Monthly mortality analysis, England and Wales: March 2023

• There were 50,920 deaths registered in England in March 2023, 5,679 deaths (12.6%) above the March five-year average (2017 to 2019, 2021 and 2022).
• There were 3,390 deaths registered in Wales in March 2023, 335 deaths (11.0%) above the March five-year average.
• The leading cause of death in both England and Wales in March 2023 was dementia and Alzheimer’s disease (11.1% and 10.6% of all deaths, respectively).
• The leading cause of excess death in England in March 2023 was symptoms, signs and ill-defined conditions, at 525 excess deaths (43.4% above average); in Wales it was heart failure and complications and ill-defined heart disease, at 27 excess deaths (58.1% above average).

There were 50,920 deaths registered in England in March 2023, based on provisional data. This was 4,712 more deaths than in March 2022 and 5,679 (12.6%) more deaths than the five-year average (2017 to 2019, 2021 and 2022).

In Wales, there were 3,390 deaths registered in March 2023. This was 186 more deaths than March 2022 and 335 (11.0%) more deaths than the five-year average.

The five-year average for 2023 has been calculated using the years 2017 to 2019, 2021 and 2022. This moves our five-year average along by a year but does not include the exceptionally high number of deaths observed in 2020. This is so that deaths in 2023 are compared with a five-year average that is up to date (rather than 2015 to 2019), while still being close to representing a usual (non-coronavirus (COVID-19) pandemic) year. For more information, see our Understanding excess deaths during a pandemic blog post.

Currently, the Office for National Statistics (ONS) compares the number of deaths in a given period with the average of five previous years. We are now investigating different ways to calculate the expected number of deaths used in excess death calculations. The background to this work and information on how to get in contact can be found in our How we measure expected and excess deaths blog post.

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

Since the beginning of our data time series in 2001, mortality rates have generally been decreasing for the month of March.

In March 2023, the ASMR for England was 1,038.4 deaths per 100,000 people. This was statistically significantly higher than the mortality rate for March 2022 (967.6 deaths per 100,000 people) and March 2021 (983.5 deaths per 100,000 people).

In March 2023, the ASMR in Wales was 1,135.6 deaths per 100,000 people. This was not significantly different to the mortality rate for March 2022 (1,104.0 deaths per 100,000 people) but was significantly higher than the mortality rate for March 2021 (1,055.9 deaths per 100,000 people).

For more information on the differences between male and female ASMRs, see our accompanying dataset.

Excess deaths in this bulletin are the difference between the observed deaths within a period compared with the five-year average (2017 to 2019, 2021 and 2022) for the same period. Most of this bulletin compares observed deaths in 2023 with the five-year average. However, this section looks at excess mortality in regards to the number of deaths and compares this with excess mortality by the age-standardised mortality rates (ASMRs).

We are currently looking at different ways to measure excess mortality. Our How we measure expected and excess deaths blog post outlines the work planned to look at the expected number of deaths used to calculate excess mortality. It also contains information on how to contact us about this work.

Because mortality rates take into account the population size and age structure at a given period, it is not unusual for excess mortality rates to be lower than excess deaths. This is because while deaths may be higher than we would expect, they may not be higher when relative to the population. For example, if the population was larger in the observed period than the average population of the years making up the five-year average, then the deaths per 100,000 people could be lower.

However, it is important to note here that the ASMRs for July 2021 onwards are based wholly or partly on 2018-based population projections. This means the projections do not currently take into account major events that would have affected the population, such as the coronavirus (COVID-19) pandemic. Once further revised populations are applied to the ASMR calculation that account for the Census 2021 population, there will be changes to the mortality rates. We will update rates in due course as revised population estimates are produced by the Office for National Statistics (ONS).

In the month of March 2023, the percentage excess based on the mortality rate was lower than the percentage excess based on number of death registrations in England (Figure 2) and in Wales (Figure 3).

In England in March 2023, the number of deaths was 12.6% above what we would expect using the five-year average. The mortality rates were 4.8% above the expected rates.

There are different ways of measuring excess mortality. These numbers will differ from those published elsewhere that use a different method, such as the Office for Health Improvement and Disparities’ (OHID) excess deaths measure. This is because the figures in this bulletin are based on the average of five years, whereas the OHID measure looks at the trend seen between 2015 and 2019, as well as accounting for population, deprivation and ethnicity. The ONS is currently working with multiple organisations to review our excess mortality measures, details of which can be found in our blog post on measuring expected and excess deaths.

In Wales in March 2023, the number of deaths was 11.0% above the five-year average, with mortality rates at 4.0% above expected.

The doctor certifying a death can list all causes in the chain of events that led to the death, and the 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 methodology.

The 10 most common underlying causes of death registered in March 2023, compared with the five-year average for March (2017 to 2019, 2021 and 2022), for England and Wales, respectively, are shown in Figures 4 and 5. Causes of death are based on our leading causes of death groupings.

In England, dementia and Alzheimer’s disease remained the leading cause of death in March 2023 (for the 21st consecutive month), with 113.7 deaths per 100,000 people (5,647 deaths). In England in March 2023, mortality rates for 4 of the 10 leading causes of death were statistically significantly lower than the five-year average. Only symptoms, signs and ill-defined conditions had a mortality rate significantly higher than the five-year average, and rates for the remaining five causes were not significantly different from the five-year average.

In Wales, the leading cause of death in March 2023 was dementia and Alzheimer’s disease, with 118.7 deaths per 100,000 people (358 deaths). This replaced ischaemic heart diseases, which was the leading cause of death in February.

In Wales in March 2023, the mortality rate for influenza and pneumonia was significantly lower than the five-year average. Of the 10 leading causes, two (symptoms, signs and ill-defined conditions, and heart failure and complications and ill-defined heart disease) had rates higher than the five-year average, and the remaining seven were not significantly different from the five-year average.

More information on leading causes of death is available in Table 12 for England, and Table 13 for Wales, in our accompanying dataset. More in-depth analysis of leading causes of death is available in our annual Deaths registered in England and Wales: 2021 bulletin, based on finalised mortality data.

Coronavirus (COVID-19) mortality

The first deaths involving COVID-19 were registered in England and Wales in March 2020. Since then, COVID-19 was the underlying cause of death in most deaths that involved COVID-19 (83.9% in England, 82.9% in Wales).

In England, COVID-19 remained the eighth leading cause of death in March 2023, at 34.3 deaths per 100,000 people (1,698 deaths), accounting for 3.3% of all deaths. This was statistically significantly higher than the mortality rate for deaths due to COVID-19 in February 2023, at 26.2 deaths per 100,000 people (1,162 deaths; 2.5% of all deaths).

In Wales, COVID-19 increased to the eighth leading cause of death in March 2023 (from twelfth in February 2023), at 34.0 deaths per 100,000 (103 deaths), accounting for 3.0% of all deaths. This was significantly higher than the mortality rate for deaths due to COVID-19 in February 2023 at 19.4 deaths per 100,000 people (53 deaths, 1.8% of all deaths).

For more information on our definition of coronavirus (COVID-19) deaths, see Section 10: Measuring the data.

More about coronavirus

• Find the latest on coronavirus (COVID-19) in the UK.
• Explore the latest coronavirus data from the ONS and other sources.
• View all coronavirus data.

Changing trends in causes of death can help us to understand possible causes of excess mortality. Leading causes of excess deaths can include some of the 10 most common causes of death (see Section 4: Leading causes of death), but will also include other leading cause of death groupings, which contribute to above average mortality.

We are currently looking at different ways to measure excess mortality. Our How do we measure expected and excess deaths blog post outlines the work planned to look at the expected number of deaths used to calculate excess mortality. It also contains information on how to contact us about this work.

While the number of deaths by cause of death may be higher in March 2023 compared with the five-year average for March (2017 to 2019, 2021 and 2022), the age-standardised mortality rate (ASMR) may be lower. This is because ASMRs take into account population size at each age group and weight. Therefore, changing trends in the age groups affected by the cause of death, and the size of that age group in the population, will cause changes to the ASMR.

In England in March 2023, the leading cause of excess death was symptoms, signs and ill-defined conditions, with 525 excess deaths (43.4% above average). Septicaemia was again observed to have the largest proportional increase in mortality rate when compared with the five-year average (7.5 deaths per 100,000 people, 54.2% above average).

It was not possible to test the statistical significance for 8 of the 69 leading causes of death groupings in England in March 2023. This is because the number of deaths, either in 2023 or the five-year average, for these causes was fewer than 10, resulting in suppressed mortality rates. The five-year average ASMR is also not available for coronavirus (COVID-19) deaths.

Of the remaining 61 causes of death, 9 were significantly higher than the five-year average, and 10 were significantly lower. The ASMRs for the remaining leading causes of death groupings for March 2023 were not significantly different from the average.

In Wales in March 2023, the leading cause of excess deaths was heart failure and complications and ill-defined heart disease, with 27 excess deaths (58.1% above average). The mortality rate (25.2 deaths per 100,000 people) was significantly above the five-year average (16.7 deaths per 100,000 people) and represented a 50.3% increase.

It was not possible to test the significance for 28 of the 69 leading causes of death groupings in Wales in March 2023. This is because the number of deaths, either in 2023 or the five-year average, for these causes was fewer than 10, resulting in suppressed mortality rates. The five-year average ASMR is also not available for COVID-19 deaths.

Of the remaining 41 causes of death, 2 were significantly lower than the five-year average and 2 were significantly higher than the five-year average. The ASMRs for the remaining leading causes for March 2023 were not significantly different than average.

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. The number of death occurrences is incomplete because it is likely that more deaths need to be registered.

Instances where the number of daily death occurrences in March were below the range of the last five years may 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, and comparisons should be treated with caution. Further information can be found in Section 10: Measuring the data.

Figure 8: In England, the number of daily deaths occurring in March 2023 decreased compared with March 2022

Number of deaths occurring on each day from March 2020 to March 2023, five-year average and range, England

Notes:

1. Figures are for deaths occurring on each day rather than deaths registered, registered up to 7 April 2023. Death occurrences will increase as more deaths are registered, particularly for later dates.
2. Figures for 2022 and 2023 (including deaths that occurred in previous years but were registered in 2022 and 2023) 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 February 2020 and two deaths in March 2020) but are not included here.
6. For deaths occurring in 2020 and 2021, the five-year average consists of deaths occurring between 2015 to 2019, whereas for deaths occurring in 2022 the five-year average consists of deaths occurring between 2016 to 2019 and 2021. For deaths occurring in 2023, the five-year average consists of deaths occurring between 2017 to 2019, 2021 and 2022.
7. The five-year average for 2023 has been provided for 2017 to 2019, 2021 and 2022, because of the impact of the coronavirus pandemic on deaths occurring in 2020. This provides an up-to-date comparison (rather than 2015 to 2019) of the number of deaths expected per day in a usual (non-coronavirus pandemic) year.

Download the data

.xlsx

In England, 38,369 deaths occurred in March 2023 and were registered by 7 April 2023. This was 5,939 fewer deaths than the five-year average (2017 to 2019, 2021 and 2022) for March (13.4% lower), and 2,221 fewer deaths than in February 2023 (5.5% lower).

Figure 9: In Wales, the number of daily deaths in March 2023 decreased compared with March 2022

Number of deaths occurring on each day from March 2020 to March 2023, five-year average and range, Wales

Notes:

1. Figures are for deaths occurring on each day rather than deaths registered, registered up to 7 April 2023. Death occurrences will increase as more deaths are registered, particularly for later dates.
2. Figures for 2022 and 2023 (including deaths that occurred in previous years but were registered in 2022 and 2023) are based on provisional mortality data.
3. Figures exclude non-residents.
4. “COVID-19 deaths” include 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 February 2020 and two deaths in March 2020) but are not included here.
6. For deaths occurring in 2020 and 2021 the five-year average consists of deaths occurring between 2015 to 2019, whereas for deaths occurring in 2022 the five-year average consists of deaths occurring between 2016 to 2019 and 2021. For deaths occurring in 2023, the five-year average consists of deaths occurring between 2017 to 2019, 2021 and 2022.
7. The five-year average for 2023 has been provided for 2017 to 2019, 2021 and 2022, because of the impact of the coronavirus pandemic on deaths occurring in 2020. This provides an up-to-date comparison (rather than 2015 to 2019) of the number of deaths expected per day in a usual (non-coronavirus pandemic) year.

Download the data

.xlsx

In Wales, 2,635 deaths occurred in March 2023 and were registered by 7 April 2023. This was 358 fewer deaths than the five-year average (2017 to 2019, 2021 and 2022) for March (12.0% below), and 59 more deaths than in February 2023 (2.3% higher).

In this section, we use the multiple health conditions that can be recorded on a death certificate to identify deaths where there were pre-existing health conditions that contributed to a death due to coronavirus (COVID-19).

Health conditions are recorded on the death certificate only if the certifying doctor or coroner believed they made some contribution to the death, directly or indirectly. The death certificate does not include all health conditions from which the deceased might have suffered if they were not considered relevant. However, the fact that a pre-existing condition was recorded does not suggest that the deceased was likely to have died from that condition in the absence of the COVID-19 infection.

This section analyses data from Quarter 1 (Jan to Mar) 2023, whereas the rest of the bulletin focuses on the month of March 2023.

This analysis of pre-existing conditions covers England and Wales as a whole. This is because of the small number of deaths due to COVID-19 in Wales in Quarter 1 2023 (326 deaths). We will continue to monitor this and provide analysis if the number of deaths in Wales increases.

When comparing pre-existing conditions for COVID-19 deaths in Quarter 1 2023 with Quarter 4 (Oct to Dec) 2022, the top 20 most common pre-existing conditions remained consistent, but varied in ranking. Symptoms, signs and ill-defined conditions, which includes “old age” and “frailty”, remained the most common pre-existing condition mentioned on death certificates in Quarter 1 2023 (31.6%), followed by dementia and Alzheimer’s disease as the second most common at 16.6%.

In addition, the proportion of COVID-19 deaths for each age group in Quarter 1 2023 have remained similar to the proportions seen in Quarter 4 2022. Of the 5,362 deaths due to COVID-19, the proportion of deaths among those aged 0 to 64 years was 6.0%, which was less than the proportion in Quarter 4 2022 (7.5%). The proportion among those aged 65 years and over increased slightly (94.0% in Quarter 1 2023 compared with 92.5% in Quarter 4 2022).

Overall, the proportion of deaths due to COVID-19 with no pre-existing conditions decreased from 11.8% in Quarter 4 2022 to 10.9% in Quarter 1 2023. However, the average number of different pre-existing conditions per death due to COVID-19 remained at 2.0 in Quarter 1 2023, consistent with Quarter 3 (July to Sept) 2022 and Quarter 4 2022.

In Quarter 1 2023, symptoms, signs and ill-defined conditions remained the most common pre-existing condition for deaths due to COVID-19 occurring in hospitals (33.2%, an increase from 31.8% in Quarter 4 2022). Dementia and Alzheimer’s disease remained the most common pre-existing condition for deaths occurring in care homes (40.6%, an increase from 37.5% in Quarter 4 2022).

Similarly to Quarter 4 2022, chronic lower respiratory diseases was the most common pre-existing condition of COVID-19 deaths occurring in private homes, at 14.8% of deaths in private homes.

For further analysis of pre-existing conditions of people whose deaths were due to COVID-19 in Quarter 1 2023 for England and Wales, see our accompanying dataset.

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 Section 10: Measuring the data.

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 about COVID-19 is available from the 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 not part of the causal sequence.

More information on the pre-existing conditions methodology is available in our Pre-existing conditions of people who died due to COVID-19, England and Wales 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 the date of occurrence and the 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 March 2023 by age and sex, and includes deaths that occurred in March 2023 by date of death. Non-residents of England and Wales are excluded. In March 2023, there were 87 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 our Deaths registered weekly in England and Wales, provisional bulletin and allows for a more timely analysis than would be possible using death occurrences. 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. Figures on death occurrences are available in our accompanying dataset for surveillance of recent mortality trends.

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

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 considering all 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:

1. U07.1: COVID-19, virus identified
2. U07.2: COVID-19, virus not identified
3. 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)
4. U10.9: multisystem inflammatory syndrome associated with COVID-19, unspecified

There are several ICD-10 codes not included in our definitions of deaths due to COVID-19 and deaths involving COVID-19. These are:

1. U08.9: personal history of COVID-19, unspecified
2. U11.9: need for immunisation against COVID-19, unspecified
3. U12.9: COVID-19 vaccines causing adverse effects in therapeutic use, unspecified

Tables 14 and 15 of our accompanying dataset provide figures of each COVID-19 ICD-10 code registered since March 2020. Our figures usually consist of first registrations only. On occasion, and after further investigation, a death can be re-registered as a different cause of death. For transparency of our statistics, these tables include re-registrations as well as initial registrations. All the other figures remain as first registration only.

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 covered. Our Coronavirus and mortality in England and Wales methodology provides more detail on how this is calculated.

Acknowledgement

We would like to thank Rachel Woods and Fred Barton 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 2022 and 2023 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 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 our Mortality statistics in England and Wales Quality and Methodology Information (QMI) and our User guide to mortality statistics methodology.