Excess mortality in England and Scotland in 2022: The long shadow of austerity and the return to an unacceptable pre-pandemic baseline
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Objectives
To establish if mortality in England and Scotland in 2022 was higher than predicted by austerity-era and pre-austerity trends.
Design
Time trend analysis.
Setting
England and Scotland.
Participants
People that died 2001-2022.
Main outcome measures
Excess deaths calculated by comparing observed age- and sex-standardised mortality rates (ASMRs; standardised to the 2013 European Standard Population) in 2022, and expected mortality based on deaths in 2001-2010 and 2012-2019.
Results
Excess mortality was observed for both comparison scenarios, both sexes, and both nations in 2022. For females in England, the relative excess was 38.2% (95% confidence interval: 37.7–38.7) and 4.4% (4.0–4.8) higher than predicted by 2001–2010 and 2012–2019 trends, respectively; for males excesses were 57.0% (56.4–57.6) and 7.2% (6.8–7.6). For females in Scotland excesses were 26.6% (25.2–28.0) and 3.4% (2.2–4.5); for males excesses were 45.2% (43.6–46.9) and 2.6% (1.5–3.8). In 2022 alone, an estimated 29,740 excess deaths occurred in England and 1,810 in Scotland assuming continuation of the 2012-2019 trend, inclusive of covid-19 deaths. Covid-19 was mentioned on the death certificates of 5.3% of all female deaths in England, 6.1% of males in England, 6.0% of females in Scotland, and 6.5% of males in Scotland. The excesses relative to the 2012-19 trend (but not relative to 2001-10) were largely explained by covid-19 deaths. ASMRs were between 1.68 (females, England) and 1.94 (males, Scotland) times higher in the most deprived fifth of areas than the least deprived fifth.
Conclusion
Mortality in England and Scotland in 2022 was higher than predicted by the 2012-2019 trend. Deaths attributable to covid-19 explained a substantial proportion of that excess. However, this excess is small compared to the 879,430 excess deaths in England and Scotland from 2012 (after excluding direct covid-19 mortality) compared to pre-2012 trends.
