Deaths registered in England and Wales (series DR): 2012

• There were 499,331 deaths registered in England and Wales in 2012, a rise of 3.1% compared with 2011
• Age-standardised mortality rates (ASMRs) continue to fall. The male rate (6,191 deaths per million population) is the lowest on record. The female rate was 4,510 deaths per million population, slightly higher than in 2011 which was the lowest rate on record
• Cancers were the broad disease group which had the largest percentage of deaths registered in 2012, accounting for 29% of all deaths
• The highest ASMR by broad disease group was for cancer with 2,004 deaths per million population for males and 1,471 deaths per million population for females

This bulletin presents the number of deaths registered in England and Wales in 2012 by age, sex and selected underlying causes of death. In addition, the 10 leading causes of death have been ranked to provide a summary for both males and females. This bulletin provides more detailed statistics than the death registration summary tables for England and Wales which were released in July 2013.

Figures reported here are based on deaths registered in 2012. For more information on the differences between death registrations and death occurrences, please see Background note 2.

Mortality rates for 2011 and 2012 have been calculated using mid-year population estimates based on the 2011 Census. Mortality rates for 2002-2010 have been calculated using the revised population estimates which take account of the 2011 Census, so rates may differ from those previously published.

There were 499,331 deaths registered in England and Wales in 2012 compared with 484,367 in 2011, a rise of 3.1%. The total number of deaths in 2012 comprised 240,238 male and 259,093 female deaths representing a rise of 2.4% for males and 3.8% for females compared with 2011. This is the fourth consecutive year that annual death registrations have been below half a million.

The age-standardised mortality rates (ASMRs) in 2012 were 6,191 deaths per million population for males and 4,510 deaths per million population for females. The male ASMR is the lowest ever recorded in England and Wales for males. For females, the ASMR increased slightly in 2012 from 4,458 deaths per million population in 2011. These age-standardised rates are for all causes and cover all ages (see Background note 5). Between 2002 and 2012, the age-standardised mortality rate for males fell by 24% (from 8,134 deaths per million), while for females it fell by 19% (from 5,542 deaths per million).

Over the course of the 20th century, ASMRs steadily decreased (Figure 1). Up until the early 1970s, year-on-year fluctuations were higher, a likely consequence of influenza epidemics and cold winters, although the relationship between temperature, influenza and winter mortality is complex (for further information see Excess winter mortality in England and Wales).

Mortality rates are generally falling; reasons for this include medical advances in the treatment of many illnesses and diseases. This is illustrated by the reduction in ASMRs for many causes of death (see Table 9 (1.05 Mb Excel sheet) of the DR tables).

Cancers (neoplasms), circulatory diseases, and respiratory diseases were the broad disease groups (chapters) of the International Classification of Diseases, 10th Revision (ICD-10) with the largest numbers of deaths registered in 2012. Cancers accounted for 29% of all deaths, while circulatory diseases (which includes deaths from ischaemic heart disease and strokes) and respiratory diseases (including deaths from pneumonia) accounted for 28% and 14% of all deaths respectively.

Over the course of the 20th century, there have been steady decreases in mortality rates for the main three broad disease groups (cancer, circulatory and respiratory) in England and Wales. The reasons for this include improvements in the treatment of these diseases and the introduction of preventative programmes, such as NHS Breast screening which was introduced in 1988. There have also been initiatives to improve people's health through better diet and lifestyle, for example, the Department of Health’s ‘Change4life campaign’ which began in 2009. More recently the Department of Health’s ‘Healthy Lives, Healthy People’ strategy for England included a tobacco control plan and a call to take action to reduce obesity in England.

In 2012, deaths from cancer had the highest age-standardised mortality rates for both males and females whereas in 2002 the highest rates were for circulatory diseases. Throughout the period 2002 to 2012, circulatory diseases (which include heart disease and strokes) have seen the largest fall in age-standardised rates for males and females (44% and 43% respectively). The fall in age-standardised mortality rates for cancer has been more gradual, with death rates 14% lower for males and 10% lower for females in 2012 than in 2002 (Figures 2 and 3).

In ‘Improving Outcomes: A Strategy for Cancer’ the Department of Health states that although improvements have been made in the quality of cancer services in England, a significant gap remains in mortality rates compared with the European average.

The Outcomes Strategy sets out how the Department of Health aims to improve outcomes for all cancer patients and improve cancer survival rates, with the aim of saving an additional 5,000 lives every year by 2014/15. The Welsh Government’s Together for Health, Cancer Delivery Plan for the NHS up to 2016 sets out the vision for the population of Wales and what this means for NHS cancer services.

The male mortality rate for respiratory diseases decreased by 18% between 2002 and 2012, while the rate for females fell by 14%. Respiratory disease mortality rates in a given year are strongly influenced by influenza levels.

Tables 1 and 2 show the 10 leading underlying causes of death in 2012 for males and females. These are ranked according to a World Health Organisation (WHO) list which categorises causes using ICD-10 groups specifically designed for determining the leading causes of death. The list has been modified for use in England and Wales (Griffiths et al., 2005). The leading causes of mortality are ranked according to the number of deaths registered for each group in 2012.

The leading cause of death for males was ischaemic heart diseases, which accounted for 15.6% of male deaths. The leading cause of death for females was dementia and Alzheimer’s disease, which accounted for 11.5% of female deaths during 2012. Ischaemic heart disease was the leading cause of death for females in 2011. The second leading cause of death in 2012 was malignant neoplasm of trachea, bronchus and lung (lung cancer) for males and ischaemic heart diseases for females.

Alzheimer’s disease is the most common cause of dementia. Deaths from dementia and Alzheimer’s disease are increasing as people live longer, with women living longer than men. Some of the rise over the last few decades may also be attributable to a better understanding of dementia meaning that doctors may be more likely to record dementia as the underlying cause of death. For more information on dementia see this infographic and trends in mortality from Alzheimer’s disease, Parkinson’s disease and dementia, England and Wales, 1979-2004.

If causes were ranked by their age-standardised mortality rates instead of number of deaths, the rankings for females would change. For example, influenza and pneumonia among females is ranked fourth on number of deaths but would be ranked seventh on mortality rates. This is because the age standardisation process gives less weight to deaths at older ages (where most of the influenza and pneumonia deaths occur).

For both sexes, lung cancer (malignant neoplasm of trachea, bronchus and lung) was the most common cancer, appearing second in the leading cause of death list for males and sixth for females. The lists also contain four other cancers for males and two for females, including ones which are sex-specific (prostate cancer and female breast cancer).

Malignant neoplasm of the oesophagus replaced diseases of the liver as one of the 10 leading causes of death for males in 2012. Heart failure and complications and ill-defined heart disease replaced malignant neoplasms of lymphoid, haematopoietic and related tissue for females.

In 2002, deaths from ischaemic heart disease accounted for 22.4% of all male deaths, this fell by 6.8 percentage points by 2012 when it accounted for 15.6% of all male deaths. In contrast the percentage of deaths from dementia and Alzheimer’s disease rose by 3.8 percentage points over the same period.

In 2012, for females the percentage of deaths from ischaemic heart disease fell by 6.2 percentage points compared with 2002. In contrast the percentage of deaths from dementia and Alzheimer’s disease rose by 7.1 percentage points in the same period for females.

This change may partially be explained by the update from ICD-10 version 2001.2 to ICD-10 version 2010. The results of the bridge coding study showed that within the dementia cause group there is a large change for vascular dementia (F01), which is a result of a correction implemented in ICD-10 v2010. In ICD-10 v2001.2, vascular dementia deaths were coded as cerebrovascular disease (I60–I69), in particular I67.9 (cerebrovascular disease, unspecified).

Also, in ICD-10 v2001.2 a number of dementia deaths were coded as N39.0 (urinary tract infection, site not specified). This change is due to an addition to the modification tables of valid causal sequences. See Background note 7 for more information on the implementation of ICD-10 v2010 in January 2011.

The information used to produce mortality statistics is based on the details collected when deaths are certified and registered. In England and Wales, deaths should be registered within five days of the death taking place but there are some situations which result in the registration of the death being delayed. Deaths considered unexpected, accidental or suspicious will be referred to a coroner who may order a post mortem and/or carry out a full inquest to ascertain the reasons for the death. The death cannot be registered until the inquest is completed, which can take many months or even years, and ONS is not notified that a death has occurred until it is registered. If someone is to be charged in relation to the death, the coroner must adjourn the inquest, and they may carry out an accelerated registration. However, the full details are not recorded until the inquest is completed. These accelerated registrations are assigned a U50.9 code, and are included in the DR Series Table 5 (2.81 Mb Excel sheet).

Mortality statistics are presented based on the number of deaths registered in a particular period, rather than the number of deaths that actually occurred in that period. This approach is used as a trade off between timeliness and data quality to meet user needs.

In 2012 there were 499,331 deaths registered in England and Wales. Of these deaths, 478,733 occurred in 2012, representing 95.9% of the deaths registered. The proportion of deaths registered in 2012 that also occurred in 2012 varies depending upon the underlying cause of death classified using the ICD-10. More information on registration delays is available on the ONS website.

The Office for National Statistics uses death data to:

• produce population estimates and population projections at both national and subnational level

• quality assure census estimates

• report on social and demographic trends

• carry out further analysis, for example life expectancies and causes of death (including deaths from injury and poisoning, certain infections and drug related deaths)

• further analyse infant mortality where infant deaths are linked to their corresponding birth record to enable more detailed analyses on characteristics such as age of parents, birthweight and whether the child was born as part of a multiple birth

The Department of Health (DH) is a key user of mortality statistics. The Public Health Outcomes Framework sets out the desired outcomes for public health and how these will be measured. Data are used, for example, to inform policy decisions and to reduce premature mortality from the major causes of death under an NHS Outcomes Framework.

Infant mortality continues to take a central role in DH’s work on health inequalities. Other key users of mortality data are local authorities and other government departments for planning and resource allocation. The Department for Work and Pensions uses detailed mortality statistics to feed into statistical models they use for pensions and benefits.

Users also include other public sector organisations such as the Police and the Home Office who are interested in data on external causes of death. Private sector organisations such as banks, insurance and investment companies are particularly interested in deaths by single year of age and region which feeds into risk estimation, while funeral directors are interested in the number of deaths occurring at the local area level.

Other users include academics, demographers and health researchers who conduct research into trends. Lobby groups and charities use death statistics to support their cause, for example, campaigns against alcohol and drug misuse or suicide. Organisations such as Eurostat and the UN use death statistics for making international comparisons. The media also report on key trends in mortality.