Excess mortality in England and Scotland in 2022: The long shadow of austerity and the return to an unacceptable pre-pandemic baseline [pre-print]

Background There are concerns that mortality remains elevated after peaks COVID-19. This study examined whether mortality rates in England and Scotland in 2022 were excessive compared to rates predicted by austerity-era (2012–2019) and pre-austerity (2001–2010) trends.

Methods A linear time trend analysis was conducted using mortality data from 2001–2022. The outcomes were observed and expected age- and sex-standardised mortality rates (ASMRs; standardised to the 2013 European Standard Population). Expected ASMRs in 2022 were calculated independently based on austerity-era and pre-austerity trends. Excess deaths were estimated by comparing observed and expected ASMRs.

Results In 2022, ASMRs were higher than predicted by austerity-era trends but substantially higher than pre-austerity trends. Relative excesses in England for females were 4.4% (4.0–4.8) and 38.2% (95% CI: 37.7–38.7), respectively; for males, excesses were 7.2% (6.8–7.6) and 57.0% (56.4–57.6). Relative excesses in Scotland for females were 3.4% (2.2–4.5) and 26.6% (25.2–28.0); for males, excesses were 2.6% (1.5–3.8) and 45.2% (43.6–46.9). COVID-19 accounted for 5.3–6.5% of deaths in 2022 and explained much of the excess relative to austerity-era trends. ASMRs in the most deprived areas were 1.68–1.94 times higher than in the least deprived.

Conclusion Mortality was higher than predicted by both austerity-era and pre-austerity trends. Deaths attributable to COVID-19 explain a substantial proportion of the excess based on austerity-era trends. However, the 879,430 excess deaths relative to pre-austerity trends, even after excluding direct COVID-19 deaths, highlights the devastating impacts of austerity on public health.