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Covid-19: UK had one of Europe’s highest excess death rates in under 65s last year

BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n799 (Published 23 March 2021) Cite this as: BMJ 2021;372:n799

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  1. Gareth Iacobucci
  1. The BMJ

The UK had a higher rate of excess deaths among people aged under 65 in 2020 than almost every other country in Europe, new figures from the Office for National Statistics show.1 By 18 December 2020 only Bulgaria had a higher cumulative excess mortality rate among under 65s (12.3% above the five year average) than the UK (at 7.7%).

The ONS report, which looked at data from 26 countries, lays bare covid-19’s effects across Europe in 2020 and highlights the differing impact of the first and second waves of the pandemic.

By midway through last year (26 June) the UK had the highest cumulative excess mortality rate in Europe of 6.7% across all age groups (table 1). By 18 December the UK (at 7.2%) remained among the 10 worst affected countries but was behind Poland (11.6%), Spain (10.6%), Belgium (9.7%), Bulgaria (8.9%), the Czech Republic (8.4%), and Slovenia (8.2%).

Table 1

Top 10 European countries ranked by relative cumulative age-standardised excess mortality rates (%) in 2020, to 26 June (week 26) and 18 December (week 51)

View this table:

Annie Campbell, of the ONS’s health analysis and life events team, said, “While the UK may no longer have one of the highest levels of cumulative excess mortality in Europe, it does persist to have some of the highest cumulative excess mortality rates for those aged under 65 years.

“Only Bulgaria had a higher cumulative excess mortality rate for this age group by the end of 2020, with the UK and its constituent countries having excess mortality levels well above most other European countries.”

The ONS said that it analysed mortality from all causes to examine the effect of the pandemic not only in terms of deaths from covid-19 but also excess deaths that have occurred “as a result of the wider impacts of the virus on healthcare systems and society.”

It added, “Given the widely differing practices in recording and reporting deaths relating to covid-19 it is not possible at this time to conduct accurate international comparisons of deaths involving covid-19 specifically.”

The report showed that while western European countries still experienced some excess mortality in autumn and early winter in 2020, this was at lower levels than the peaks experienced in the spring. In contrast, central and eastern European countries had the highest levels of excess mortality in Europe during the second half of 2020.

The highest peak in weekly excess mortality in 2020 was recorded in Spain (142.9% in the week ending 3 April), with Bulgaria recording the second highest of 112.3% in the week ending 27 November. The UK’s highest weekly peak was 101.5% in the week ending 17 April.

Among the under 65s, Bulgaria recorded the highest peak in weekly excess mortality rates, at 108.5% in the week ending 27 November. The UK recorded the second highest at 62.7% in the week ending 24 April.

In the autumn and early winter the cities of Sofia (112.5%) and Warsaw (103.8%) had the highest weekly excess mortality rates. But these rates were much lower than cities affected during the spring, such as Madrid (452.0%), Barcelona (266.0%), and London (228.4%).

Commenting on the data, Kevin McConway, emeritus professor of applied statistics at the Open University, said, “The difference in relative death rates by age could be because mortality directly caused by covid-19 in younger people was relatively higher here than elsewhere in Europe, or it could be because excess deaths from non-covid causes were relatively higher here than elsewhere, or some combination of the two.

“For that we’d need data on the actual causes of death—and then we’d be right back into the issue that covid-19 deaths are defined differently in different countries.”

McConway also highlighted the fact that the data did not span the whole of the second wave, with the UK having many more deaths in early 2021.

“By mid-December, the position had changed, with the UK falling further down this dreadful league table,” he noted. “To some extent, though, that is because the high mortality in the UK in the second wave did not really occur until after mid-December and so is not included in that particular comparison at all.”

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