Monthly mortality analysis, England and Wales: January 2022

• In January 2022, there were 49,807 deaths registered in England, 5,655 deaths (10.2%) fewer than the January five-year average (2016 to 2019, and 2021); there were 3,262 deaths registered in Wales, 402 deaths (11.0%) fewer than the January average.

• In January 2022, there were 49,807 deaths registered in England, 3304 deaths (6.2%) fewer compared to the previous five-year average (2015 to 2019) for January, there were 3,262 deaths registered in Wales, 265 deaths (7.5%) fewer than the previous five year average for January.

• The leading cause of death in England in January 2022 was dementia and Alzheimer's disease (accounting for 11.9% of all deaths); in Wales, the leading cause was ischaemic heart diseases (11.5% of all deaths).

• Coronavirus (COVID-19) was the third leading cause of death in January 2022 in both England (accounting for 7.6% of all deaths) and Wales (7.3% of all deaths).

• The proportion of deaths due to COVID-19 (of all deaths that involved COVID-19) decreased between December 2021 and January 2022 in both England (from 83.8% to 73.7%) and Wales (from 79.6% to 76.2%).

• Taking into account the population size and age structure, the age-standardised mortality rate (ASMR) for deaths due to COVID-19 increased significantly between December 2021 and January 2022 in both England (79.3 deaths per 100,000 people, up from 56.3) and Wales (81.0 deaths per 100,000 people, up from 59.3).

• London was the English region with the highest ASMR for deaths due to COVID-19 in January 2022 (120.1 deaths per 100,000 people).

Based on provisional data, there were 49,807 deaths registered in England in January 2022. This was 18,983 fewer deaths than in January 2021 and 5,655 fewer deaths than the five-year average (2016 to 2019, and 2021), a decrease of 10.2%. Compared to the previous five-year average (2015 to 2019) there were 3304 fewer deaths (6.2%) in January 2022 in England.

In Wales, the provisional number of deaths registered in January 2022 was 3,262. This was 1,169 fewer deaths than in January 2021 and 402 fewer deaths than the five-year average for January (11.0% below). Compared to the previous five-year average (2015 to 2019) there were 265 fewer deaths (7.5%) in January 2022 in Wales.

Age-standardised mortality rates (ASMRs) are used for comparisons over time rather than numbers of deaths, as ASMRs account for changes to the population size and age structure.

In England, 2002 was the year with the highest January mortality rates since our time series began in 2001, at 1,581.7 per 100,000 people. Since then, overall mortality rates in England for the month of January generally decreased to a low of 1,034.2 deaths per 100,000 people in January 2016. Though a statistically significant increase in the mortality rate was observed in January 2021 (1,465.2 deaths per 100,000 people, compared with 1,151.7 per 100,000 people in January 2020), the ASMR significantly decreased in January 2022 (1,039.3 deaths per 100,000 people). This pattern in ASMRs over time was seen in both males and females (Figure 1).

In Wales, mortality rates for January have generally decreased over time. The ASMR decreased from 1,626.5 per 100,000 people in January 2001 to a low of 1,114.0 deaths per 100,000 people in January 2016. Though a statistically significant increase in mortality rate was observed in January 2021 (1,538.2 deaths per 100,000 people, compared with 1,253.9 per 100,000 people in January 2020), the ASMR significantly decreased in January 2022 (1,117.1 deaths per 100,000 people). This pattern in ASMRs over time was seen in both males and females (Figure 1).

The doctor certifying a death can list all causes in the chain of events that led to the death, and pre-existing conditions that may have contributed to the death. Using this information, we determine an underlying cause of death. More information on this process can be found in our User guide to mortality statistics.

Since March 2020 (when the first deaths involving coronavirus (COVID-19) were registered in England and Wales), when COVID-19 was mentioned on the death certificate it was the underlying cause of death in most cases (88.0% in England, 86.7% in Wales).

In England, April 2020 had the highest proportion of deaths involving COVID-19 that were also due to COVID-19 (95.2%), whereas May 2021 had the lowest proportion (68.8%). In Wales, April 2020 had the highest proportion of deaths involving COVID-19 that were also due to COVID-19 (94.1%), whereas June 2021 had the lowest proportion (42.9%). These proportions generally correspond with periods of low or high numbers of COVID-19 deaths in England and Wales.

The proportion of deaths due to COVID-19 (of all deaths that involved COVID-19) decreased between December 2021 and January 2022 in both England (from 83.8% to 73.7%) and Wales (from 79.6% to 76.2%). For more information on our definition of COVID-19 deaths, see the Measuring the data section.

Of the 49,807 deaths registered in January 2022 in England, 7.6% (3,797 deaths) were due to COVID-19, a larger proportion than in December 2021 (5.4%). Including all deaths involving COVID-19 (5,151 deaths), this percentage increases to 10.3% of all deaths in England in January 2022.

In Wales, 7.3% of the 3,262 deaths registered in January 2022 were due to COVID-19 (237 deaths), a larger proportion than in December 2021 (5.2%). Including all deaths involving COVID-19 (311 deaths), this percentage increases to 9.5% of all deaths in Wales.

Mortality rates for deaths due to COVID-19

When adjusting for the size and age structure of the population, age-standardised mortality rates (ASMRs) for deaths due to COVID-19 in both England and Wales for January 2022 showed statistically significant increases compared with December 2021 (Figure 3). The ASMR for deaths due to COVID-19 increased to 79.3 deaths per 100,000 people in January 2022 in England (compared with 56.3 in December 2021), and to 81.0 deaths per 100,000 people in Wales (compared with 59.3 deaths per 100,000 people in December 2021). January 2022 is the fifth consecutive month where the ASMR for deaths due to COVID-19 in Wales was higher than in England.

In England, the ASMR for deaths due to COVID-19 significantly increased in January 2022 for both males (105.0 deaths per 100,000 males) and females (60.0 deaths per 100,000 females), compared with December 2021.

In January 2022, the ASMR for deaths due to COVID-19 in Wales increased significantly compared with December 2021 in males (111.1 deaths per 100,000 males). The ASMR also increased, though not significantly, in females (59.2 deaths per 100,000 females).

More information on mortality rates by sex is available in Tables 3a and 3b of the accompanying dataset.

Figures 4 and 5 show the 10 most common underlying causes of death (based on the leading causes of death groupings), registered in January 2022 for England and Wales, compared with the five-year average for January (2016 to 2019, and 2021).

In England, dementia and Alzheimer's disease continued to be the leading cause of death in January 2022, at 122.9 deaths per 100,000 people (5,939 deaths). In Wales, ischaemic heart diseases was the leading cause of death, at 127.2 deaths per 100,000 people (374 deaths).

In both England and Wales, coronavirus (COVID-19) was the third leading cause of death in January 2022 (3,797 and 237 deaths respectively), up from fourth in both England and Wales in December 2021.

In England in January 2022, 9 of the 10 leading causes of death were statistically significantly lower than the five-year average, and 1 of the 10 leading causes was statistically significantly higher than the five-year average (symptoms, signs, and ill-defined conditions, with a 9.0% increase in the age-standardised mortality rate (ASMR)). As seen in previous months, the mortality rate for deaths with an underlying cause of influenza and pneumonia was lower in January 2022 than the five-year average for January (51.2% lower). This is likely, in part, to be because of people continuing to follow coronavirus guidance, such as social distancing, reducing the spread of infections such as flu.

In Wales in January 2022, 5 of the 10 leading causes of death were statistically significantly higher than the five-year average and 5 of the 10 leading causes were not significantly different from the five-year average. As seen in England, the January 2022 mortality rate for influenza and pneumonia was significantly lower than the five-year average for January (56.6% lower).

This section is based on the date a death occurred - rather than the date of registration used in the previous sections - to monitor current mortality trends. Further information can be found in the Measuring the data section.

In England, 43,503 deaths occurred in January 2022 (and were registered by 7 February 2022). This was 11,877 fewer deaths than the five-year average (2016 to 2019, and 2021) for January (21.4% lower). Of all deaths that occurred, 8.4% (3,669 deaths) were due to coronavirus (COVID-19).

In Wales, 2,965 deaths occurred in January 2022 (and were registered by 7 February 2022), which was 618 fewer deaths than the five-year average (17.2% lower). COVID-19 was the underlying cause of death in 7.9% of all deaths that occurred (234 deaths). In England, the first death due to COVID-19 occurred on 30 January 2020, whereas in Wales the first death due to COVID-19 occurred on 15 March 2020. Figures 6 and 7 show the trends in COVID-19 death occurrences from March 2020 onwards, for England and Wales respectively.

Figure 6: In England in January 2022, daily deaths due to COVID-19 increased since December 2021

Number of deaths occurring on each day from March 2020 to January 2022, five-year average and range, England

Notes:

1. Figures are for deaths occurring on each day rather than deaths registered, registered up to 7 February 2022. Death occurrences will increase as more deaths are registered, particularly for later dates.

2. Figures for 2021 and 2022 (including deaths that occurred in 2020 but were registered in 2021, and deaths that occurred in 2021 but were registered in 2022) are based on provisional mortality data.

3. Figures exclude non-residents.

4. "COVID-19" includes only deaths where COVID-19 was the underlying cause.

5. This chart includes deaths from 1 March 2020. Three deaths due to COVID-19 occurred prior to this in England (one death in January 2020 and two deaths in February 2020), but are not included here.

6. The five-year average for 2022 has been provided for 2016 to 2019 and 2021, providing an up-to-date comparison that is still close to representing a usual (non-pandemic year), but not including the exceptionally high number of deaths seen in 2020. For more information, see Understanding excess deaths during a pandemic.

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Figure 7: In Wales in January 2022, daily deaths due to COVID-19 increased since December 2021

Number of deaths occurring on each day from March 2020 to January 2022, five-year average and range, Wales

Notes:

1. Figures are for deaths occurring on each day rather than deaths registered, registered up to 7 February 2022. Death occurrences will increase as more deaths are registered, particularly for later dates.

2. Figures for 2021 and 2022 (including deaths that occurred in 2020 but were registered in 2021, and deaths that occurred in 2021 but were registered in 2022) are based on provisional mortality data.

3. Figures exclude non-residents.

4. "COVID-19" includes only deaths where COVID-19 was the underlying cause.

5. The five-year average for 2022 has been provided for 2016 to 2019 and 2021, providing an up-to-date comparison that is still close to representing a usual (non-pandemic year), but not including the exceptionally high number of deaths seen in 2020. For more information, see Understanding excess deaths during a pandemic.

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It is important to note that the number of death occurrences is incomplete as it is likely that more deaths need to be registered, therefore comparisons should be treated with caution.

In particular, instances where the number of death occurrences on each day in January was below the range of the last five years are likely to be a result of when the data extract was created. Specifically, deaths that occurred towards the end of the month may not have been registered by the time the data extract was created. We would therefore expect the number of death occurrences to be higher in future releases.

Age-specific mortality rates

Age-specific mortality rates are used to allow comparisons between specified age groups.

Age-standardised mortality rates

Age-standardised mortality rates (ASMRs) are used to allow comparisons between populations that may contain different proportions of people of different ages. The 2013 European Standard Population is used to standardise rates. In this bulletin, we have adjusted the monthly ASMRs to allow for comparisons with annual rates. For more information see the Measuring the data section.

Coronaviruses

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, with a further 13 deaths mentioning the virus as a contributory factor on the death certificate.

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).

Pre-existing condition

A pre-existing condition is defined as any condition that either preceded the disease of interest (for example, COVID-19) in the sequence of events leading to death or was a contributory factor in the death but was not part of the causal sequence. More information on the pre-existing conditions methodology is available in the accompanying dataset.

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.

Statistical significance

The term "significant" refers to statistically significant changes or differences. Significance has been determined using the 95% confidence intervals, where instances of non-overlapping confidence intervals between estimates indicate the difference is unlikely to have arisen from random fluctuation.

95% confidence intervals

A confidence interval is a measure of the uncertainty around a specific estimate. If a confidence interval is 95%, it is expected that the interval will contain the true value on 95 occasions if repeated 100 times. As intervals around estimates widen, the level of uncertainty about where the true value lies increases. The size of the interval around the estimate is strongly related to the number of deaths, prevalence of health states and the size of the underlying population. At a national level, the overall level of error will be small compared with the error associated with a local area or a specific age and sex breakdown. More information is available on our uncertainty pages.

This bulletin provides timely surveillance of mortality in England and Wales, based on the best available provisional data, including all-cause mortality and coronavirus (COVID-19) deaths.

Analysis contains deaths registered in January 2022 by age and sex, and also includes deaths that occurred in January 2022 by date of death. Non-residents of England and Wales are excluded. In January 2022, there were 89 deaths of non-residents that were registered in England and Wales.

Data sources

This bulletin is based primarily on death registrations. Analysis by month of death registration is consistent with the weekly death registrations release and allows for a more timely analysis than would be possible using death occurrences. There is a section on death occurrences for surveillance of recent mortality trends. Death occurrences show the number of deaths that occurred within a calendar period and give a better indication of exactly when deaths were at their highest. This allows mortality to be related to other factors such as weather patterns.

A provisional extract of death registrations and death occurrences data is taken on the first working day after the eighth of the month, to allow time for deaths to be registered. For more detail on the data sources used, see our methodology article.

Definition of COVID-19 deaths

We use the term "due to COVID-19" when referring only to deaths with an underlying cause of death of COVID-19. When taking into account all of the deaths that had COVID-19 mentioned anywhere on the death certificate, whether as an underlying cause or not, we use the term "involving COVID-19". The International Classification of Diseases (ICD-10) codes used to define COVID-19 are:

• U07.1: COVID-19, virus identified
• U07.2: COVID-19, virus not identified
• U09.9: Post-COVID condition, unspecified (this cannot be assigned to the underlying cause of death so is not included in the "deaths due to COVID-19" definition)
• U10.9: Multisystem inflammatory syndrome associated with COVID-19, unspecified

Our definition of COVID-19 (regardless of whether it was the underlying cause or mentioned elsewhere on the death certificate) includes some cases where the certifying doctor suspected the death involved COVID-19 but was not certain (U07.2). For example, a doctor may have clinically diagnosed COVID-19 based on symptoms but this diagnosis may not have been confirmed with a test, so they may write "suspected COVID-19" on the death certificate. Of the 144,923 deaths due to COVID-19, 4,150 (2.9%) were classified as "suspected" COVID-19. Including all 164,737 deaths involving COVID-19, "suspected" COVID-19 was recorded on 2.9% (4,778 deaths) of all deaths involving COVID-19 in England and Wales (excluding non-residents). For more information on the ICD-10 definition of COVID-19, see the methodology article.

Monthly mortality rates

To calculate monthly mortality rates that are comparable with annual rates, adjustments must be made to annual population estimates to account for the time period covered. The methodology article provides more detail on how this is calculated.

Acknowledgement

We would like to thank Alex Cooke, Rachel Woods, Fred Barton, and Paul Brown for their valued contribution to this bulletin.

Provisional data are used

Provisional death registrations and death occurrences data are used in this bulletin. This enables timely analysis to be completed to monitor mortality trends. However, as the data for 2021 and 2022 are provisional, they are subject to change.

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. However, because of registration delays, monthly death occurrence data are always somewhat incomplete. This is especially true for deaths that occurred towards the end of the month.

More 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.