Excess Deaths Attributable to Influenza in England and Wales: Age at Death and Certified Cause
Abstract
The multiple regression statistical method has already been used to estimate excess deaths attributable to influenza in England and Wales by winter period. Now we report further studies of deaths by age group and certified cause of death. During the ten winters since the influenza A/Hong Kong (H3N2) virus first arrived (1968/69 to 1977/78) there have been about 120,000 excess deaths. Of these about 82% were estimated to be in those aged 65+ years, 17% in the 40-64 year age group and 1% in younger adults. Sixty-seven per cent were certified as due to respiratory disease and 31% due to circulatory system disease. Respiratory deaths increased in all age groups during an epidemic, but of the deaths certified as due to circulatory disease, cerebrovascular deaths were mostly in the 65+ age group and ischaemic heart disease deaths in the 40-64 year age group. In this 40-64 year age group there was evidence that the effects of cold weather and epidemic influenza were multiplicative rather than additive. During the worst influenza winter of 1969/70 respiratory deaths increased by approximately 55% and circulatory system deaths by 4%. Deaths in the elderly increased by 10%, in those aged 40-60 years by 8% and in younger adults by 4%. There was no evidence that excess deaths are followed by a deficit during the following year.
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Excess all-cause mortality has been widely used to quantify the mortality toll of previous epidemics such as influenza and HIV.
“This approach for estimating excess all-cause mortality has been widely used to quantify the mortality toll of previous epidemics such as influenza6 or HIV7 and has also begun to be applied for COVID-19.1 8”
From Estimating the burden of the COVID-19 pandemic on mortality, life expectancy and lifespan inequality in England and Wales: a population-level analysis (2021) · cites this paper as [6]
In the 1969/70 second wave, deaths in the elderly increased by 10%, in those aged 40-60 years by 8%, and in younger adults by 4%.
“Deaths in the elderly increased by 10%, in those aged 40–60 years by 8% and in younger adults by 4%.”
From Bacterial and viral infections associated with influenza (2013) · cites this paper as [29]
Excess respiratory deaths were recorded in the second wave of the 1969/70 pandemic and increased by approximately 55%, and circulatory system deaths by 4%.
“However, excess respiratory deaths were recorded in the second wave of the pandemic in 1969/70 and increased by approximately 55% and circulatory system deaths by 4%.”
From Bacterial and viral infections associated with influenza (2013) · cites this paper as [29]
In 1969, England and Wales saw a 55% increase in respiratory deaths, of which co/secondary bacterial infection was a major contributor.
“In 1969, England and Wales saw a 55% increase in respiratory deaths, of which co/secondary bacterial infection was shown to be a major contributor (Tillett et al., 1983).”
From Secondary bacterial infections associated with influenza pandemics (2017) · cites this paper as Tillett et al., 1983
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LEE, J.-S., SHIN, K.-C., NA, B.-K., et al. (2007) · Epidemiology and Infection · doi:10.1017/s0950268807007820 · Cited by 23 · see citing works
“last longer and produce lower clinical incidence peaks [18, 19].”
BackgroundSruamsiri, R., Ferchichi, S., Jamotte, A., Toumi, M., Kubo, H., & Mahlich, J. (2017) · Influenza and Other Respiratory Viruses · doi:10.1111/irv.12505 · Cited by 23 · see citing works
“Influenza as primary medical diagnosis 2343 (44) 924 (67) 169 (26) 1250 (38) 445 (68)”
Deaths in winter in Northern Ireland: the role of low temperature.
McKee, M. (1990) · PubMed · Cited by 23 · see citing works
Autoimmune Nature of Influenza Atherogenicity
Gurevich, V. S., Pleskov, V. M., & LEVAYA, M. V. (2005) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1313.092 · Cited by 22 · see citing works
“It may be concluded from the data reviewed here that the following main potential autoimmune mechanisms exist whereby influenza plays a role in the development and progression of atherosclerotic vascular injury: (1) in some cases, the effect may simply be that of enhancing the lipid peroxidation as a result of inflamm…”
BackgroundElevated infection parameters and infection symptoms predict an acute coronary event
Pesonen, E. J., Andsberg, E., GRUBB, A. O., et al. (2008) · Therapeutic Advances in Cardiovascular Disease · doi:10.1177/1753944708098695 · Cited by 21 · see citing works
“ity for coronary heart disease increases [Tillett et al. 1983], but influenza vaccination decreases mortality [Gurfinkel et al.”
BackgroundTime series methods for obtaining excess mortality attributable to influenza epidemics
Nunes, B., Natário, I., & Carvalho, M. L. (2010) · Statistical Methods in Medical Research · doi:10.1177/0962280209340201 · Cited by 21 · see citing works
Bird flu: if or when? Planning for the next pandemic
Sellwood, C., Asgari‐Jirhandeh, N., & Salimee, S. (2007) · Postgraduate Medical Journal · doi:10.1136/pgmj.2007.059253 · Cited by 21 · see citing works
Influenza diagnosis and treatment: a view from clinical practice
Fleming, D. (2001) · Philosophical Transactions of the Royal Society B Biological Sciences · doi:10.1098/rstb.2001.1008 · Cited by 21 · see citing works
“In the pandemic of 1969-1970 it was estimated at 28 000 (Tillett et al. 1983) and in 1989 it was estimated at 25000 (Curwen et al.”
BackgroundInfluenza—a trigger for acute myocardial infarction
Dvorakova, A., & Poledne, R. (2003) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2003.09.005 · Cited by 20 · see citing works
Weber, T. P., & Stilianakis, N. I. (2008) · Photochemistry and Photobiology · doi:10.1111/j.1751-1097.2008.00416.x · Cited by 20 · see citing works
Avoidable mortality risks and measurement of wellbeing and inequality
Tang, K. K., Chin, J. T. C., & Rao, D. S. P. (2007) · Journal of Health Economics · doi:10.1016/j.jhealeco.2007.08.003 · Cited by 20 · see citing works
Cardiovascular protection by anti-inflammatory statin therapy
Howard-Alpe, G. M., Foëx, P., & Biccard, B. M. (2008) · Best practice & research. Clinical anaesthesiology · doi:10.1016/j.bpa.2007.08.001 · Cited by 19 · see citing works
Mucormycosis an added burden to Covid-19 Patients: An in-depth systematic review
Shah, N. N., Khan, Z., Ahad, H., Elderdery, A. Y., Alomary, M. N., Atwah, B., Alhindi, Z., Alsugoor, M. H., Elkhalifa, A. M. E., Nabi, S. U., et al. (2022) · Journal of Infection and Public Health · doi:10.1016/j.jiph.2022.10.011 · Cited by 18 · see citing works
“In 1968 Hong Kong pandemic, England and Wales observed 55 % increased incidence of pneumonic deaths in which bacterial pneumonia was the major contributor [31].”
BackgroundJoint Extremes in Temperature and Mortality: A Bivariate POT Approach
Li, H., & Tang, Q. (2020) · North American Actuarial Journal · doi:10.1080/10920277.2020.1823236 · Cited by 16 · see citing works
“It is widely recognized that elderly are more vulnerable to extreme climate events (see, e.g., Tillett, Smith, and Gooch 1983; Åstr€om, Bertil, and Joacim 2011).”
Excess winter mortality: Method of calculating mortality attributed to influenza is disputed
Fleming, D., Cross, K. W., Watson, J. M., et al. (2002) · BMJ · doi:10.1136/bmj.324.7349.1337 · Cited by 17 · see citing works
“Data covering the period 1970-99 were used, but the authors state that the regression analysis started on 1 January 1990. On the basis of the 10 year analysis, they estimate an average of 1265 per million excess winter deaths from all causes, equivalent to 67 000 nationally in England and Wales. They say that 2.4% of…”
ResultInfluential
- Authors
- TILLETT, H. E., SMITH, J. W. G., & GOOCH, C. D.
- Affiliations
- National Institute for Biological Standards and Control (GB)
- Venue
- International Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 1983
- Volume
- 12
- Issue
- 3
- Pages
- 344-352
- ISSN
- 0300-5771 (ISSN-L)
- 1464-3685
- OpenAlex
- W2137780431
- Cited by
- 146
- References
- 0
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 4 · 2020: 5 · 2019: 1 · 2018: 4 · 2017: 5 · 2015: 4 · 2014: 8 · 2013: 6 · 2012: 1
- FWCI
- 0.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Royal College of General Practitioners
- Topics
- Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
- Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
- Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
- Keywords
- influenza, excess mortality, age at death, cerebrovascular disease, ischemic heart disease, older adults, cold weather, multiplicative effects, influenza epidemic, England and Wales
- MeSH terms
- Adolescent, Adult, Age Factors, Aged, Cardiovascular Diseases, Cerebrovascular Disorders, Coronary Disease, England, Humans, Influenza, Human, Middle Aged, Models, Biological, Respiration Disorders, Seasons, Wales
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