 2020 and the 2015 to 2019 average. The average provides a comparison of how many deaths we would expect in a usual year. A five-year period was used because there has been relatively little year-on-year population change over the last five years (less than 1% increase each year).
Z-scores demonstrate how mortality in 2020 differed from the five-year average. The Z-score is the number of standard deviations the observed number of deaths (registered in 2020) is from the average (2015 to 2019). Z-scores can be used to determine statistical significance. In this analysis, a Z-score of 0 means the number of deaths in 2020 was the same as the five-year average.
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. COVID-19 refers to the "coronavirus disease 2019" and is a disease caused by a specific type of coronavirus.
Deaths "due to COVID-19" are deaths registered in England and Wales where COVID-19 was the underlying (main) cause on the death certificate. A doctor can certify the involvement of COVID-19 based on symptoms and clinical findings – a positive test result is not required. International Classification of Diseases, 10th Edition (ICD-10) codes U.071, U.072, and U10.9 are included in our "due to COVID-19" definition. This article uses finalised mortality data for 2020, so numbers of deaths due to COVID-19 differ from figures in other publications based on provisional data, such as weekly deaths.
Causes of death
The ONS has a short list for cause of death, developed in consultation with the Department of Health and Social Care, and based on one developed by the WHO. This list uses more specific groupings than the broad group level, splitting causes such as cancer and circulatory diseases into different subtypes, to provide policymakers with enough detail to generate appropriate health policies. In this article, short list cause groups with under 1,000 deaths in 2020 were merged with other groups to reduce problems associated with small counts. For more information on the groupings used see the Definitions tab of the accompanying dataset.
This analysis focuses on the underlying cause of death only. Multiple health conditions that contributed to a death can be mentioned on the death certificate, and from these a single underlying (main) cause of death is derived using a set of rules. Information on pre-existing conditions of people who died due to COVID-19 is available based on provisional data.
This analysis focuses on deaths registered in 2020; there is a delay between a death happening and it being registered, so some of the 2020 death registrations will have occurred in previous years. Deaths from external causes, such as accidents, violence and suicides can only be registered after investigation by a coroner. This process has been impacted by the pandemic, affecting the number of death registrations in 2020 from these causes.