By Megan Hart, Senior Consultant and Raman Hundal, Associate Consultant, Hymans Robertson
We note that studying the change in age-standardised mortality rates (ASMRs) is the most preferred way to understand underlying trends by cause of death, as any changes in the population by age are controlled over the period being considered. As 2024 cause of death data is not yet available by age, we have instead considered the trends in the total number of deaths over the period 2013 to 2024. For each of the main causes of death, we have compared the total actual deaths (in England and Wales) against the pre-pandemic (2013-2019) linear trend. This is represented by the dashed line in each graph shown.
Circulatory disease
Circulatory diseases, such as heart disease and heart attacks, cause a significant proportion of total deaths every year. Changes in the number of deaths for this group can therefore have a big impact on overall mortality improvements.
Despite the deaths for this cause reducing year on year before the pandemic, between 2019 and 2023, the number of deaths increased. Last year marks the first post-pandemic year where the number of deaths declined (by c4% compared to 2023).
Some of the contributing factors for the recent increase in deaths include the impact of COVID-19 infection on cardiovascular health and pandemic related disruptions to the NHS. These factors may have accelerated deaths that might otherwise have occurred in later years, which could partly explain the reduction observed in 2024.
Cancer
The healthcare disruption caused by the pandemic has resulted in delays in cancer screening, diagnostics and treatments. As a result, excess cancer deaths may have been anticipated to have materialised, at least by 2024. However, there has been no significant divergence from the pre-pandemic trend since 2020.
Aside from the dip in 2021, cancer deaths have followed a steady upward trajectory since 2013. We note that cancer ASMRs published by the ONS up to 2023 are reducing and are not showing any excess mortality. The drop in 2021 is potentially due to the disruption referenced above during the early phase of the pandemic, meaning that some deaths due to cancer may not have been recorded correctly.
Other causes
One of the key drivers of reductions in excess mortality has been lower levels of deaths from COVID-19. Only 6,600 deaths were attributed to COVID-19 as the primary cause last year, down from 75k deaths at the height of the pandemic.
The number of deaths relating to respiratory system diseases was relatively flat across 2013-2019. However, we saw a sharp fall during the pandemic, primarily driven by fewer deaths attributed to influenza and pneumonia. This was likely due to the social distancing restrictions that were in place during those years, which would have reduced the spread of these viruses. Deaths from these causes also could have been misclassified as COVID-19. Over the past 2 years, the number of deaths from this cause has returned to a similar level to that seen before the pandemic.
The total number of deaths attributable to dementia and Alzheimer’s has been steadily increasing. This, in part, is due to people living longer and so reaching the ages when these diseases are more prevalent. Since the pandemic, deaths due to these causes have plateaued. One possible explanation is that older individuals who might have otherwise died of these conditions have instead died from COVID-19.
Finally, since 2019, there has been a rise in deaths due to digestive system diseases. This is primarily driven by an uptick in deaths attributed to alcoholic liver disease. This has been linked to increased levels of high-risk alcohol consumption since the start of the pandemic. This elevated level has persisted in 2024, albeit the total number of deaths was marginally lower than in 2023.
Conclusions
After a period of high levels of excess mortality, last year marks a noteworthy year where age standardised mortality rates are now comparable to 2019. This shift appears to be driven by much lower levels of deaths from COVID, combined with fewer deaths relating to dementia and Alzheimer’s. The excess mortality observed from circulatory diseases appears to be reducing from last year, yet remains above the pre-pandemic trend. Fortunately, the anticipated excess deaths from cancer have not yet materialised.
We do note that the return to pre-pandemic levels isn’t consistent across all ages, with the younger age groups instead seeing increases in mortality rates (as discussed in this article).
Our team has extensive experience in setting mortality trend assumptions. We offer a range of services in this area, including independent reviews, scenario analysis and industry benchmarking. Please get in touch if you would like to discuss more.
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