Excess winter deaths and seasonal flu

Excess deaths in winter (EWD) are an important public health issue in the UK linked to cold weather, which can be reduced through implementing preventative approaches with vulnerable groups, for example, older people and those with long term conditions. It has been observed that other countries in Europe especially the colder Scandinavian countries have relatively fewer excess winter deaths in winter compared to the UK.

Public Health England’s (PHEs) “Excess winter mortality 2012-13“ report concluded that excess deaths was found predominantly in the elderly and in deaths coded as resulting from respiratory causes. Their analysis showed influenza to be a major explanatory factor. The seasonal flu vaccination programme targets vulnerable populations and is a means by which we can reduce excess winter deaths.

What do we know?

As noted above, excess winter deaths are important because they are largely preventable. Though related to cold weather and presence of disease, which are factors out of our control, the rate of excess deaths mainly reflects how well equipped people are to cope with the drop in temperature. Some ways to reduce excess winter deaths, therefore, are:

  • supporting energy efficient interventions in housing
  • encouraging fuel poverty referrals
  • increasing uptake of flu and pneumococcal vaccinations among priority groups.

Excess winter deaths are calculated from the excess of deaths in winter (December to March) compared with non-winter months from the preceding August to November and the following April to July expressed as a percentage.

An estimated 18,200 excess winter deaths occurred in England and Wales in 2013/14 – the lowest number of excess winter deaths since records began in 1950/51. This means that 11.6% more people died in the winter months compared with the non-winter months.

There were more excess winter deaths in females than in males in 2013/14 as in previous years. The majority of deaths occurred among those aged 75 and over. Excess winter deaths The excess winter mortality index was highest in the West Midlands and lowest in the North East in 2013/14.

Facts, figures, trends

Excess Winter Deaths

Over the three years from 2010 to 2013, 167 extra deaths in winter occurred above that expected given the rate of deaths in summer. This means that over this period an additional 22.6% deaths occurred in winter compared to summer months. Compared to similarly deprived Unitary Authorities (in the third most deprived decile), Slough ranked second worst in terms of excess winter deaths in 2013.

From 2013 to 2014, 30 extra deaths in Slough occurred in the winter above that expected given the rate of deaths in summer. This means that over this period an additional 11% deaths occurred in winter compared to summer months. This was similar to the national average.

For 2014/15 there was an increase to a rate of 27.2% excess winter deaths in England, local authority level data for 2014/2 has not yet been released (as of January 2016).

Figure 1 Excess Winter Deaths Index Slough 2004-2014

Figure 1

 (Source: ONS Excess Winter Mortality in England and Wales)

Fuel Poverty

The map below shows the percentage of households in difference parts of Slough that are estimated to be living in ‘fuel poverty’. A household is considered to be living in fuel poverty if they have required fuel costs that are above the national average, and if they to spend that amount they would be left with a residual income below the official poverty.
Overall in Slough it is estimated that 10% of households are living in fuel poverty. This is similar to the national average but significantly higher than the average in the South East of 8%.

Figure 2: Fuel poverty – LSOA (2013)


(Source: ONS sub-regional fuel poverty data 2013)


While for those aged under 65 years in Slough, percentage uptake of flu vaccine is significantly higher than the national average at 54% (2014/15), in older people aged 65 and over, uptake of flu vaccine is below the target 75% uptake and falling (Figure 3).

Figure 3. Seasonal flu vaccine uptake in those aged over 65 in Slough

Figure 3

Figure 4. Pneumococcal vaccine uptake in those aged 65 in Slough

Figure 4

(Source: Public Health England Fingertips)

National and local strategies (current best practices)

The Cold Weather Plan for England 2018 describes an action plan for winter preparedness and works on the basis of Cold Weather Alerts from Level 0 (year-round winter planning) and Level 1 (winter preparedness and action programme) to Level 4 representing a major incident.

NICE Guidance on Excess Winter Deaths and Morbidity 2015 sets out evidence-based recommendations for reducing the local burden of excess winter deaths.

Stay Well This Winter Campaign Launched in 2015, this national campaign supported by NHS England and Public Health England gives advice to help people aged 65 or over, those with long-term health conditions, pregnant women and parents of children aged two, three and four and in school years 1 and 2 stay well this winter. Advice includes:

  • getting a flu vaccination
  • heat your home to at least 18 degrees C (65f), if you can
  • seeking immediate advice and help from a pharmacist as soon as they feel unwell, before it gets too serious
  • keeping an eye on elderly or frail friends, neighbours and relatives
  • getting prescriptions before Christmas Eve
  • take your prescribed medicines as directed.

National services and incentives provided include the immunisation programme as detailed above as well as winter fuel payment which are annual payments of £100 to £300 tax-free made to older people to help pay heating bills.

What is this telling us?

The take up of flu vaccinations is significantly lower in Slough than the national target of 75% in all groups and the uptake in those over 65 years was significantly lower than the England average in 2014/15. There has been a similar decline in the uptake of pneumococcal vaccine uptake in those aged over 65.

Though deprivation is associated with both fuel poverty as well as poor uptake of vaccines, there are other local authorities with similar deprivation profiles to Slough that have a lower rate of excess winter deaths, suggesting that improvements can be made in spite of Slough’s socioeconomic profile.

What are the key inequalities?

Cold weather has the effect of increasing health inequalities but disproportionately affecting vulnerable sections of society. Reducing the burden of cold weather and therefore excess winter deaths will work to reduce inequalities in health.

What are the unmet needs/service gaps?

  • There is a need to increase uptake of flu and pneumococcal vaccinations to achieve national targets.
  • There also remains a significant proportion of the local population at risk of living in cold conditions over winter.

Recommendations for consideration by other key organisations:

  • To raise awareness of the flu immunisation programme within general practice with a focus on the over 65s, pregnant women and those in at-risk groups.
  • To raise awareness of the flu immunisation programme with older people in the community targeting those living in deprived communities and for those from priority groups for example: those with long term conditions, mental health problems, learning disabilities and Black and Minority Ethnic (BME) communities.
  • To work with Housing to ensure that support is available to vulnerable people to keep themselves warm in winter.
  • By improving access to flu jabs by making offering through other settings for example community pharmacies, antenatal clinics.

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