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Late registration of deaths in England and Wales - further statement

(Note: the following statement has involved correspondence with the National Statistician, the Office for National Statistics and the Health and Social Care Information Centre.)

At the meeting of its Council on 30 January 2013, the Royal Statistical Society re-affirmed its concern (as set out in its statement of 25 January 2012) that delayed registration of deaths in England and Wales poses a risk to public health by potentially undermining the evidence-base for public health monitoring, record-linkage research and policy development.

Late registration of deaths in England and Wales occurs because registration of the fact of death is coupled with the registration of cause of death. In England and Wales, if a death is referred to the coroner and subject to an inquest, no registration of the fact of death need be made until the coroner’s verdict is given. This may be months or even years later.

The Royal Statistical Society (RSS) therefore calls for the registration of deaths to be uncoupled from the registration of cause of death in England and Wales – as in Scotland and in a majority of 30 non-UK European countries surveyed on the RSS’s behalf. Uncoupling requires legislation.

While cause of death information can be legitimately delayed (by awaiting an inquest-verdict), the Society believes that, without any exception, registration of the fact of death should occur promptly.

The Society highlights that:
 

  • There is a delay of at least six months in the registration of 10,000 deaths per annum in England and Wales. Registration-delay of at least six months affects one in five of all deaths at 5-44 years of age1.
  • England and Wales are out of line with other European countries. A survey conducted by the Society showed that prompt registration of fact of death occurred in the majority (23/29) of non-UK European countries whose national statistician responded (29/30).

In support of its position the Society has published a document setting out ten arguments against late registration: 1) statistical competence, 2) impeded discovery-potential in record-linkage studies, 3) monitoring the lethality of epidemics, 4) hindrance to good clinical practice, 5) hindrance to safety monitoring in randomized controlled trials, 6) handicap to the monitoring of, and action on, premature mortality, 7) obscuring of calendar-year trends in mortality, 8) inaction on overlong waiting-times for registration of cause of death,  9) disharmony of death-registration across UK, and 10) risk of distress to the bereaved.

The Society hopes that the necessary legislation in England and in Wales to uncouple the registration of the fact of death from the registration of cause of death can be laid in 2013, which is the International Year of Statistics.

Until the necessary legislation is enacted, the Society has identified two actions to be taken without delay.

The first will ensure full awareness by both the producers and consumers of official statistics that, in England and Wales, death-year and death-registration-year differ importantly, not trivially.

The second will ensure that research teams who seek to verify the survival-status of patients or study-participants clearly understand that they are informed not about deaths which have occurred (which is generally what they want to know) but about deaths which have occurred and been registered as having occurred. The two differ importantly because the registration-delay is at least six months for around 10,000 deaths per annum in England and Wales, 4,000 of them at ages 5-44 years.

The two urgent actions that the Royal Statistical Society commends are:

  • the National Statistician, and her heads of statistical profession in government departments, should ensure that all official statistical tables on deaths in England and Wales make crystal clear whether tabulation is by death-year or by death-registration-year and give an explanation that these differ, and the extent to which they do; and
  • the Office for National Statistics and the Health and Social Care Information Centre should develop a brief explanatory text which makes clear that requests by research teams for checks against the register of deaths in England and Wales on whether any members of their study-cohort have died by a specified date can only yield information on deaths that have both occurred and been registered by the date of interest. (It should be noted that researchers are required to pay for these checks and that they may currently be unaware that the data they purchase may not be what they were expecting. Typically, researchers expect to be informed about all deaths that have occurred by the date of interest.)

1 Parliamentary questions by Patrick Mercer OBE MP revealed that one in five deaths of 5-44 year olds in England and Wales is not registered for at least six months. Late-registration bedevils premature deaths, in particular.

Age-group
at death

Registration-delay (%) for deaths which occurred in 2005+2006+2007+2008 in England & Wales and were ONS-registered by the end of 2011

Number of registered deaths by age-group

91 days or more

183 days or more

366 days or more

  0 -   4 years

   2 715 (17%)

   1 496 (10%)

     497 (3.2%)

     15 702

  5 – 14 years

      869 (30%)

      527 (18%)

     176 (6.1%)

       2 865

15 – 44 years

 27 806 (39%)

 15 531 (22%)

  4 277 (6.0%)

     70 721

45 – 59 years

 15 810 (10%)

   7 588 (  5%)

  1 939 (1.2%)

   157 493

60 -  69 years

 10 353 (  4%)

   4 829 (  2%)

  1 205 (0.5%)

   244 440

70 +     years

 26 746 (  2%)

 12 467 (  1%)

  3 072 (0.2%)

1 542 900

 
All ages

 
84 297 ( 4%)

 
42 438 (  2%)

 
11 166 (0.5%)

 
2 034 121

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