The ASMR has risen by 5%. So, once again, we repeat: how many deaths will it take for the Government to take note?

In an editorial in March, we raised concerns that more than 10,000 extra deaths had occurred in the first 7 weeks of 2018, compared to the average of the last 5 years.(1) As mentioned in a previous rapid response,(2) Jeremy Hunt was asked on 20th March 2018 in the House of Commons: ‘During the first seven weeks of 2018, 10,375 more people died in hospital than in the same weeks in the previous five years…Why did all these extra deaths occur?

The Secretary of State for Health and Social Care replied:
As the hon. Gentleman will know, these figures cover England and Wales. He will also know that they do not take account of changes in population or changes in demography, so we use the age-standardised mortality rate, which, according to Public Health England, has remained broadly stable over recent years.(3)

The response from a spokesperson for the Department of Health and Social Care to our concerns when the excess deaths had reached 20,000(4) on 8th May 2018 was similar:
We keep all research in this area under review, but the ‘age standardized mortality rate’ – which has been broadly stable in recent years – is considered a much more reliable measure, as this type of research doesn’t take into account fluctuations in population numbers and the ageing population.(5)

The Quarterly Mortality report from the Office for National Statistics (ONS) published on Monday confirms our fears.(6) It states:
The age-standardised mortality rate for deaths registered in Quarter 1 2018 was 1,187 deaths per 100,000 population – a statistically significant increase of 5% from Quarter 1 2017 and the highest rate since 2009’.

Figure 1 from ONS shows how remarkable this is:

Figure 1: Age-standardised mortality rate, deaths registered in Quarter 1 (Jan to Mar), 2001 to 2018

The ASMR has risen by 5%. So, once again, we repeat: how many deaths will it take for the Government to take note?

References:
1. Hiam L, Dorling D. Rise in mortality in England and Wales in first seven weeks of 2018. BMJ 2018;360:k1090 https://www.bmj.com/content/360/bmj.k1090
2. Hiam L, Dorling D. Re: Rise in mortality in England and Wales in first seven weeks of 2018. BMJ 2018;360:k1090 https://www.bmj.com/content/360/bmj.k1090/rr-4
3. House of Commons Hansard. Topical Questions, 20 March 2018. https://hansard.parliament.uk/commons/2018-03-20/debates/3E71DB83-CDBA-4A69-9701-73C78A781CD6/TopicalQuestions (accessed 19 June 2018)
4. Hiam L, Dorling D. Re: Rise in mortality in England and Wales in first seven weeks of 2018. BMJ 2018;360:k1090 https://www.bmj.com/content/360/bmj.k1090/rr-8
5. Iacobucci G. Government must investigate rising excess deaths in England and Wales, experts warn. BMJ 2018;361:k2127
6. Office for National Statistics. Quarterly Mortality Report, England: January to March 2018. 18 June 2018. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/quarterlymortalityreports/januarytomarch2018 (accessed 19 June 2018)

Competing interests: No competing interests

20 June 2018

Lucinda Hiam, Honorary research fellow, London School of Hygiene and Tropical Medicine
Professor Danny Dorling, University of Oxford
Professor Martin McKee, London School of Hygiene and Tropical Medicine

@lu_hiam @dannydorling @martinmckee

To see the response in the BMJ, or for a PDF of this response, click here.