Age-adjusted mortality

Age-Standardised Mortality Rate Comes in Below Five-Year Average for *Fourth* Consecutive Month

The ONS announced on Friday that there were 38,611 deaths registered in England in June, which is 9.1% more than in May, and 0.8% more than the five-year average. However, the increase is relative to an exceptionally low value the month before. What about the age-standardised mortality rate (which is the best overall measure)?

In June, the age-standardised mortality rate was 12.5% higher than in May, but was still 6.1% lower than the five-year average. It was also the second-lowest figure on record for that month. (The only lower figure was observed in June of 2019.)

This means that England’s age-standardised mortality rate has been below the five-year average for four consecutive months. In other words, we’ve had four months in a row of “negative excess mortality”.

This chart from the ONS shows the age-standardised mortality rate for the first six months of the year, each year, going back to 2001:

Although 2021’s figure was higher than the figure for 2019, it was 3.6% lower than the figure for 2015 and 2.4% lower than the figure for 2018. This means that – despite higher-than-expected mortality in the winter – the overall level of mortality in the first half of 2021 was actually lower than three years before.

The past four months have “cancelled out” more than 85% of the age-adjusted excess mortality observed in January and February. Unsurprisingly, COVID-19 was not among the leading causes of death in June. All in all, the first half of 2021 has been pretty normal with respect to the average level of mortality.

What Pandemic? New Figures Reveal Age-Adjusted Mortality in the First Six Months of 2021 is Below the 10-year Average

New figures from the Institute and Faculty of Actuaries (IFA) Mortality Monitor released today show that cumulative mortality in the first six months of 2021 in England and Wales is running 0.4% below the 10-year average, once adjusted for the size and age of the population (see above). This means, despite the surge in winter Covid deaths in January and February that spooked the country into accepting ongoing restrictions, 2021 is officially now a low mortality year. The low mortality since March has entirely cancelled out the initial spike.

The IFA used to report the cumulative age-adjusted mortality figures compared to the 10-year average each week, but controversially changed their baseline in their weekly reports in May from the 10-year average to 2019 (the lowest mortality year on record) just as 2021 was about to go below average. This means we have had to wait for the quarterly report today for the next update in order to be able to announce this milestone.

England and Wales (BMJ)

The past 10 years are the least deadly years in history (see above), so for 2021 to be below the 10-year average (so far) means it too is one of the least deadly years in history. Even the pandemic year of 2020 was one of the least deadly years, having lower age-adjusted mortality than every year before 2009. Not all of the additional deaths are from COVID-19, of course – many are due to lockdowns and other aspects of the Government’s response and the attendant panic.

The new figures raise the obvious question: how can the Government justify continuing with any kind of restrictions or emergency measures for a moment longer when overall mortality is so low? Where is the ’emergency’ that justifies extraordinary measures?

Some will say it is only the restrictions that have prevented things being much worse. But where is the evidence of that? The U.K. has had more Covid deaths per head of population than countries such as Sweden which had fewer restrictions, while U.S. states which had few or no restrictions over the winter fared no worse (and often better) than those which had the strictest measures. Numerous studies have shown no relationship between restrictions and COVID-19 death tolls.

The latest figures, placing 2021 squarely among the least deadly years in history, should leave no one in any doubt that the emergency is well and truly over.

Age-Standardised Mortality Rate Falls To Lowest Level on Record, Again

The ONS announced today that there were 35,401 deaths registered in England in May, which is 9% less than in March, and 10.7% less than the five-year average. As I keep mentioning, however, the best overall measure of mortality isn’t the number of deaths, but rather the age-standardised mortality rate.

In May, the age-standardised mortality rate was 12% lower than in April, and a remarkable 16.7% lower than the five-year average. Like April’s figure, it was the lowest on record for that month. In fact, it was the second-lowest figure on record for any month. (The only lower figure was last August’s age-standardised mortality rate.)

This means that the last two months have both seen recorded-breakingly low levels of mortality. (The ONS’s dataset goes back as far as 2001, and given that mortality has been decreasing more-or-less continuously for the past few decades, April and May’s figures were probably the lowest ever.)

This chart from the ONS shows the age-standardised mortality rate for the first five months of the year, each year, going back to 2001:

Although 2021’s figure was higher than the figure for 2019, it was 2.2% lower than the figure for 2015 and 2.5% lower than the figure for 2018. This means that – despite higher-than-expected mortality in January and February – the overall level of mortality in the first five months of 2021 was actually lower than three years before.

The past three months have “cancelled out” more than 70% of the age-adjusted excess mortality observed in January and February. If June’s age-standardised mortality rate comes in as low as May’s, the overall level of mortality in the first five months of 2021 will be below the five-year average.

Stop Press: MailOnline reports that COVID-19 was the 24th leading cause of death in England in May, and made up fewer than 1% of all fatalities.

Sweden’s Mortality Rate Last Year Was Lower Than in 2015

As I’ve mentioned several times, when you calculate mortality the correct way – as the age-standardised mortality rate, or as life expectancy – the year 2020 in England doesn’t look that unusual. Last year’s rate was a fair bit higher than 2019’s, but that was a year of unusually low mortality. 

Plotting the age-standardised mortality rate over time (as the ONS has been doing each month since July of 2020) shows that mortality last year rose to a level last seen in 2008. So while the year-on-year change was large, the level wasn’t particularly high – at least by historical standards. 

Interestingly, this point even found its way into a BBC article last September. The author noted:

And if you look at the age-adjusted mortality rates, which take into account the size and age of the population, you can see that while 2020 has undoubtedly been a bad year compared to recent years, what has been seen in terms of people dying is not completely out of sync with recent history. It is actually comparable with what happened in the 2000s.

Given that 2008 – which, to repeat, saw a higher level of morality than last year – wasn’t that long ago, one might argue the pandemic’s lethality has been overhyped. Of course, others would contend that, if we hadn’t taken the drastic measures we did take, mortality would have risen to a far higher level.

But I’m not convinced the UK’s lockdowns did do much to curb mortality, over and above the effect of restrictions on large gatherings and voluntary social distancing. And I’d argue that we could have saved more lives with a well-executed focused protection strategy.

However, many people continue to insist that mortality would have been far higher in the absence of lockdowns. It’s therefore worth looking once again at Sweden – the only major European country that didn’t lock down.

We already know that Sweden’s age-adjusted excess mortality up to week 51 was only 1.7% – below the European average. But when was the last time its mortality rate was as high as last year?

Going up to the end of week 52, the rate for 2020 – based on the European Standard Population – comes out as 16.4 per 100,000 (which is actually lower than in Denmark). And the last time Sweden saw this level of morality was in 2015 – just five years ago.

So despite taking the least restrictive approach of any major Western country, Sweden’s mortality rate only returned to the level of 2015. This casts doubt on the claim that mortality in the UK would have been much higher in the absence of lockdowns.

Taking the Average of 2019 and 2020, Sweden Had Lower Mortality Than Both Denmark and Finland

Faced with mounting evidence that lockdowns did not substantially reduce COVID-19 deaths in most of the countries where they were implemented, lockdown proponents have fallen back on what Paul Yowell calls the “neighbour argument” – i.e., the argument that comparing Sweden to its neighbours shows that lockdowns really do work.

On May 10th, a tweet plotting cumulative COVID-19 deaths per million in Sweden, Norway and Finland – which referred to the “Nordic natural experiment” – garnered over 6,000 likes. 

However, this argument isn’t convincing for a whole number of reasons, as I’ve outlined in two previous posts. For example: the other Nordics had a head start on Sweden; border controls – not lockdowns – made the difference in the first wave; and once you include the Baltics, Sweden no longer stands out.

However, suppose we just look at the mortality figures. Do they show that Sweden had an exceptionally bad year? Far from it. As I’ve noted before, the country saw age-adjusted excess mortality up to week 51 of just 1.7% – below the European average. 

Now, it’s true that all three other Nordics saw negative excess mortality (of up to –5% in Norway’s case). Because mortality rates declined gradually from 2015 to 2019, no change from 2019 to 2020 yields a negative value for excess mortality. In addition, there may have been fewer flu deaths and car accidents, thanks to social distancing. 

However, one reason why Sweden’s excess mortality figure isn’t lower is that the country saw particularly low mortality in 2019 (which brings down the average of the last five years). In that year, Sweden had the lowest mortality of all four Nordics – its rate was 4% lower even than Norway’s.

As several commentators have pointed out, this meant that there were more frail elderly people alive at the beginning of 2020 than there otherwise would have been. So even in the absence of a pandemic, you’d have expected to see a slight rise in mortality – owing to the “dry tinder” effect.

If we take the average of 2019 and 2020, then Sweden’s age-standardised mortality rate was 15.8 per 100,000, Denmark’s was 17.6, Finland’s was 16.4 and Norway’s was 15.5. In other words, Sweden’s was lower than both Denmark’s and Finland’s, and was only slightly higher than Norway’s. 

Of course, the average of the last two years isn’t a measure of the impact of the pandemic (and other relevant events). For that, we can need to compute the excess mortality for 2019–20, by comparing the average mortality rate in those two years to the average over the preceding four years. When we do that, the numbers come out as follows: –3.3% in Sweden, –4.4% in Demark, –4.8% in Finland and –4.9% in Norway. 

Although Sweden still saw the least favourable change (i.e., the smallest decline in mortality), the disparity with respect to its neighbours is much reduced. 

This exercise is not meant to obscure the fact that Sweden saw a moderate rise in mortality last year, unlike the other Nordics. It’s simply meant to put that rise in mortality into perspective. After all, having a sense of perspective is very important when trying to evaluate the measures that were taken during the pandemic.  

Age-Standardised Mortality Rate Falls To Lowest Level on Record

The ONS announced today that there were 38,899 deaths registered in England in April, which is 15% less than in March, and 6% less than the five-year average. However, as I’ve noted before, the best overall measure of mortality isn’t the number of deaths, or even the death rate, but rather the age-standardised mortality rate.

In April, the age-standardised mortality rate was 12% lower than in March, and a remarkable 12.5% lower than the five-year average. As a matter of fact, it was the lowest on record for that month. (The ONS’s dataset goes back as far as 2001, and given that mortality has been decreasing more-or-less continuously for the past few decades, April’s age-standardised mortality rate was probably the lowest ever.)

This chart from the ONS shows the age-standardised mortality rate for the first four months of the year, each year, going back to 2001:

Although 2021’s figure was higher than the figure for 2019, it was only 0.2% higher than the figure for 2018, and was actually equal to the figure for 2015. Hence – despite higher-than-expected mortality in January and February – the overall level of mortality in the first four months of the year was close to what you’d expect.

If the age-standardised mortality rate remains low for the next two or three months, it will “cancel out” a large share of the excess mortality observed in the second wave. Indeed, the most plausible explanation for the current low level of mortality is that deaths were “brought forward” by the pandemic.

This post has been updated.