Deaths in Scotland are on the rise - so what's the cause?

Also puzzling is evidence that the increase in the death rate is more pronounced among young adults aged 20 to 24 than it is among elderly Scots in their 80s.

On Thursday, the National Records of Scotland published its monthly mortality analysis for March.

The latest publication means that we now have a full set of statistics covering the first quarter of 2023, albeit provisional.

READ MORE: A&E and excess deaths - is this the new normal? 

So what does it tell us?

In total, there were 17,464 deaths registered between January and the end of March.

Compared to the average for the same period in 2017, 2018, 2019, 2021 and 2022, the death toll in 2023 was 8.2 per cent higher.

That has implications for frontline services such as hospices and palliative care nurses working in the community as well as for hospital mortuaries and funeral directors who may be struggling to cope with an increase in demand as 1,300 more deaths than usual occurred.

However, with an increasingly elderly population and a population that is growing in size, it is inevitable that the number of deaths would increase.

The more statistically significant figure is the age-standardised mortality rate (ASMR) which measures changing mortality patterns after adjusting for these shifting demographics, so that trends can be gauged more fairly year on year.

According to the ASMR, the mortality rate for the first quarter of 2023 was 1,279 per 100,000 - in other words there were 1,279 deaths registered in Scotland from all causes for every 100,000 people living here.

Monthly excess mortality in Scotland by number of deaths (light purple) and death rate (dark purple) since 2013 (Image: NRS)

When that is compared against the five year average, we actually see a 2.4% increase in the mortality rate - up from 1,249 - suggesting that we have registered roughly 30 additional deaths per 100,000 residents than we might have expected.

The patterns varies, however, depending on the age group or cause.

For example, the ASMR for Scots aged 80 to 89 was 21,014 deaths per 100,000 in January to March this year.

In other words, people in that age bracket had a one in five chance of passing away from any cause.

This was up very slightly - 1% - on the five-year average of 20,813, but means that there were roughly 201 excess deaths for every 100,000 people in this age group.

Given that elderly Scots are more likely to be frail and suffering from multiple chronic health conditions, we might expect that this age group would be experiencing a rise in their mortality rate under the current circumstances of overstretched social care providers, overcrowded A&E departments, and an NHS that is short of beds and staff.

READ MORE: Warning that lack of action on alcohol deaths 'could set Scotland back 30 years'

Oddly, however, it is the opposite end of the spectrum which is showing a more obvious uptick.

In the 20 to 24 age group, the mortality rate in January to March this year was 15% higher than the five-year average.

This sounds dramatic, but it also has to be put into the context of comparatively small numbers: a total of 43 deaths were registered, translating into a mortality rate of 55 per 100,000 versus a five-year average of 48 per 100,000.

To put it another way, if you were aged 20 to 24 and living in Scotland from January to March this year your probability of dying was roughly one in 1,820.

The small numbers involved mean that the death rate for this age group is more vulnerable to random fluctuations, but it is a trend that deserves to be monitored nonetheless and investigated if it continues.

Notably, the overall picture for young adults - 20 to 39-year-olds - shows a 10% reduction in mortality: 334 deaths per 100,000 in January to March compared to the five-year average of 371 per 100,000.

There were 519 deaths in January to March where Covid was registered as the main cause, compared to 945 in the same period in 2022 (Image: PA)

Arguably the more important question for policymakers is what are people dying from, and were those deaths preventable?

Based on the ASMR data, we can say that death rates from cancer and dementia (including Alzheimer's disease) are down compared to the five-year average - as of March by 1.7% and 1.8% respectively.

Deaths from non-Covid respiratory causes (a broad category that could include flu, pneumonia, bronchitis, COPD, asthma) had also declined by March, to 1.5% below the five-year average.

The death rate from circulatory causes (strokes, blood clots, heart attacks, heart disease, brain haemorrhages and so on) is up very slightly, at around 1%.

This is somewhat surprising given that Covid - which remains prevalent - is known to make the blood stickier, increasing the risk of clots.

The mortality rate for Covid itself has halved in the past year, although testing has also been cut back and this relates specifically to cases where the infection is listed as the single "underlying" (ie. main) cause of death.

READ MORE: Why are cancer deaths in Scotland lower in 2022 than before Covid? 

What really stands out is the death rate from "other" causes - an umbrella term for "everything else".

In the first quarter of 2023, the "other" death rate was 13% higher than the five year average (324 versus 286 per 100,000) and, by some distance, the highest it has been since records began in 2005.

The category accounted for one in four deaths registered during that period (4,377 out of 17,464).

It is difficult to say what exactly is driving the trend, but some clues might lie in the last detailed breakdown from NRS covering deaths during the final quarter of 2022.

NRS analysis for 2021 showed an increase in the rate of alcohol-specific deaths. Data for 2022 and 2023 is not yet available. In comparison, the suicide rate in 2021 fell, but again no data is currently available for 2022 or 2023 (Image: NRS)

Suicide rate for Scotland as of 2021 (Image: NRS)

Compared to the five year average, it showed that the number of deaths (not death rate) from diabetes was up 12%; falls by 12%; chronic liver disease by 9%; and diseases of the kidney and ureter by 19%.

This could hint at a mixture of problems, from alcohol abuse aggravated during the pandemic to chronic conditions such as diabetes deteriorating as the NHS becomes overloaded.

Detailed scrutiny of the "other" category by NRS would be welcome in order to answer those two key questions: what's really going on, and was it avoidable?