Deaths registered in England and Wales (series DR): 2014

• There were 501,424 deaths registered in England and Wales in 2014, a fall of 1.1% compared with 2013

• Age-standardised mortality rates (ASMRs) continued to decrease in 2014. There were 11,213 deaths per million population for males and 8,219 deaths per million population for females. Since 2004, ASMRs have fallen by 20% for males and 17% for females

• Cancers (neoplasms) were the broad disease group (based on International Classification of Diseases (ICD) chapters) for which the largest percentage of deaths were registered in 2014, accounting for 29% of all deaths registered

• The leading cause of death for males in 2014 was ischaemic heart diseases (14.8% of all male deaths). For females, the leading cause was dementia and Alzheimer disease (13.4% of all female deaths)

This bulletin presents the number of deaths registered in England and Wales in 2014 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 2015.

Figures reported here are based on deaths registered in 2014. There is more information on the differences between death registrations and death occurrences in background notes 1 and 2.

There were 501,424 deaths registered in England and Wales in 2014, compared with 506,790 in 2013, a fall of 1.1%. The total number of deaths in 2014 comprised of 245,142 male and 256,282 female deaths. This represents a fall of 0.2% for males and 1.9% for females, compared with 2013. The number of deaths has generally decreased each year since the early 1970s with the exception of some small rises, the most recent being in 2012 and 2013.

In contrast, the population at older ages has increased in recent years, with the proportion of the population aged 65 and over increasing over the past 30 years from 15% to 18%. For more information please see the article on the Ageing of the UK population.

Mortality rates take into account the size and age structure of the population, which both affect the number of deaths. Mortality rates for both males and females have continued their long-term decline.

The age-standardised mortality rates (ASMRs) in 2014 were 11,213 deaths per million population for males and 8,219 deaths per million population for females. The male ASMR has decreased each year since 1995 (Figure 1). For females, the ASMR has decreased since 1995 with the exception of 3 small rises, the latest was in 2012. These ASMRs are for all causes and cover all ages (background note 4 has further details). Between 2004 and 2014, the ASMR for males fell by 20% (from 14,007), while for females it fell by 17% (from 9,927).

Over the course of the 20th century, ASMRs steadily decreased. Up until the early 1970s, year-on-year fluctuations were higher. This is a likely consequence of influenza epidemics and cold winters, although the relationship between temperature, influenza and winter mortality is complex (Excess winter mortality in England and Wales, 2013/14 provisional and 2012/13 final has more information).

Mortality rates are generally falling and people are tending to live longer for a variety of reasons. These include improved lifestyles and 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 of the DR tables (1 Mb Excel sheet)).

On 1 January 2014, ONS changed the software used to code cause of death to a package called IRIS (version 2013). These updates include changes to the use of codes within the neoplasms (cancer) chapter (ICD-10 codes C00-D48). Further information can be found in background note 5 and in the dual coding study looking at the impact on mortality statistics.

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 2014. Cancers accounted for 29% of all deaths, while circulatory diseases (which include deaths from heart disease and strokes) accounted for 27% of all deaths. Respiratory diseases (including deaths from pneumonia) accounted for 13% of all deaths.

Over the course of the 20th century, there have been steady decreases in mortality rates for the main 3 broad disease groups (cancer, circulatory and respiratory) in England and Wales. The reasons for this include improvements in the treatment and diagnosis of these diseases, in addition to 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, in England, the Department of Health’s (DH) “Change4life campaign“, which began in 2009. There have been other high-profile awareness campaigns such as the “Be clear on cancer campaign“, which has been active since 2010 to 2011 and “Stoptober“, which runs every October. Be Clear on Cancer campaigns, now run by Public Health England (PHE) in conjunction with DH and NHS England, aim to raise awareness of signs and symptoms of cancer to promote early diagnosis. Recommendation 15 of the independent Cancer Taskforce report, Achieving World-Class Cancer Outcomes: A Strategy for England 2015-2020 (July 2015), states that PHE should continue to invest in Be Clear On Cancer campaigns.

In March 2013, DH published Living Well for Longer: National support for local action to reduce premature avoidable mortality. This sets out the actions national partners for health and care, including Government, National Health Service (NHS) and Public Health England (PHE) would take in 2014 to 2015 to reduce premature avoidable mortality. A report, Living Well for Longer – One Year On has been published describing progress towards these commitments. This also explains how the system would continue to prioritise actions towards reductions in premature death as part of mainstream functions. For more information on avoidable mortality please see Avoidable mortality in England and Wales.

Similarly, Public Health Wales has a number of campaigns such as “Stop smoking Wales”, “Change4life Wales”, which launched in 2010 and the “Screening for life” campaign, which is run every July.

In 2014, deaths from cancer had the highest ASMRs for both males (3,446 deaths per million population) and females (2,359 deaths per million population). However, in 2004 the highest rates were for circulatory diseases. From 2004 to 2014, circulatory diseases (which include heart disease and strokes) have seen the largest fall in ASMRs for males and females (40% and 42% respectively). There has been a more gradual fall in ASMRs for cancer, with death rates 11% lower for males and 8% lower for females in 2014 than in 2004 (Figures 2 and 3).

The Outcomes Strategy sets out how the Department of Health aims to improve outcomes for all cancer patients and improve cancer survival rates to save an additional 5,000 lives every year by 2014/15. The main focus was on earlier diagnosis and improved access to the best possible treatment. The “Improving Outcomes: A Strategy for Cancer, Fourth Annual Report” (December 2014), estimates that on average between 6,500 and 17,000 more patients per year diagnosed from 2011 to 2015 will survive cancer for 5 years compared to patients diagnosed from 2006 to 2010. The “Be clear on cancer campaign” aims to make sure people are aware of the signs of cancer to ensure early diagnosis.

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 23% between 2004 and 2014, while the rate for females fell by 21%. Respiratory disease mortality rates in a given year are strongly influenced by influenza levels.

On 1 January 2014, ONS changed the software used to code cause of death to a package called IRIS (version 2013). These updates include changes to the use of codes within the neoplasms (cancer) chapter (ICD-10 codes C00-D48). Further information can be found in background note 5 and in the dual coding study looking at the impact on mortality statistics.

Tables 1 and 2 show the 10 leading underlying causes of death in 2014 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 2014.

The leading cause of death for males in 2014 was ischaemic heart diseases, which accounted for 14.8% of male deaths (Table 1). The leading cause of death for females was dementia and Alzheimer disease, which accounted for 13.4% of female deaths during 2014 (Table 2). The second leading cause of death in 2014 was dementia and Alzheimer disease for males (third in 2013) and ischaemic heart diseases for females.

If causes were ranked by their age-standardised mortality rates, instead of number of deaths, the rankings for males and females would change slightly. For example, cerebrovascular diseases among males is ranked fifth on number of deaths but fourth on mortality rates, while malignant neoplasm of trachea, bronchus and lung among females is ranked sixth on number of deaths, but fourth on mortality rates. The age-standardisation process has been altered following a revision to the European Standard Population in 2013 and now gives a greater weight to deaths at older ages (further details in background note 4).

For both sexes, lung cancer (malignant neoplasm of trachea, bronchus and lung) was the most common cancer, appearing third in the leading cause of death list for males and sixth for females. The lists also contain 3 other cancers for both males and females, including those which are sex-specific (prostate cancer and female breast cancer).

Malignant neoplasms, stated or presumed to be primary of lymphoid, haematopoietic and related tissue has replaced heart failure and complications and ill-defined heart disease as 1 of the 10 leading causes of death for females in 2014, it did not appear in the 10 leading causes of death for females in 2013, but has previously appeared in 2011.

On 1 January 2014, ONS changed the software used to code cause of death to a package called IRIS (version 2013). These updates include changes to the use of codes within the neoplasms (cancer) chapter (ICD-10 codes C00-D48). Further information can be found in background note 5 and in the dual coding study looking at the impact on mortality statistics.

In 2004, deaths from ischaemic heart disease accounted for 21.0% of all male deaths (Figure 4) and 15.3% of all female deaths (Figure 5). In 2014, it accounted for 14.8% of all male deaths, a fall of 6.2 percentage points and 9.4% of all female deaths, a fall of 5.9 percentage points.

In contrast, the percentage of deaths from dementia and Alzheimer disease increased by 5.0 percentage points for males over the same period (from 2.0% to 7.0%) and by 8.7 percentage points for females (from 4.7% to 13.4%).

The increase in deaths from dementia may be partially explained by an update to the ICD coding frame, introduced in January 2011 (background note 5 has more information).

Alzheimer disease is the most common cause of dementia. Deaths from dementia and Alzheimer 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. This means that doctors may be more likely to record dementia on the death certificate. In 2012, the Prime Minister launched the “Prime Minister’s challenge on dementia” with the main aim to deliver improvements in dementia care and research by 2015. One of the key commitments was increased diagnosis rates through improvements in health and care. In 2015, the Prime Minister launched his second dementia challenge, the Prime Ministers Challenge on Dementia 2020, which built on the achievements made from 2012-2015, and aims to identify what needs to be done to ensure dementia care, support, awareness and research are transformed by 2020.

There is more information on Alzheimer disease, on the Alzheimer’s Society website and trends in mortality from Alzheimer’s disease, Parkinson’s disease and dementia, England and Wales, 1979-2004.

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 5 days of the death taking place. However, 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. 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. Accelerated registrations are assigned a U50.9 (inquest adjourned) code, and are included in the DR Series Table 5 (1.86 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 2014, there were 501,424 deaths registered in England and Wales. Of these deaths, 477,752 occurred in 2014, representing 95% of the deaths registered. The proportion of deaths registered in 2014 that also occurred in 2014 varies by the underlying cause of death, classified using the ICD-10. More information on registration delays is available on our website and in background notes 1 and 2.

ONS uses mortality data for the following purposes:

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

• reporting on social and demographic trends

• carrying out further analysis, for example, on life expectancy, health expectancy and by cause of death (including avoidable mortality, drug-related deaths and suicides)

• further analysing 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, gestational age, ethnicity and whether the child was born as part of a multiple birth

• quality assuring census estimates

The Department of Health (DH) is an important user of mortality statistics. The Public Health Outcomes Framework sets out the desired outcomes for public health and how these will be measured, while the NHS Outcomes Framework measures performance in the health and care system at a national level. Data from both frameworks are used, for example, to inform policy decisions and to reduce premature mortality from the major causes of death.

The Welsh Government (WG) is another important user of mortality statistics. The Programme for Government sets out the indicators, one of which is 21st Century Healthcare. Data are then used to determine delivery priorities, such as those relating to cancer and circulatory diseases, as outlined in the NHS Wales health delivery plans.

Infant mortality is also seen as an important measure among health outcomes and there is a long established link between social and health inequalities, and infant mortality. Infant mortality continues to take a central role in Department of Health (DH) and Welsh Government (WG)’s work on health inequalities.

Other important 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 to feed into risk estimation. 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 main trends in mortality.