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

BackgroundThere 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. MethodsA 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. ResultsIn 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. ConclusionMortality 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. KEY MESSAGESO_ST_ABSWhat is already known on this topic?C_ST_ABSMortality in England and Scotland remained elevated following the peaks of 2020 and 2021 caused by COVID-19, indicating a further worsening of the unprecedented stalling of mortality rates observed from around 2012. What this study addsWhile COVID-19 explained much of the 2022 excess mortality relative to projections based on austerity-era trends, far greater excesses emerged when compared to projections based on the consistent decline in mortality observed prior to austerity. How this study might affect research, practice or policyThese findings highlight the profound, long-term harm of austerity, particularly in deprived areas, with an estimated 879,430 excess deaths between 2013 and 2022. The study strengthens calls for urgent policy action to reverse austeritys effects and reduce health inequalities.