Impact of registration delays on mortality statistics in England and Wales: 2020

• The median time between a death occurring and being registered (registration delay) in England and Wales increased from four days in 2019 to five days in 2020; this could be explained by an increase in the number of deaths registered (530,841 in 2019 and 607,922 in 2020).

• In 2020, 75.2% of deaths were registered within one week (seven days or fewer) of the death occurring.

• In 2020, Wales had a higher percentage (80.2%) of deaths registered within one week compared with England (74.9%) for the eighteenth consecutive year.

• Within England, the percentage of deaths registered within one week was highest in the North East (83.7%) and lowest in the East of England (68.3 %).

• The proportion of coroner-certified deaths registered within two weeks (14 days or fewer) reached a low of 40.9% in 2020; coroner-certified deaths registered between two weeks and three months (15 to 91 days) reached a high of 28.6%.

Registration delay is the difference between the date of death occurrence and date of death registration. A death that occurred and was registered on the same day has a delay of zero days, while a death that was registered the day after it occurred has a delay of one day. From 2001 to 2019, registration delays generally increased; for more information, see the 2019 edition of this release.

In 2020, 607,922 deaths were registered in England and Wales. Of these, 99.3% were registered within one year (365 days or fewer).

While there was an increase in the number of deaths registered in 2020 compared with 2019 (530,841 deaths), this did not affect the proportion of deaths registered within one week (seven days or fewer). Deaths registered within one week increased marginally for the second consecutive year, to 75.2% from 75.0% in 2019. Deaths registered between one and two weeks (8 to 14 days) also increased to 13.9% from 13.5% in 2019 (Figure 1).

The proportion of deaths with a registration delay of over two weeks (15 days or more) decreased for the second consecutive year, to 10.9% from 11.5% in 2019. This could have been driven by deaths due to coronavirus (COVID-19; the leading cause of death in 2020), which are typically registered within one week (see Section 3: Registration delays by cause of death).

The delay between death occurrence and registration can differ depending on the cause of death (see accompanying dataset).

Registration delays in the most common causes of death

In 2020, deaths due to coronavirus (COVID-19) had the highest percentage of deaths registered within one week (seven days or fewer), at 86.5% of 73,766 COVID-19 deaths.

Of the chapters in the International Classification of Diseases, Tenth Revision (ICD-10), neoplasms (cancers; Chapter 2) had the highest percentage of deaths registered within one week (85.4% of 151,116 deaths in 2020).

Causes of death with the longest registration delays

Generally, deaths from external causes (ICD-10 Chapter 20), such as accidental injuries and assaults, are least often registered within one week of occurrence. This is because they are referred to a coroner and have potentially lengthy inquests, and in some cases a criminal trial, before the cause of death can be determined.

In 2020, deaths from external causes registered within one week remained at a low of 9.9%. Whereas 28.9% had a registration delay of between three and six months (92 to 183 days), 26.3% of between six months and one year (184 to 365 days), and 9.8% took over one year (366 days or more) to be registered.

For specific causes of death that require coroner's inquests (alcohol-specific, suicide, drug-related, neonatal and postneonatal deaths), timeliness decreases greatly in comparison with other causes (Figure 3). In 2020, suicide and drug-related deaths had the lowest proportion of deaths registered within one week at 0.2% and 0.7% respectively.

These specific causes of death have higher registration delays than all causes combined (Figure 4). In 2020, most suicide-related deaths were registered between three and six months (92 to 183 days; 42.7%), whereas most drug-related deaths were registered between six months and one year (184 to 365 days; 41.5%).

In 2020, 10.3% of suicide and 11.6% of drug-related deaths took over one year (366 days or more) to be registered. More than 91% of suicide and drug-related deaths required an inquest and post-mortem.

Deaths certified by a coroner after inquest generally take much longer to be registered than the more "routine" deaths certified by a doctor. For example, some deaths are re-registered later because of a retrial or an official inquiry. Alternatively, delays may occur where there is no body of the deceased (but they are presumed to be dead), or a body is found after many years.

Coroner-certified deaths registered within two weeks (14 days or fewer) reached a low of 40.9% in 2020, whereas deaths registered between two weeks and three months reached a high of 28.6% (Figure 5).

The proportion of deaths registered by a doctor reached a high of 84.3% in 2020. The proportion of coroner-certified deaths with an inquest reduced from 5.9% in 2019 to 5.1% 2020.

To reduce the impact of outliers on the measurement of the average registration delay, we calculate the median registration delay (see accompanying dataset).

In 2020, the median delay for coroner-certified deaths with an inquest was 149 days, compared with 13 days for coroner-certified deaths without an inquest (Figure 6).

For information on registration delays for coroner-certified deaths with an inquest between 2014 and 2016, see the 2019 edition of this release.

In Wales, 80.2% of deaths (29,990 of 37,399 deaths) were registered within one week (seven days or fewer) in 2020, compared with 74.9% in England (426,883 of 569,698 deaths).

Of the English regions, the percentage of deaths registered within one week was highest in the North East (83.7%) and lowest in the East of England (68.3%) in 2020 (Table 1). Further geographical breakdowns are available in the accompanying dataset.

Neonatal

The death of an infant aged under 28 days.

Postneonatal

The death of an infant aged between 28 days and 1 year.

Coroner

A coroner is a public official responsible for the investigation of violent, sudden or suspicious deaths.

Inquest

An inquest is an inquiry into the cause of an unexplained, sudden or violent death held by a coroner.

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 is available from the World Health Organization (WHO).

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.

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

Data coverage, timeliness and registration delays

Mortality data give complete population coverage. They ensure the estimates are of high precision and are representative of the underlying population at risk.

In England and Wales, deaths should be registered within five days of the death occurring, but there are some situations that result in the death registration being delayed, occasionally extending into years.

Deaths considered unexpected, accidental, or suspicious will be referred to a coroner, who may order a post-mortem or carry out a full inquest to ascertain the reasons for the death. The coroner can only register the death once an investigation is concluded, and they are satisfied that the death has been thoroughly investigated with a correctly certified cause of death. The time taken to investigate the circumstances of the death can often result in a death registration exceeding the five-day period. 

We have developed a statistical model to estimate the number of deaths likely to have occurred in each week based on previous experience of the pattern of registration delays, including the effects of bank holidays. You can find out more about this statistical model in our Predicting total weekly death occurrences in England and Wales methodology. Results are shown in the "Estimated total deaths 2021" tab of the Deaths registered weekly in England and Wales dataset.

Methodology

As a way of measuring the quality of the mortality data, it is important to regularly assess the impact of registration delays. This article looks at registration delays, how this has changed over time, and what factors influence the delay, such as cause of death. Causes of death are coded using the World Health Organization's (WHO) International Classification of Diseases, Tenth Revision (ICD-10). More information on cause of death coding can be found in our user guide.

In this article, registration delays have been grouped into the following categories for analysis:

• within one week (seven days or fewer)

• one to two weeks (8 to 14 days)

• two to three weeks (15 to 21 days)

• three weeks to one month (22 to 30 days)

• one to three months (31 to 91 days)

• three to six months (92 to 183 days)

• six months to one year (184 to 365 days)

• over one year (366 days or more)

Registrations that do not provide enough information to calculate the delay are excluded from analyses. This is usually when the date of death occurrence is missing from the death certificate.

This article focuses on delays based on registration year. This is because data based on registration year are seen as complete, which means the numbers of deaths taking over a year to be registered will not need to be revised in following years. However, a death occurrence can be registered at any point after the death, meaning that these numbers will need to be revised each year. Information based on year of occurrence is available in the accompanying dataset.

For analysis on 2020 deaths registration data, see Deaths registered in England and Wales, and Deaths due to COVID-19, registered in England and Wales.

Further information can be found in the 2019 edition of this release.

Acknowledgment

We would like to thank Rachel Woods, Heidi Wilson, Fred Barton, and Jon Lewis for their contribution to this release.