Excess Winter Deaths

Introduction

Across the UK there is a rise in the number of deaths in the winter months compared to the warmer months of the year. This difference in the number of deaths during the winter period compared to the warmer months is known as excess winter mortality. Excess winter deaths figures are widely used to inform policy, planning and research in the public sector, in particular to measure the effectiveness of cold weather planning. Local authorities and public health organisations across England and Wales use these data to assess levels of excess winter mortality in their area. In addition, charities use excess winter deaths statistics to support a variety of campaigns.

COVID-19 has had a significant impact on excess winter mortality and trends since 2019/20, and emerging data is discussed in the second part of this section.

Facts and Figures

Excess winter deaths are defined by the Office for National Statistics as the difference between the number of deaths during the four winter months (December to March) and the average number of deaths during the preceding August to November and the following April to July. Comparing absolute numbers of excess winter deaths among different areas and from year to year is difficult as the numbers are dependent on the total numbers of deaths that occurred in a particular setting. The comparison is made using the excess winter mortality index (EWMI). This is the ratio of excess winter deaths to average non-winter deaths expressed as a percentage.

• • In Blackpool during the period 2003/04 – 2018/19 there were 17.6% more deaths in winter than in summer (the excess winter mortality index). This is comparable with the England figure of 18.1%
  • In the winter of 2018/19 there were 80 excess winter deaths in Blackpool.
  • Winter periods have a greater impact on older people. For example, in England during 2018/19 the EWMI for those under 75 was 10.8%, whilst for over 90s it was 20.3%.
  • Excess winter deaths also vary by sex. In England during 2018/19 the EWMI for males was 13%, whilst for females it was 16.1%. Provisional data for 2019/20 shows the rate for males to be 17.2% compared to 16.4% for females.
  • Although excess winter deaths are associated with low temperatures, conditions directly relating to cold, such as hypothermia, are not the main cause of excess winter deaths. The majority of are (usually) caused by cerebrovascular diseases, ischaemic heart disease, respiratory diseases and influenza.

Figure 1 shows that there is huge fluctuation between winters and the Blackpool trend broadly follows the England and North West trends. Blackpool is subject to many of the same risk factors as the rest of the country, such as winter temperatures and influenza outbreaks.

Figure 1 - Excess Winter Mortality Index - 1991/92 - 2020/2021

The Impact of COVID-19 on Excess Winter Mortality

COVID-19 had a significant impact on excess winter mortality, and on the EWMI over the COVID-19 period. From 2019/20 the Office for National Statistics (ONS) reported excess winter deaths and the EWMI both including and excluding COVID-19 deaths (as shown in Figure 1)¹. At time of publication, provisional ONS data for 2020/21 is only available for deaths including COVID-19 at national level.

For the 2019/20 winter period, excluding COVID-19 deaths there were an estimated 27,040 excess winter deaths in England, compared to 22,350 in 2018/19 and 46,030 in 2017/18. Including COVID-19 there were 9,110 excess winter deaths in England in 2019/20, the lowest number on record. However, "this low estimate is explained by the comparison with the large number of COVID-19 deaths that occurred mainly in the non-winter months April to July, rather than an exceptionally low number of winter deaths"². In Blackpool over this period there were 140 excess winter deaths excluding COVID-19 compared to 80 in 2018/19 and 180 in 2017/18. Including COVID-19 there were an estimated 70 excess winter deaths in Blackpool in 2019/20.

Provisional data from the ONS suggests that there were 58,600 excess winter deaths including COVID-19 in the winter of 2020/21 (36.5% more deaths during the winter months compared to non-winter months). This was 6 times the number of excess winter deaths in 2019/20 and the highest EWMI since the measure began in 1991/92. The increase was mostly due to the large number of COVID-19 deaths in the non-winter months of 2020 and the winter months of 2021, with COVID-19 accounting for 84% of all excess winter deaths in England³. Local data for 2020/21 is not yet available, though across the North West region there were an estimated 5,900 excess winter deaths (EWD Index = 24.8%).

National and local strategies (current best practices)

• • The Cold Weather Plan for England (NHS England, 2015) - aims to prevent avoidable harm to health by alerting people to the negative health effects of cold weather. This should enable them to prepare and respond appropriately, and help to reduce the number of excess winter deaths. The plan sets out a series of actions to be taken by the NHS, social care and other agencies throughout the year, and in response to forecast or actual severe winter weather. It also encourages local communities to support the most vulnerable in their area, such as checking on them during severe weather and offering other support.
  • 'Keep Warm Keep Well' booklet (Public Health England, 2018) - provides advice on staying well during cold weather, for example healthy lifestyle, heating, flu vaccinations, and making sure that people know about all the benefits and services to which they are entitled.
  • Annual Flu Programme (Public Health England) - sets out a coordinated and evidence-based approach to planning for, and responding to, the demands of influenza across England.

[1] For the purpose of excess winter mortality data the ONS defines a COVID-19 death as "deaths registered in England and Wales where COVID-19 was mentioned on the death certificate. A doctor can certify the involvement of COVID-19 based on symptoms and clinical findings – a positive test result is not required". 

[2] Office for National Statistics, Excess winter mortality in England and Wales: 2019 to 2020 (provisional) and 2018 to 2019 (final).

[3] Office for National Statistics, Excess winter mortality in England and Wales: 2020 to 2021 (provisional) and 2019 to 2020 (final).