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In common with other countries, in England and Wales more people die in the winter than in the summer. This produces the number of excess winter deaths (EWDs), which is then rounded to the nearest 10 for final data and to the nearest 100 for provisional data. The EWM index shows the percentage of extra deaths that occurred in the winter and is reported to 1 decimal place. EWM figures are based on deaths occurring in each period (August through to the following July). Around 5 December, the number of daily deaths began to climb noticeably higher than the five-year average.
Although it is often thought the main cause of excess winter deaths is temperature, it is not the only factor affecting levels of mortality. A greater proportion of homes in England now have measures to improve energy efficiency, such as cavity wall insulation, modern central heating and double-glazing compared with 1996.
Figure 6 compares the excess winter mortality (EWM) index for males and females grouped by age for the last 3 winters.
Totals for all ages will not be equal to the sum of the individual age groups due to rounding. The excess winter mortality (EWM) index is calculated as excess winter deaths divided by the average non-winter deaths, expressed as a percentage. In previous bulletins EWM has only been presented by underlying cause death for the previous winter, as the provisional data for the most recent winter is not fully quality assured. Respiratory disease is a leading cause of death in England and Wales, (ONS, 2015a), and it also has the largest seasonal effect of all of the causes included in Table 1. Dementia and Alzheimer’s disease was one of the leading causes of death in 2014 (ONS, 2015a), and also displays marked seasonal effects. Underlying cause of death is defined using the International Classification of Diseases, Tenth Revision (ICD-10). Figures are based on deaths occurring in each period (August through to the following July). Figures for England, English regions and Wales exclude deaths of persons usually resident in each area. As with regional EWM figures, there is no consistent pattern in EWM across local authorities in England and Wales over time.
The cold can have various physiological effects, which may lead to death in vulnerable people. In this year’s bulletin we have calculated the England and Wales influenza-like-illness (ILI) rates from week 31 of 2014 by combining data provided by the Royal College of General Practitioners (RCGP - England ILI incidence and population data) and Public Health Wales (PHW - Wales ILI incidence and population data). We code cause of death using the World Health Organization's (WHO) International Classification of Diseases, Tenth Revision (ICD-10). To understand the impact of these changes on mortality statistics, we carried out bridge coding studies in which samples of deaths that had previously been coded using the old software were then independently recoded using the new version of ICD-10 (ONS, 2011 and 2014a). The move to v2010 in 2011 had a big impact on the assignment of deaths to an underlying cause of “Mental and Behavioural Disorders”. The move to IRIS (version 2013) software in 2014 caused the number of deaths allocated to “Dementia and Alzheimer’s disease” to increase by 6.2%.
These coding changes will not have affected the overall number of excess winter deaths from all causes; nor will it have had a significant impact on the excess winter mortality index as any impact will be spread fairly evenly throughout the year.
In the 2009 annual report from the Chief Medical Officer (CMO) for England, it was noted that, although excess winter deaths (EWDs) have declined over the last 50 years, the number was still too high (Donaldson, 2010). This prompted the government to develop an annual Cold Weather Plan for England, which has been published yearly since November 2011.
The UK government introduced the “green deal” project, whereby householders can have improvement work carried out on heating and home insulation, paid back through savings in energy bills. Winter mortality figures for Scotland and Northern Ireland are both based on death registrations, whereas England and Wales figures are based on occurrences.
For Northern Ireland mortality data, there can be a significant delay between when the death occurred and when it was registered for some causes of death. Brown G, Fearn V and Wells C (2010) ‘Exploratory analysis of seasonal mortality in England and Wales, 1998 to 2007’.


Fowler et al (2014) ‘Excess winter deaths in Europe: a multi-country descriptive analysis’. Wilkinson P, Landon M, Armstrong B, Stevenson S, Pattenden S, McKee M and Fletcher T (2001) ‘Cold comfort: The social and environmental determinants of excess winter deaths in England, 1986–96’, Published for the Joseph Rowntree Foundation by The Policy Press, Bristol.
Excess winter mortality figures are derived from the data collected when deaths are certified and registered. Once statistics have been designated as National Statistics it is a statutory requirement that the Code of Practice shall continue to be observed. After the death of Charles in 1858, Mary lived with her son George, a gardener, and his family in Acocks Green, Worcestershire. Numbers of deaths from January to July 2015 are provisional, and have been adjusted to take account of late registrations (see background note 3 in the statistical bulletin). During the winter period, there were only 2 days where the number of daily deaths was below the five-year average: 2 December and 18 March.
The number of daily deaths peaked on 1 January, and remained about 30% above average until 10 January, and around 10% above average until early March. Numbers of deaths from January to July 2015 are provisional, and have been adjusted to take account of late registrations (see Background note 3 in the statistical bulletin).
The EWM index is used to show how many more people died in winter than in the non-winter months, expressed as a percentage. Numbers of deaths from January to July 2015 are provisional, and have been adjusted to take account of late registrations (see Background notes 2 and 3 in the statistical bulletin). More information on the calculation and interpretation of excess winter deaths, the excess winter mortality index and confidence intervals can be found in the Definitions sheet. In fact, no EWM occurred in either local authority; in Fareham, there were more deaths in the non-winter months than there were in the winter. It has been shown that low indoor temperature is associated with higher EWM from cardiovascular disease in England (Wilkinson et al., 2001). The majority of additional winter deaths are caused by cerebrovascular diseases, ischaemic heart disease and respiratory diseases.
Where possible, deaths are automatically coded using specialist software, with the remaining deaths being manually coded. The majority of the change was the result of deaths previously coded as “Diseases of the Circulatory System” (I00–I99) in ICD–10 v2001.2 now being coded as deaths from dementia (F01 and F03) under v2010.
The main reason for this increase is the change to the coding of chest infections, so deaths which mention both a chest infection and dementia or Alzheimer’s disease are now allocated an underlying cause of dementia or Alzheimer’s disease, whereas in ICD-10 v2010 (NCHS), the chest infection would have been assigned as the underlying cause. However, the coding changes will have affected the number of excess winter deaths for specific causes, with the biggest impact being for dementia and Alzheimer’s disease. The CMO argued that many of these deaths were preventable and that more needed to be done to protect vulnerable people during cold winter months. Public Health England (PHE) published the 2015 edition in October 2015 in partnership with NHS England, the Local Government Association and the Met Office. Local authorities and public health organisations across England and Wales use our data to assess levels of excess winter mortality in their area.
In Scotland a death must be registered within 8 days, and fact of death can be registered (with a cause given as unascertained, pending investigations) before the Procurator Fiscal has completed their investigations. Most deaths (almost 95%) are registered within one month of the date of occurrence, although violent or unexpected deaths, which need further investigation from a coroner, can take much longer. Where appropriate, tables contain the number of excess winter deaths, the excess winter mortality index and the upper and lower confidence limits. The extra day in February has been taken into account in the calculation of the mean number of daily deaths, and the corresponding five-year average in Figure 2.
Through the non-winter months the number of daily deaths was generally similar to the five-year average, but during the winter daily deaths were far higher. From this peak on 1 January, the number of daily deaths gradually declined until the beginning of April at which point they reached levels similar to the five-year average.
Consistent with the five-year average, the peak in monthly mortality occurred in January in 2015 with an average daily number of deaths of 1,916.
The elderly and those with underlying health conditions are particularly at risk of developing complications (Public Health England, 2014b),   which can result in hospitalisation and death (Public Health England, 2014c).


Deaths peaked a week later, in the week beginning 5 January, which is consistent with the lag effect discussed by the Eurowinter group (1997).
The majority of these deaths for both sexes occurred amongst those aged 75 and over, with females aged 85 and over having the greatest number of EWDs.  Female EWDs are generally higher than males, especially in older age groups. However, the number of circulatory disease deaths remains high throughout the year, so the seasonal effect is not as large as we see with either respiratory diseases or dementia and Alzheimer’s disease. This is the third year running that the East Midlands has had one of the highest EWM indices, however, the South West often ranks much lower. In Wales, Blaenau Gwent had the highest level of EWM, with 26% more deaths in winter compared with the non-winter period. This means that figures for 2011 onwards by underlying cause of death will not be directly comparable with figures for 2001 to 2010. Therefore, Scottish mortality data are not subject to the same registration delays as mortality data for England and Wales. Therefore, EWM figures from Northern Ireland and England and Wales are not directly comparable. So that timely EWM figures can be produced, we generate a special extract of mortality data in September for deaths that were registered by this month, but which occurred up to the end of July. These limits form a confidence interval around the index, which is a measure of the statistical precision of an estimate and shows the range of uncertainty around the estimated figure. However, the extra day is not taken into account in the overall calculation of excess winter deaths. The number of daily deaths was highest above the five-year average on 10 January (38% higher). The month with the second highest mean number of daily deaths was December with 1,712 deaths.
England and Wales both have higher than average EWM and exhibit high variation in seasonal mortality. Deaths with an underlying cause of death coded to “Diseases of the Circulatory System” decreased by 5%, while those coded to “Diseases of the Respiratory System” showed an increase of 2%.
This should enable them to prepare and respond appropriately, and help to reduce the number of excess winter deaths. Almost all deaths that occurred in the relevant period will be included in the Scottish figures, meaning winter mortality figures from Scotland are comparable with our figures for England and Wales. These figures are then adjusted using the provisional number of deaths from the previous year’s extract, compared with the final number of deaths. This means that in leap years the winter period (December to March) will contain deaths for one extra day. The most noticeable changes were seen in the more recent years due to deaths being included that were not yet registered at the time the data was last revised. Mean daily deaths were lowest in August and September 2014 and July 2015 (1,248, 1,282 and 1,232 respectively). In vulnerable groups, for example in the elderly or those with pre-existing health problems, influenza can lead to life-threatening complications, such as bronchitis or secondary bacterial pneumonia (Public Health England, 2014b).
This produces a provisional estimated number of deaths for January to July in the current year so that EWM can be calculated for the previous winter. It is estimated that between 1,300 and 1,700 deaths occur on 29 February, therefore in leap years (for example, the winter of 201112) there will be around an extra 1,500 excess winter deaths compared with non-leap years. It may be that the outdoor temperature now has less of an effect on excess winter mortality, as better insulation and energy efficiency means that houses are easier to heat and keep warm, potentially resulting in more stable indoor temperatures.
The reasons for the seasonal pattern in deaths from dementia and Alzheimer's disease are not clear.
The Met Office issues cold weather alerts from November to March to support the Cold Weather Plan (Public Health England, 2015).  The ‘Keep Warm Keep Well’ booklet provides advice on staying well during cold weather, for example healthy lifestyle, heating, flu vaccinations, and making sure that people know about all the benefits and services to which they are entitled (Public Health England, 2015).



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