October 19, 2020

expert reaction to ONS data on deaths in private homes in England and Wales, registered from 28 December 2019 to 11 September 2020

The Office for National Statistics (ONS) have released the latest data on deaths in private homes in England and Wales, registered from 28 December 2019 to 11 September 2020.

Prof Kevin McConway, Emeritus Professor of Applied Statistics, The Open University, said:

“This new statistical bulletin from ONS provides relevant information for those of us (including me) who have been concerned for some time that numbers of deaths in people’s homes have been running well above the average level from recent years. But it still leaves a lot of questions unanswered.

“The report is based on death registrations. At the height of the pandemic in April and May, there were many more deaths in every kind of location (home, hospital, care home, and other places) than the average level over the last five years, and a great number of them involved Covid-19. But since the end of May, the pattern has been different, numbers of deaths in hospitals fell to below their average level of the time of year, and to a lesser extent the same thing happened in care homes. But there continued to be more deaths than usual in private homes, around 700 or 800 a week in England and Wales taken together. There seems to be no sign of a decreasing trend in this weekly number. The pattern goes on beyond the period up to mid-September covered by the new ONS bulletin, as can be seen from the weekly ONS bulletins on death registrations. The most recent of those still showed 725 excess deaths in private homes in the week ending 2 October. Up to that date, total deaths in all places are running only slightly above the five-year average, so these extra deaths at home are due to people dying in different places than in previous years, not to there being a lot more deaths generally.

“So far, it’s been difficult to see the reason for the extra deaths at home, though several suggestions have been made. Are people dying at home because they could not get treatment for some life-threatening condition, maybe because they are frightened to use health services or hospitals because of the risk from COVID-19, or because they cannot get access to the health care they require because of reorganisation of health care services due to the pandemic? Or are people choosing to die at home, which many would prefer to do anyway, so that they can be with their loved ones?

“The new bulletin throws a little light on this, though it still leaves many questions unanswered. It makes it clear that most of the deaths at home, in recent months, do not directly involve Covid-19, though that was known already from the weekly ONS death registration bulletins. The report presents results for England and Wales separately, though in broad terms the pattern is the same in both countries. What’s new is that it gives data on the causes of death for people who die at home, and in other places. The majority of deaths at home seem to be from the causes of most deaths in most years – such as heart disease, some cancers (particularly prostate cancer in men, breast cancer in women, and lung cancer in both), and (in women) Alzheimer’s disease and other dementias. And deaths from these causes, at home, are at higher levels than the average for recent years.

“For most of these causes, the overall number of deaths across all places hasn’t changed all that much, this year, compared to the last five years. That means that the extra deaths at home from these causes match corresponding reductions in numbers of deaths from the same causes elsewhere, particularly in hospital. But data like this can’t tell us why the deaths are tending to occur more at home. Is it because people prefer to stay at home if they can, or because they can’t get into hospital or are discharged earlier?

“There is one pattern in causes of death that looks rather different. In women, the total number of deaths (across all places) from dementias has increased considerably, as has the number of deaths from “symptoms, signs and ill-defined conditions”, a category of causes that is quite often used for old and frail people who have many health issues. There were almost 5,500 more deaths in women from these causes, than the average of the previous 5 years, in England, between mid-March and mid-September, and a bit over 300 more in Wales. (The report does not give data on these causes for men.) The numbers of deaths from these causes, in women, are up considerably in care homes and hospices as well as in private homes, compared to previous years, though down considerably in hospitals. So, in women at any rate, there does seem to be a considerable increase generally in deaths from these causes, as well as a change in the pattern of the places where they occur. Is this because of real changes in the state of these women’s health or in the health care they receive? Are they dying from dementias and ill-defined conditions in circumstances where, in a different year, they might have died from, say, a heart attack instead, or is there some other reason? Or is something else going on? The new report does not throw much light on this, but there will be other analyses in the future.”

Prof Sir David Spiegelhalter, Chair, Winton Centre for Risk and Evidence Communication, University of Cambridge, said:

“Over 25,000 extra home deaths have occurred this year, particularly from ischaemic heart disease, diabetes and dementia and alzheimers.

“Usually around 300 people die each day in their homes in England and Wales – the latest ONS analysis confirms that even after the peak of the epidemic this has stayed at around 400 a day and shows no sign of declining – that’s one-third extra, very few of which are from Covid. 

“Non-Covid deaths in hospital have correspondingly declined, suggesting most of these deaths would normally have occurred in hospital, and people have either been reluctant to go, discouraged from attending, or the services have been disrupted.  It is unclear how many of these lives could have been extended had they gone to hospital, for example among the 450 extra deaths from cardiac arrhythmias.

“Crucially, the ONS data cannot tell us about the quality of these deaths, particularly in terms of the end-of-life care provided to the patients and the support for their families.”

https://www.ons.gov.uk/releases/deathsinprivatehomesenglandandwales

All our previous output on this subject can be seen at this weblink:

www.sciencemediacentre.org/tag/covid-19

Declared interests

Prof Kevin McConway: “I am a Trustee of the SMC and a member of the Advisory Committee, but my quote above is in my capacity as a professional statistician.”

None others received.