Avoidable mortality in England and Wales: 2023

• Around one in five deaths in 2023 were considered preventable or treatable in England (21.6%) and in Wales (22.7%); this is a similar proportion of avoidable deaths to the previous year, and premature mortality rates are still higher than pre-coronavirus (COVID-19) pandemic levels in both countries. 

• There was regional variation within England, with the highest rates of avoidable mortality in the most northern regions and the lowest rates of avoidable mortality in the most southern regions. 

• There were higher rates of avoidable mortality in more deprived areas; in England, the avoidable mortality rate for the most deprived decile was 3.9 times higher than the least deprived decile for males and 3.5 times higher for females, in Wales, the most deprived quintile's avoidable mortality rate was 2.7 times higher than the least deprived quintile for both males and females.    

• There were higher rates of avoidable mortality for males compared with females and this was the case across all deprivation deciles in both countries. 

• The leading cause of avoidable mortality in both England and Wales remained neoplasms (cancers), despite the rate steadily decreasing over time, followed by diseases of the circulatory system. 

• Avoidable mortality due to alcohol- and drug-related causes has been increasing since 2001 with the largest rises seen from 2019 onwards.

• There is a higher rate of avoidable mortality in the most deprived group compared with the least deprived group in all of the most prevalent causes of avoidable mortality in both England and Wales in 2023.

Avoidable mortality 

Avoidable mortality is defined as deaths that are either preventable or treatable for those aged under 75 years, in line with the international avoidable mortality definition. For the list of causes of death that are classified as avoidable, please see our accompanying datasets. 

In 2023: 

• 21.6% of all deaths in England were considered avoidable (117,527 of 544,054 deaths); in England, the age-standardised mortality rate was 237.8 (confidence intervals 236.4 to 239.1) deaths per 100,000 people  

• 22.7% of all deaths in Wales were considered avoidable (8,193 of 36,054 deaths); in Wales, the age-standardised mortality rate was 277.3 (confidence intervals 271.3 to 283.4) deaths per 100,000 people 

In both England and Wales, the age-standardised mortality rates in 2023 were similar to the rates in the previous year. There were higher rates of avoidable mortality in Wales than in England, which has been the case since this analysis started in 2001. 

Age-standardised mortality rates in both England and Wales increased throughout the coronavirus (COVID-19) pandemic from 2019 to 2021, and following this, decreased from 2021 to 2022. From 2022 to 2023, the rates are no longer decreasing. Avoidable mortality rates in both England and Wales in 2023 are still higher than in 2019 before the pandemic.

Preventable and treatable mortality 

There are two types of avoidable mortality: preventable mortality and treatable mortality, which refer to deaths that could be attributed to conditions considered preventable or treatable. More information about how these types of avoidable mortality are categorised can be found in our Avoidable mortality in the UK Quality and Methodology Information. 

Of the 117,527 avoidable deaths in England in 2023, 75,693.5 (64.4%) could be attributed to conditions considered preventable and 41,833.5 (35.6%) could be attributed to conditions considered treatable. 

Of the 8,193 avoidable deaths in Wales in 2023, 5,305.5 (64.8%) could be attributed to conditions considered preventable and 2,887.5 (35.2%) could be attributed to conditions considered treatable. 

Avoidable mortality by English regions 

Rates of avoidable mortality vary between the English regions.

The highest rates of avoidable mortality in the year 2023 were in the North East with a mortality rate of 298.8 per 100,000 (confidence intervals 292.0 to 305.6) and the North West with a rate of 291.4 per 100,000 (confidence intervals 287.2 to 295.5).

The lowest rates of avoidable mortality in 2023 were in the South East with a mortality rate of 200.6 per 100,000 (confidence intervals 197.6 to 203.7) and London with a rate of 209.6 per 100,000 (confidence intervals 205.9 to 213.3).

The Index of Multiple Deprivation (IMD) is a measure of relative deprivation in England, and the Welsh Index of Multiple Deprivation (WIMD) measures the same for Wales. It ranks areas from most deprived to least deprived, using datasets specific to each nation.

IMD deciles rank areas of England from 1 (most deprived) to 10 (least deprived). WIMD quintiles rank areas of Wales from 1 (most deprived) to 5 (least deprived). Figures for England and Wales are therefore not comparable. 

England 

In all IMD deciles in England in 2023, the age-standardised mortality rate (ASMR) was higher for males than females, suggesting that regardless of deprivation, males are more at risk of avoidable mortality. 

In 2023, the male avoidable ASMR in the most deprived areas of England (decile 1) was 602.9 deaths per 100,000 males (confidence intervals 592.0 to 613.8). This was 3.9 times higher than the 155.5 deaths per 100,000 males (confidence intervals 150.6 to 160.3) seen in the least deprived areas (decile 10). 

The female ASMR also showed a large difference between most and least deprived areas, with 365.9 deaths per 100,000 females (confidence intervals 357.5 to 374.3) in the most deprived areas (decile 1), which was 3.5 times higher than the 104.6 deaths per 100,000 females (confidence intervals 100.8 to 108.5) in the least deprived areas (decile 10).

Wales 

Similarly to England, in all WIMD quintiles in Wales in 2023, the age-standardised mortality rate (ASMR) was higher for males than females.  

In 2023, the male avoidable ASMR in the most deprived areas of Wales (quintile 1) was 557.5 deaths per 100,000 males (confidence intervals 527.7 to 587.3). This was 2.7 times higher than the 207.3 deaths per 100,000 males (confidence intervals 191.0 to 223.6) seen in the least deprived areas (quintile 5).  

The female ASMR also showed a large difference between most and least deprived areas, with 348.0 deaths per 100,000 females (confidence intervals 324.9 to 371.0) in the most deprived areas of Wales (quintile 1), which was 2.7 times higher than the 126.7 deaths per 100,000 females (confidence intervals 114.5 to 138.9) in the least deprived areas (quintile 5).

England and Wales 

In 2023, the leading cause of avoidable mortality in both England and Wales was neoplasms (cancers), followed by diseases of the circulatory system (heart and blood vessels). This was the same in 2022. Neoplasms have been the most common cause of avoidable deaths since 2007.

Neoplasms (cancers) are classified as an avoidable cause of death because some cancers (including lung, liver and skin cancers) are classified as preventable, and others (including breast cancer and testicular cancer) are classified as treatable. Therefore, deaths caused by treatable cancers are considered to be avoidable through timely and effective healthcare interventions after their onset. 

Neoplasms remain the leading cause of avoidable mortality in both England and Wales, even though the avoidable mortality rates for neoplasms have continued to decline in both countries. In 2023, the ASMR for neoplasms was 74.9 per 100,000 people in England (confidence intervals 74.1 to 75.6) and 81.6 per 100,000 people in Wales (confidence intervals 78.3 to 84.8). 

In 2023, the ASMR for diseases of the circulatory system was 66.1 per 100,000 people in England (confidence intervals 65.3 to 66.8) and 80.0 per 100,000 people in Wales (confidence intervals 76.8 to 83.2). 

Contrary to the trend of avoidable mortality caused by neoplasms steadily decreasing over time since 2001, avoidable mortality due to alcohol- and drug-related causes has been increasing since 2001, with the largest rises seen from 2019 onwards.

Figure 4: The leading cause of avoidable mortality in both England and Wales was neoplasms (cancers), followed by diseases of the circulatory system

Age-standardised mortality rates for deaths from avoidable causes by cause, England and Wales, registered from 2001 to 2023

Notes

1.    Age-standardised mortality rates are expressed per 100,000 people and standardised to the 2013 European Standard Population.
2.    Deaths of non-residents are excluded.
3.    Figures are for deaths registered in each calendar year.

Children and young people in England and Wales 

For children and young people (aged 0 to 19 years), the leading cause of avoidable mortality in 2023 in England and Wales was injuries, with 647 registered deaths, which has increased from 556 registered deaths in 2022.

Injuries as a cause of death includes the following reasons: 

• transport accidents 

• assault 

• injuries which were unintentional

• injuries where the intent was undetermined 

• intentional self-harm 

Injuries have been the leading cause of avoidable mortality in children and young people for over 20 years.

England 

In 2023 in England, there was a higher number of avoidable deaths in the most deprived group compared with the least deprived group in all seven cause groups of avoidable mortality we present.  

There is also a difference in avoidable mortality in England by deprivation between sexes. The rate of avoidable mortality is higher in males, particularly in the most deprived groups.

Figure 5: There is a higher rate of avoidable mortality in the most deprived areas compared with the least deprived areas in all the most prevalent causes of avoidable mortality in England

Age-standardised mortality rates for deaths from avoidable causes, by sex, deprivation decile and cause, England, registered in 2023

Notes:

1. Age-standardised mortality rates are expressed per 100,000 people and standardised to the 2013 European Standard Population.
2. Deaths of non-residents are excluded.
3. Figures are for deaths registered in each calendar year.
4. Deprivation deciles are based on the Index of Multiple Deprivation. Most deprived areas refer to decile 1, and least deprived to decile 10.

Wales

In 2023 in Wales, there was a higher number of avoidable deaths in the most deprived group compared with the least deprived group in all seven cause groups of avoidable mortality we present.

Figure 6: There is a higher rate of avoidable mortality in the most deprived areas compared with the least deprived areas in all the most prevalent causes of avoidable mortality in Wales

Age-standardised mortality rates for deaths from avoidable causes, by sex, deprivation quintile and cause, Wales, registered in 2023

Notes:

1.    Age-standardised mortality rates are expressed per 100,000 people and standardised to the 2013 European Standard Population.
2.    Deaths of non-residents are excluded.
3.    Figures are for deaths registered in each calendar year.
4.    Deprivation quintiles are based on the Welsh Index of Multiple Deprivation. Most deprived areas refer to quintile 1, and least deprived to quintile 5.

Alcohol- and drug-related causes of avoidable mortality 

As mentioned in Section 4: Avoidable mortality by cause, avoidable mortality due to alcohol- and drug-related causes has increased from 2001 to 2023. In England, the mortality rate for both sexes and all levels of deprivation has increased by around half compared to a decade previously. However, as with other causes, the highest rates are found among men living in the most deprived areas.

Figure 7: The highest rates of avoidable mortality due to alcohol-related and drug-related causes are found among men living in the most-deprived areas

Age-standardised mortality rates for deaths from alcohol- and drug-related causes, by sex, by most and least deprived group in IMD for England or WIMD for Wales, England and Wales, registered from 2001 to 2023

Notes:

1.    The least deprived group in England is the Index of Multiple Deprivation (IMD) decile 10, and the most deprived group is Index of Multiple Deprivation decile 1.
2.    The least deprived group in Wales is the Welsh Index of Multiple Deprivation (WIMD) quintile 5, and the most deprived group is Index of Multiple Deprivation quintile 1.
3.    Age-standardised mortality rates are expressed per 100,000 people and standardised to the 2013 European Standard Population.
4.    Deaths of non-residents are excluded.
5.    Figures are for deaths registered in each calendar year.

Age-standardised mortality rates 

Age-standardised mortality rates are used to allow comparisons between populations that may contain different proportions of people of different ages.

Avoidable mortality 

Avoidable mortality refers to deaths that are preventable or treatable. 

Preventable mortality 

Preventable mortality refers to causes of death that can be mainly avoided through effective public health and primary prevention interventions (that is, before the onset of diseases or injuries, to reduce incidence). 

Slope Index of Inequality (SII) 

Models the absolute inequality (the difference between the hypothetical most and least deprived populations) in avoidable mortality using weighted linear regression. This takes account of the inequality across all adjacent deciles of relative deprivation, rather than focusing only on the differencing of the two extremes.

Statistical significance 

Refers to statistically significant changes or differences. Statistical significance has been determined using the 95% confidence intervals, where instances of non-overlapping confidence intervals between figures indicate the difference is unlikely to have arisen from random fluctuation.

Treatable mortality 

Treatable mortality refers to causes of death that can be mainly avoided through timely and effective healthcare interventions, including secondary prevention and treatment (that is, after the onset of disease, to reduce case-fatality).

Figures are calculated using death registration data for England and Wales held by the Office for National Statistics (ONS), published in our Deaths registered in England and Wales bulletin. 

Defining avoidable mortality 

More quality and methodology information on strengths, limitations, appropriate uses, and how the data were created is available in our Avoidable mortality in the UK Quality and Methodology Information. 

Socioeconomic deprivation 

Socioeconomic deprivation is measured using England's Index of Multiple Deprivation (IMD) on GOV.UK, which provides an overall relative measure of deprivation for each Lower layer Super Output Area (LSOA). More information can be found in our Socioeconomic inequalities in avoidable mortality Quality and Methodology Information.