This bulletin presents the number of deaths registered in England and Wales in 2010 by age, sex and selected underlying cause of death. In addition, the ten leading causes of death have been ranked to provide a summary for both males and females.
There were 493,242 deaths registered in England and Wales in 2010 compared with 491,348 in 2009, a rise of 0.4 per cent. The total number of deaths in 2010 comprised 237,916 male and 255,326 female deaths. This compares with 238,062 male and 253,286 female deaths registered in 2009.
The infant mortality rate in 2010 (based on registrations) is the lowest ever recorded in England and Wales. In 2010 there were 3,140 infant deaths (under 1 year of age) registered giving a rate of 4.3 deaths per 1,000 live births compared with 4.7 in 2009. Infant mortality is monitored under a Public Service Transparency Framework.
The age-standardised mortality rates in 2010 were also the lowest since records began in England and Wales at 6,406 deaths per million population for males and 4,581 deaths per million for females. This compares with age-standardised rates of 6,573 deaths per million for males and 4,628 deaths per million for females in 2009. These age-standardised rates are for all causes and cover all ages (see Background note 5). Between 2000 and 2010, the age-standardised rate for males fell by 24 per cent (from 8,477 deaths per million), while for females it decreased by 19 per cent (from 5,679 deaths per million). Reasons for these improvements in mortality include medical advances in the treatment of many illnesses and diseases.
Circulatory diseases, cancers (neoplasms) and respiratory diseases were the broad disease groups (chapters) of the International Classification of Diseases, Tenth Revision (ICD–10) (WHO 1992–1994) with the largest numbers of deaths in 2010. Circulatory diseases, which include deaths from ischaemic heart disease and strokes, accounted for 32 per cent of all deaths, while cancers and respiratory diseases (including deaths from pneumonia) accounted for 29 per cent and 14 per cent of all deaths respectively.
Over the course of the 20th century, there have been fairly steady decreases in mortality rates for these three broad disease groups in England and Wales. The reasons for this include improvements in the treatment of these illnesses. Government backed initiatives to improve people’s health through better diet and lifestyle, for example, the Department of Health’s White Paper entitled 'Choosing Health: making healthy choices eas ier' published in 2004 could also have contributed to improvements in mortality rates.
Throughout the period 2000 to 2010, circulatory diseases (which include heart disease and strokes) have seen the largest fall in age-standardised rates for males and females (40 per cent and 38 per cent respectively). The fall in age-standardised mortality rates for cancer has been more gradual, with death rates 15 per cent lower for males and 12 per cent lower for females in 2010 than in 2000. Deaths from cancer now have the highest age-standardised mortality rates for both males and females, whereas in 2000 the highest rates were for circulatory diseases. Although advances have been made in the treatment of cancer, the number of deaths from cancer has risen slightly over the past decade.
In ‘ Improving Outcomes: A Strategy for Cancer’ the Department of Health states that although improvements have been made in the quality of cancer services in England, a significant gap remains in mortality rates compared with the European average. The Outcomes Strategy sets out how the Department of Health aims to improve outcomes for all cancer patients and improve cancer survival rates, with the aim of saving an additional 5,000 lives every year by 2014/15. The Welsh Government is in the process of developing the third and final delivery plan for its current cancer policy 'Designed to Tackle Cancer in Wales'. The commitment is to reduce cancer mortality and achieve survival that is within the top quartile of European countries.
The rate for respiratory diseases in males decreased by 26 per cent between 2000 and 2010, while the rate for females fell by 17 per cent. Respiratory disease mortality rates in a given year are strongly influenced by the seasonal pattern of mortality in that year and so differences between two years should always be examined in the context of long-term trends.
Comparability ratios have been applied to the figures for each of the three cause of death groups for 2000 in order to produce a consistent trend that adjusts for the change to ICD–10 in 2001; see the Background note 4.
The two tables below show the ten leading underlying causes of death in 2010 for males and females. These are ranked according to a World Health Organisation (WHO) list which categorises causes using ICD–10 groups specifically designed for determining the leading causes of death; see the Background note 7. The leading cause of mortality are ranked according to the number of deaths registered for each group in 2010.
|Rank||Underlying cause of death||Number of deaths||Percentage of all male deaths||Age-standardised mortality rate per 100,000 population|
|1||Ischaemic heart diseases (I20-I25)||40,721||17.1||108.3|
|2||Cerebrovascular diseases (I60-I69)||16,909||7.1||42.2|
|3||Malignant neoplasm of trachea, bronchus and lung (C33, C34)||16,807||7.1||46.5|
|4||Chronic lower respiratory diseases (J40-J47)||13,137||5.5||33.4|
|5||Influenza and Pneumonia (J09-J18)||10,620||4.5||26.3|
|6||Malignant neoplasm of prostate (C61)||9,638||4.1||23.8|
|7||Malignant neoplasm of colon, sigmoid, rectum and anus (C18-C21)||7,700||3.2||21.1|
|8||Dementia and Alzheimer's disease (F01, F03, G30)||7,347||3.1||17.1|
|9||Malignant neoplasms of lymphoid, haematopoietic and related tissue (C81-C96)||5,826||2.4||16.1|
|10||Diseases of the liver (K70-K76)||4,724||2.0||15.9|
|All male deaths||237,916||:||:|
The leading cause of death for both sexes was ischaemic heart diseases, which accounted for 17.1 per cent of male deaths and 11.5 per cent of female deaths during 2010. Cerebrovascular diseases (strokes) was the second leading cause of death for both males and females and accounted for 7.1 per cent of all male deaths and 10.4 per cent of all female deaths in 2010. For males, cerebrovascular diseases replaced lung cancer as the second leading cause of death in 2010, compared with 2009.
|Rank||Underlying cause of death||Number of deaths||Percentage of all female deaths||Age-standardised mortality rate per 100,000 population|
|1||Ischaemic heart diseases (I20-I25)||29,475||11.5||47.8|
|2||Cerebrovascular diseases (I60-I69)||26,454||10.4||39.6|
|3||Dementia and Alzheimer's disease (F01, F03, G30)||17,759||7.0||23.5|
|4||Influenza and Pneumonia (J09-J18)||14,903||5.8||21.5|
|5||Malignant neoplasm of trachea, bronchus and lung (C33, C34)||13,170||5.2||29.9|
|6||Chronic lower respiratory diseases (J40-J47)||12,848||5.0||23.8|
|7||Malignant neoplasms of female breast (C50)||10,290||4.0||24.5|
|8||Diseases of the urinary system (N00-N39)||7,365||2.9||10.7|
|9||Heart failure and complications and ill-defined heart disease (I50-I51)||6,461||2.5||9.0|
|10||Malignant neoplasm of colon, sigmoid, rectum and anus (C18-C21)||6,402||2.5||12.9|
|All female deaths||255,326||:||:|
The difference between the top two causes of death, ischaemic heart diseases and cerebrovascular diseases was greater among males (a difference of nearly 24,000 deaths) than females (just over 3,000 deaths).
For both sexes, lung cancer (malignant neoplasm of trachea, bronchus and lung) was the most common cancer, appearing third in the underlying cause of death list for males and fifth for females. The list also contained three other cancers for males and two for females, including ones which are sex-specific (prostate cancer and female breast cancer).
If causes were ranked by their age-standardised mortality rates instead of number of deaths, the rankings would change. For example, dementia and Alzheimer’s disease among females is ranked third on number of deaths but would be ranked sixth on mortality rates. This is because the age-standardisation process gives less weight to deaths at older ages (where most of the dementia and Alzheimer’s disease deaths occur).
For males, there have been decreases in the majority of mortality rates for the leading underlying causes since 2005. The largest percentage fall in male mortality rates was for ischaemic heart diseases which fell by 26 per cent between 2005 and 2010. There were increases in the male mortality rates over the same period for dementia and Alzheimer’s disease and for diseases of the liver (21 and 3 per cent respectively).
For females, the all age mortality rates for ischaemic heart diseases also showed the largest fall between 2005 and 2010 (30 per cent). The mortality rates of three of the leading causes increased over the same period. Diseases of the urinary system increased by 8.1 per cent, dementia and Alzheimer's disease increased by 26 per cent and lung cancer increased by 3.5 per cent.
The Office for National Statistics uses death registrations data to:
Produce population estimates and population projections both national and subnational
Quality assure census estimates
Report on social and demographic trends
Carry out further analysis, for example life expectancies and causes of death (including deaths from injury and poisoning, certain infections and drug related deaths)
Further analyse infant mortality where infant deaths are linked to their corresponding birth record to enable more detailed analyses on characteristics such as age of parents, birthweight and whether the child was born as part of a multiple birth
Produce life expectancy estimates
The Department of Health (DH) is a key user of mortality statistics. Data are used, for example, to inform policy decisions and to reduce premature mortality from the major causes of death under a new NHS Outcomes Framework. The outcomes framework has replaced the Public Service Agreement system that was in place under the previous government. Infant mortality is also seen as a key measure among health outcomes and there is a long established link between social and health inequalities, and infant mortality. Infant mortality continues to take a central role in DH’s work on health inequalities.
Other key users of mortality data are local authorities and other government departments for planning and resource allocation. The Department for Work and Pensions uses detailed mortality statistics to feed into statistical models they use for pensions and benefits.
Users also include other public sector organisations such as the Police and the Home Office who are interested in data on external causes of death. Private sector organisations such as banks, insurance and investment companies are particularly interested in deaths by single year of age and region which feeds into risk estimation, while funeral directors are interested in the number of deaths occurring at the local area level.
Other users include academics, demographers and health researchers who conduct research into trends. Lobby groups and charities use death statistics to support their cause, for example, campaigns against alcohol and drug misuse or suicide. Organisations such as Eurostat and the UN use death statistics for making international comparisons. The media also report on key trends in mortality.
This bulletin accompanies tables published in the annual publication, Mortality statistics, Deaths registered in England and Wales - 2010 (Series DR).
Metadata, which accompanies these tables, provides further information on data quality, legislation and procedures relating to deaths.
The Summary Quality Report for Annual Mortality Statistics in England and Wales is available on the ONS website.
An interactive mapping tool which enables trends in mortality to be analysed at the local level is available.
The tool is based on age-standardised mortality rates (ASMRs) by local authority district for 2001–2010. These are published as part of the ‘Mortality Statistics: Deaths registered in England and Wales by area of usual residence’, figures for 2010 were released on 6 October 2011.
View Statistics on deaths in Scotland.
View Statistics on deaths in Northern Ireland.
Crude death rates for selected international countries are available in Table 1.1 ‘Population and vital rates: international’.
Department of Health (2004), Choosing Health: Making healthy choices easier, accessed 30 September 2011.
Department of Health (2010), NHS outcomes framework, accessed 30 September 2011.
Department of Health (2011), Improving outcomes: a strategy for cancer, accessed 30 September 2011.
Griffiths C, Rooney C and Brock A (2005) ‘Leading causes of death in England and Wales – how should we group causes?’, Health Statistics Quarterly 28, 6–17.
World Health Organisation (WHO) (1992–94) International Statistical Classification of Diseases and Related Health Problems, volumes 1, 2 and 3 (Tenth Revision). WHO: Geneva.
Registrations and occurrences: the year in which a death is registered may not correspond to the year in which the death occurred. Up to 1992, Office for National Statistics (ONS) publications gave numbers of deaths registered in the data year. Between 1993 and 2005 the majority of ONS’s published figures represented the number of deaths that occurred in the data year. For 2006 onwards, ONS changed the reporting of death figures back to deaths registered in a reference year. In most years (and for most causes of death), this change has little effect on annual totals but allows the output of more timely mortality data. For an annual extract of death occurrences to be acceptably complete, it must be taken some months after the end of the data year to allow for any late registrations.
Coding underlying cause of death: the cause of death data are based on the final underlying cause of death, which takes account of any additional information provided by medical practitioners or coroners after the death has been registered. The original underlying cause of death only changes in a very small number of deaths (around 0.2 per cent) in a given year. Since January 2001 cause of death has been coded to the Tenth Revision of the International Classification of Diseases and Related Health Problems (ICD–10) (WHO, 1992–1994). This was introduced on the recommendation of the WHO and replaced the Ninth Revision (ICD–9), which had been in use since 1979. ICD–10 represents the largest change in the ICD in over 50 years. The major changes have been described in detail on the ONS website. Cause of death is assigned by an automated coding system with the exception of deaths due to external causes (ICD–10 codes U50–Y89). These are coded clerically using information from coroners’ certificates (including inquest verdicts) to produce consistent figures on suicides, homicides and other deaths not from natural causes.
Following guidance from the World Health Organisation (WHO), the ICD–10 code J09 ‘Influenza due to identified avian influenza virus’ has been used to record H1N1 swine influenza. For ease of use J09 has been renamed to ‘Influenza due to identified avian or swine influenza virus’ in the tables. There were 142 deaths due to swine flu and no deaths due to avian flu in 2010. These have been included with the influenza and pneumonia deaths (J10–J18) for 2010. The number of deaths shown under J09 differs from the figures reported by the Chief Medical Officer (CMO). The CMO reported deaths as related to pandemic A/H1N1 using information from either the death certificate or from laboratory testing or both.
Comparability ratios: in order to help quantify the changes arising as a result of the change to ICD–10, ONS carried out a bridge coding study. All deaths registered in 1999 were independently coded to both ICD–9 and ICD–10 and the causes in each revision were compared using internationally agreed groups of equivalent codes. Comparability ratios were produced for selected causes of death, including each ICD cause chapter, to indicate the net effect of the change in classification on a particular cause. The ratios were calculated by dividing the number of deaths coded to a particular cause in ICD–10 by the number coded to that cause in ICD–9. These ratios can then be applied to England and Wales data (from 1993 onwards) coded to ICD–9 in order to examine trends over time. For a particular cause, the number of deaths coded to the equivalent cause in ICD–9 is multiplied by the comparability ratio in order to give an ‘expected’ number of deaths that would have been coded to this cause in ICD–10. The ratios can also be applied directly to rates to give an ‘expected’ rate.
The age-standardised mortality rates in this release cover all ages and are directly age-standardised to the European Standard Population, which allows comparisons between populations with different age structures, including between males and females and over time. Age-standardised rates for 2010 in this release are calculated using the mid-2010 population estimates.
The population figures used to calculate rates are mid-year estimates of the resident population of England and Wales based on the 2001 Census of Population. These estimates include members of HM and non-UK armed forces stationed in England and Wales, but exclude those stationed outside. ONS mid-year population estimates are based on updates from the most recent census, allowing for births, deaths, net migration and ageing of the population.
The population estimates used for the calculation of mortality rates are the latest consistent estimates available at the time of production. Further information on population estimates and their methodology can be found online.
Leading causes of death in England and Wales: the cause of death groups used here are based on a list developed by the World Health Organisation which categorises causes using ICD–10 groups specifically designed for determining the leading causes of death. The list has been modified for use in England and Wales and further information on the rationale behind ranking leading causes of death and how causes are grouped can be found in an article published on this subject in Health Statistics Quarterly 28.
Areas previously referred to as Government Office Regions (GORs) are now designated as 'regions' for statistical purposes only. GORs were abolished on 31 March 2011 after the Government Comprehensive Spending Review.
Special extracts and tabulations of mortality data for England and Wales are available to order for a charge (subject to legal frameworks, disclosure control, resources and agreement of costs, where appropriate). Such enquiries should be made to:
Vital Statistics Output Branch
Health and Life Events Division
Office for National Statistics
Hampshire PO15 5RR
Tel: +44 (0)1329 444110
We welcome feedback from users on the content, format and relevance of this release. The Health and Life Events user engagement strategy is available to download from the ONS website. Please send feedback to the postal or email address above. An online user survey will also be available to complete from 10 November 2011.
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Next publication: Autumn 2012
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