• 50-64 year old age bracket experiencing highest levels of excess deaths

•  Deaths involving cardiovascular diseases 33% higher than expected among those aged 50-64

• Deaths in private homes are persistently high, particularly from cardiovascular causes

A commentary published today in the Lancet Regional Health has found that heart disease is one of the main driving factors leading to a rise in excess deaths amongst middle-aged adults post the Covid-19 pandemic. Excess deaths are deaths over and above those that are expected. The study also found that more of these deaths than expected were occurring in private homes rather than in hospitals.

The commentary is the first to provide granular insights into the underlying drivers of the persisting excess deaths observed in England since the Covid-19 pandemic.

The excess deaths are likely to be occurring because of the direct and indirect impacts of the pandemic. This includes: worsening pressures on NHS urgent care services, resulting in poorer outcomes from episodes of acute illness; the direct effects of Covid-19 infection; and disruption to chronic disease prevention, detection and management.

The commentary draws upon newly published data from the Office for Health Improvement and Disparities (OHID). This shows that from June 2022 to June 2023:

• Excess deaths for all causes were highest in relative terms for 50–64-year-olds, namely 15% higher than normal.
• In comparison, excess deaths were 11% higher than expected for 25–49-year-olds and under 25s and only 9% higher for over 65s.
• For these middle-aged adults (aged 50-64), deaths involving cardiovascular diseases such as heart disease and stroke were 33% higher than expected. This compares to a 12% excess for this disease group for all ages.
• Other causes of significant excess deaths at ages 50-64 were acute respiratory infections (43% excess) and diabetes (35% excess). This compares to excesses of 14% (acute respiratory infections) and 13% (diabetes) across all ages.
• Across all ages, deaths in private homes were 22% higher than expected compared with 10% in hospitals, no excess deaths in care homes, and 12% fewer deaths than expected in hospices. Deaths from cardiovascular causes in private homes were 27% higher than expected.

Previous analysis by the Office for National Statistics (ONS) found over 7% more excess deaths in the UK in 2022 compared to the five-year average, with this trend persisting to 2023. The insights in the commentary go further by providing a granular breakdown of cause, place and age group to inform prevention and disease management efforts. 

Whilst the greatest number of excess deaths in the acute phase of the pandemic were in older adults, the commentary highlights the considerable ongoing impact now on the younger population. Cardiovascular diseases, including ischaemic heart disease and heart failure, were amongst the highest cause-specific excess deaths, with liver disease, acute respiratory infections, and diabetes also seeing relatively high excesses. Other major causes of death were at or below expected levels.

The commentary is a collaboration between the ONS, the Continuous Mortality Investigation (CMI), OHID (part of the Department of Health and Social Care) and the actuarial and health analytics consultancy LCP.

Dr Jonathan Pearson-Stuttard, Head of LCP Health Analytics and lead author of the commentary, said on the findings: 

‘Our commentary provides a data-driven review of the analyses with more detailed insights than previously available to assess the drivers of persisting excess deaths since the Covid-19 pandemic. From summer 2022-2023, excess deaths were most prominent in relative terms in middle-aged and younger adults, with deaths from heart disease and deaths in private homes being most affected. Granular insights such as these provide opportunities to mitigate what seems to be a continued and unequal impact on mortality, and likely corresponding impacts on morbidity, across the population.’