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Rocketing death rate sparks call for national investigation

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Public health experts have called for investigation after statistics showed the biggest increase in the national death rate for several decades in 2015.

Preliminary figures indicate there were 5.4% more deaths in England in Wales in 2015 than in 2014, and 6.3% more than the average of the preceding five years.

“Public Health England really needs to get behind this and investigate more thoroughly as guardian of the nation’s health”

David Buck

The Office for National Statistics figures suggest the crude death rate – not adjusted for changes in the population age profile between years – increased by 4.9% on 2014.

The increases in both the number of deaths and crude death rate are the biggest for many years. Similar increases appear to have taken place in the early 1950s and the late 1960s.

Much of the increase in deaths took place in the first months of 2015. The spike in deaths during winter 2014-15 has previously been identified by national officials and partly attributed to flu and ineffective vaccines.

“We need to understand exactly what is happening if we are to prevent it continuing”

Dominic Harrison

However, public health experts told Nursing Times’ sister title Health Service Journal this did not adequately explain the growth in 2015, and similar patterns in recent years.

A report, which was published by Public Health England last week, found that a large number of areas had seen falls in life expectancy for some groups of older people in 2014, in contrast to growth at a national level.

There were also unexpected surges in deaths among older people in 2012 and 2013. Those years saw smaller increases in the overall death rate.

The chart below shows the annual crude death rate over the past 30 years to 2015:

The reasons for the increase are not known and a wide range of factors have been floated by public health experts. They include the impact of a rapidly growing older population; older people returning to England; random fluctuation; weather; flu; cuts to care, support and health services; the economic downturn; high pressure on NHS services; an unidentified infection; and complex past changes affecting the health of the current “cohort” of older people.

Dominic Harrison, an honorary professor at Central Lancashire University and Blackburn with Darwen’s public health director, who was a member the advisory group for the PHE report on older age life expectancy, said the changes were a “strong and flashing amber warning light [that] something is making the population more vulnerable to avoidable death”.

“It is clearly important to keep a close eye on the trends and consider a range of possible explanations”

John Newton

It may be due to cuts and constraint on health and care spending, Mr Harrison warned. He said: “One of the things this data may be telling us is it is just not possible… to contain costs, improve quality, reduce inequality and improve outcomes within such a rapidly diminishing resource envelope. We need to understand exactly what is happening if we are to prevent it continuing.”

Another adviser on the report, Danny Dorling, professor of geography at Oxford University and an expert on inequality, said further research might reveal that, after taking into account population changes, 2015 might prove to be the biggest rise in deaths “since wartime”.

He said he did not believe the trend was explained by flu or ineffective vaccines, and there were many possible reasons – including the impact of funding constraint, other policy, and the economic downturn. He called for the chief medical officer to investigate.

David Buck

David Buck masthead

David Buck

David Buck, senior fellow for public health and inequalities at the King’s Fund think-tank, suggested there were multiple possible causes. He said: “PHE really needs to get behind this and investigate more thoroughly as guardian of the nation’s health.”

He said such an investigation needed to include looking at links to cuts to services, particularly social care, which had not been examined in the PHE report.

Periods with large numbers of deaths are sometimes preceded or followed by stretches with fewer than normal. This chart shows a rolling 24 month total of deaths and indicates that the combined total over 2014 and 2015 was high.

PHE chief knowledge officer Professor John Newton said: “We have been monitoring changes in life expectancy and mortality in England… We find the statistics for older people fluctuate quite a bit from year to year and around the country.

“There is often no obvious pattern to this but it is clearly important to keep a close eye on the trends and consider a range of possible explanations,” he said.

Public Health England

John Newton

John Newton

“In 2015, the monthly death figures suggest that cold weather and flu may have played a part in the high numbers of deaths in the early part of the year,” he said. “Especially given that A(H3N2) was the dominant subtype circulating last flu season in the UK.

“In any flu season dominated by an H3 subtype, unfortunately we can expect the burden of illness to be seen in the elderly and therefore a relatively high overall mortality,” he added.

“Changes in the population over time can also have some surprising effects on these statistics for technical reasons. It is important to keep an open mind,” said Professor Newton.

Chart showing how the increase in deaths, compared to the average of the past five years, was spread through 2015:

Chart showing the annual change in the number of deaths from 1935 to 2015:

Chart showing the number of deaths each year from 1935 to 2015:

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