THE total number of deaths in Scotland last winter was the third highest since the century began.

A report by National Records of Scotland found that 22,055 deaths were registered in the four months from December 2021 to the end of March this year.

This was down from 23,370 during the first winter with Covid in 2020/21, and 23,153 in 2017/18 - an exceptionally high flu season.

Otherwise, last winter saw the highest mortality since 1999/2000 - when 23,379 deaths were registered.

The Herald: Total winter deaths per year compared to total deaths during autumn and spring periods (Source: National Records Scotland) Total winter deaths per year compared to total deaths during autumn and spring periods (Source: National Records Scotland) (Image: PHS)

It comes amid fears that a combination of Covid plus flu, the cost of living crisis, and severe pressure on hospitals and care services could see winter mortality spike this year.

The NRS report notes that excess winter mortality last year was comparatively low, but only due to "unusually high" numbers of deaths from August to November 2021.

The Herald: Flu rates were exceptionally high in winter 2017/18, and while the are currently low (red line) rates are much higher than usual for the time of year (Source: PHS)Flu rates were exceptionally high in winter 2017/18, and while the are currently low (red line) rates are much higher than usual for the time of year (Source: PHS) (Image: PA)

Excess mortality in winter is calculated by comparing the total number of deaths from December to March against the average for the four months before and after winter.

In winter 2021/22, there were 1,320 excess deaths compared to an average of around 2,600 for the past decade.

However, this was skewed by the 21,679 deaths registered in August to November 2021 - by far the highest total recorded during any autumn period since counting began in 1951/52, and only the second time in 70 years that it has exceeded 21,000 (the last time was August-November 1993, with 21,104 deaths).

NRS said these were "partly attributed to Covid-19".

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However, it would also have overlapped with the period when A&E performance began to steeply deteriorate, with studies having shown that patients who wait more than five hours in emergency departments prior to admission are more likely to die during the subsequent 30 days. 

Figures obtained under freedom of information also show that 4,069 patients spent over 24 hours in A&E in the year to September 25, including 859 waiting over 36 hours and 243 over 48 hours. 

The Herald: The number of patients attending Emergency Departments who were seen, treated and discharged/transferred/admitted within four hours has remained consistently below 80 per cent since July 2021, and is currently around 65%, against a target of 95% (PHS)The number of patients attending Emergency Departments who were seen, treated and discharged/transferred/admitted within four hours has remained consistently below 80 per cent since July 2021, and is currently around 65%, against a target of 95% (PHS) (Image: PHS)

The causes of death with the largest seasonal increases in winter 2021/22 were dementia and Alzheimer’s disease (250 additional deaths compared to the pre- and post-winter periods); cerebrovascular disease (180 additional deaths); and coronary (ischaemic) heart disease, other circulatory system diseases and chronic lower respiratory disease (each 150).

Very few deaths were directly due to cold weather - for example, hypothermia.

Covid was the underlying cause of 60 of the 1,320 additional deaths in winter 2021/22, compared to 80 caused by pneumonia and 50 due to accidental falls.

The Herald: Dementia/Alzheimer's accounted for the largest share of the additional winter deaths in 2021/22Dementia/Alzheimer's accounted for the largest share of the additional winter deaths in 2021/22 (Image: NRS)

Prior to the pandemic, most of the additional deaths in winter were caused by heart disease and strokes, penumonia and chronic obstructive pulmonary disease (COPD), or dementia and Alzheimer’s disease.

Between 2010/11 to 2018/19, these diseases combined accounted for almost 80% of the seasonal increase in mortality. 

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Julie Ramsay, Head of Vital Events Statistics at NRS, said: “The seasonal increase in mortality can change substantially from winter to winter, but the long-term trend has clearly been downward.

"In the 1950s and 60s there was an average seasonal increase of over 5,200 deaths in winter, whereas over the most recent decade it has averaged around 2,600.

“Older age groups are consistently the most affected by increased mortality in winter. For people aged 85 and over, there were 9% more deaths than the months before and after winter, compared to 5% more winter deaths in the under 65 population.”