Trends In Causality for England, 2014/w23 – 2022/w46 (part 2)
Statistical analysis of a dataset obtained under FOI by Joel Smalley revealing weekly deaths by date of death, age, sex and primary cause of death
You’ll need to refer back to part 1 of this series for all the background gubbins. Without further ado I shall now get the big coffee pot on the stove (on one of those dangerous gas hobs), pop a couple of muffins on my plate, check my personal pronouns and continue with the slide show…
Cause #6: Diseases of the digestive system
Well that’s a relief – there’s no evidence of a strange spike during 2020/w15 (w/e 10th April)! I admit to seasonality for this series being a bit of a surprise but then again our eating and drinking habits generally do take a dive into less healthy waters during the winter months. In fact, with seasonality expressing itself in all manner of ways, it’s beginning to feel like English folk fall well and truly apart during the winter!
The hike after 2019 is interesting in view of various commentaries on the decline of eating habits during the pandemic, and lockdowns in particular. Is this what ready meals, fast food, take-outs and microwave dinners does to the nation? Strewth. My eyeballs also clock a bit of argy-bargy for the tail end of 2022. I guess I better take a closer look at this in a future article.
Cause #7: External causes of morbidity & mortality
Now this is seriously wacko, and rather makes the point that we are missing a fair few deaths owing to delays in processing. It sure looks to me like we can forget 2022 as offering a meaningful count for external causes and this surely casts doubt on all other causes of death.
Folk are bound to ask what is actually meant by external causes, and I have to stress that this chapter covers a rather expansive and wide-ranging coding block from V01 to Y99. I shall briefly summarise the situation thus-wise:
V01-V99: deaths involving traffic/transportation (road, rail, air, sea).
W00-W99: deaths at specific locations (farm, residential home, industrial unit, school, sport arena etc).
X00-X99: deaths at specific locations - continued.
Y00-Y99: deaths caused by specific individuals (spouse, parent, friend etc); deaths caused by legal interventions (war, police action, military operations); deaths caused by pharmaceuticals (penicillins, antivirals, anticoagulants, anaesthetics, benzodiazepenes, vaccines etc); deaths during medical procedures (dialysis, surgery, catheterization, transfusion etc); deaths due to implants and prostheses; deaths due to intoxication and overdose.
This chapter is such a massive catch-all that I’m going to have to come back to dissecting this trend in a future article. I’m going to bet good money that readers will have clocked mention of vaccines, but we’ve also got a mix of causes associated with the younger generations (transport/employment) as well as the older generations (prostheses & medical procedures) - watch this space!
Cause #8: Codes for special purposes
No prizes for guessing what dominates this ICD10 chapter! In terms of peak crude mortality rate COVID-19 beats all other diseases hands down, hitting 14.77 deaths per 100k population during 2021/w3 (w/e 22 Jan), 14.28 deaths per 100k population during 2020/w16 (w/e 17 Apr) and 14.19 deaths per 100k population during 2020/w15 (w/e 10 Apr).
As regards the latter two weeks of mayhem COVID-19 wasn’t alone in striking down the population, for these were also peak weeks for deaths due to cancer, cardiac, mental and nervous system death (see part 1). We must ask just what the heck was going on back in spring of 2020 for five primary causes to peak simultaneously! I smell something fishy and it ain’t my Prik Nam Pla Thai fish sauce I’ll be throwing in a wok later for lunch.
Cause #9: Signs and abnormal findings NEC
Oh look, there goes that fishy spike again popping up during 2020/w15 (w/e 10 Apr)! I’ve abbreviated the title of this chapter because it is a bit of a mouthful (Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified). This chapter is a catch-all for stuff that medics are picking up as diagnostic tests are run and as symptoms develop. It starts simple enough with conditions like tachycardia, bradycardia, dyspnoea, chest pain, nausea, pallor, disorientation, shock, fever and hallucinations, but then goes on to specific abnormalities arising from histopathological work, microbiological work, imaging etc.
If we summarise this chapter as ‘something ain’t right’ then we won’t be far from grasping the jist. The big question is why something wasn’t ‘right’ back in 2020/w15 that didn’t surface again despite viral variants and all manner of dystopian policy. Just what did medics see during the big death week? I guess I better add this time series to the ‘to-be-looked-at-later pile.’
One thing we should note before we slip to the next slide is the general upward trend for ‘something ain’t right’. This could be caused by all manner: from introduction of new diagnostic tools to clinical/management policy changes to improvement in practice to deterioration in the health of the nation to attitudes to health. One thing is for sure and that is it ain’t ever simple. Oh, and don’t forget to clock some seasonality.
Cause #10: Diseases of the genitourinary system
If symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified are going up then diseases of the genitourinary system are going down, and in a rather seasonal manner. And there’s that crazy spike again during 2020/w15 (w/e 10 Apr). WTAF! Let’s just recap on this persistent spike for we now have simultaneous mortality peaks in no less than 7 chapters, these being:
Cause #11: Endocrine, nutritional & metabolic diseases
Well I spoke to soon or, rather, I tabulated prematurely for here we have the 2020/w15 (w/e 10 Apr) spike cropping up in chapter IV Endocrine, nutritional and metabolic diseases. I’m trying to get my head round simultaneous presentation across 8 chapters of ICD-10 and conclude that either undiagnosed SARS-COV-2 performed feats of magic behind the scenes or something else killed a fair few people all at the same time. Such a broad spectrum of death is precisely what I would expect if clinically vulnerable folk in hospital beds were subject to dangerous discharge en masse and/or were placed on end-of-life care pathways that quickly cleared beds for the computer predicted explosion of severe COVID cases that never came.
Setting such depressing thoughts of iatrogenic death aside please note the general upward trend and seasonality. The dip from 2022 onward is likely artefact. We may once again ponder on why the nation has been getting sicker in the endocrine/metabolism department and, of course, incidence of diabetes springs to mind.
As a nipper I recall my grandmother suffered from what the doctor with his black bag used to call “sugar diabetes”; you won’t hear that phrase these days (Google search returns are also thin on the ground), for we now use the sterile expression ‘type 2 diabetes’ and mumble something about poor regulation of glucose.
Cause #12: Certain Infectious & parasitic diseases
This is a rather curious curve! Infectious and parasitic diseases dropped from the radar during 2020 and, since I cannot imagine all those little critters agreed to be helpful little bugs, I can only assume we are looking at the impact of yet more creative coding. Even during lockdown you can scoff a dodgy prawn or under-cook a pork chop on the BBQ, so I don’t buy any official narrative that suggests a billion different bugs played nicely with humans all at the same time.
There used to be some seasonality to infestations that disappeared during the winter of 2020 and 2021. I’m pretty sure it would have been there had death certification been an honest affair. This leaves us with an interesting looking hump for 2022 that doesn’t seem to want to go away. I suspect this may be an indicator of poor gut health but we also have to consider what face nappies have been doing.
Cause #13: Diseases of the musculoskeletal system and connective tissue
This is the first chapter that looks like nothing much happened apart from a decline in seasonality during the winter of 2021. Again I suspect coding is to blame, for the WHO wanted us to track COVID-19 at all costs even if this didn’t make medical sense (their words - check out this article).
To be continued…
Kettle On!
I heard that old statisticians were broken down by age and sex but I didn’t know they suffered premature tabulation. Looking forward to part 3.
Thank you for your important work. The slipperiness of coding may explain some of the synchronous spikes across categories in the ONS data. It perplexes me for instance that Dementia is in a different ICD10 chapter (Mental and behavioural disorders) from Alzheimer’s (Diseases of the nervous system and sense organs).
When a frail elderly person deteriorates and their death is not unexpected, it is a best guess as to what is the underlying cause of death. For example, most people develop a rattly chest at some point in the dying process. Whether we consider that an aspiration pneumonia due to reduced conscious level, a primary or secondary pneumonia, or a sequelae of their dying from frailty, dementia, UTI etc depends on the circumstances, and that can influence the certification. There have been efforts in recent years to improve the consistency of certification to reduce this variability, but it still happens a fair bit.
Do the ONS take the Part 1 underlying cause of death for these statistics? If so then I’m sure there will be similar deaths put under different ICD-10 headings, due to the way the certificate is completed. Examples which I think illustrate this:
1. Person with dementia develops a UTI and subsequently dies:
a. Part 1a Urosepsis 1b UTI 2 Dementia, Type 2 Diabetes = N00-99 XIV. Diseases of the genitourinary system N39 = UTI
b. Part 1a Urosepsis 1b UTI 1c Multi-infarct Dementia 2 Type 2 Diabetes = F00-99 V. Mental and behavioural disorders F01, F03 Dementia
c Part 1a UTI 1b Alzheimer’s = G00-H95 VI-VIII. Diseases of the nervous system and the sense organs G30 Alzheimers Disease
2. Person with Parkinson’s and dementia develops chest symptoms and dies:
a. Part 1a Aspiration pneumonia 1b Severe Parkinson’s Disease and Dementia = G00-H95 VI-VIII. Diseases of the nervous system and the sense organs
b. Part 1a Bronchopneumonia 2 Severe Parkinson’s Disease and dementia = J00-99 X. Diseases of the respiratory system J12-18 Pneumonia
c. Part 1a Influenza 2 Severe Parkinson’s Disease and dementia = J00-99 X. Diseases of the respiratory system J09-11 Influenza
d. Part 1a Covid-19 Part 2 Severe Parkinson’s Disease and dementia = U01-89 XXII. Codes for Special Purposes U07 Covid-19
3. Person with severe frailty gets a flu like illness, then develops cardiac chest pain and dies:
a. Part 1a MI 1b IHD 2 Severe frailty of old age, recent influenza = I00-99 IX. Diseases of the circulatory system I20-25
b. Part 1a MI 1b Covid-19 2 Severe frailty of old age = U01-89 XXII. Codes for Special Purposes U07 Covid-19
c. Part 1a Influenza 1b Severe frailty of old age 2 IHD = Not sure about this one - Severe frailty I think might come under R00-99 XVIII. Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified.
Many of the Covid-19 deaths would have in previous years been classified under different ICD-10 headings if they had followed Influenza-like illness. However as you have alluded to I suspect there will be other structural/policy reasons to explain the synchronous spikes in wk 15.