Introduction

The CSO has a policy of careful and considered investigation of a data source before employing it to inform official statistics. However, as a result of the COVID-19 pandemic, the CSO began to explore experimental ways of obtaining up-to-date mortality data. The CSO published the first analysis of death notices using the website RIP.ie in July 2020. The initial analysis explored the use of death notices on RIP.ie to measure trends in mortality, finding a strong correlation between death notices and CSO official mortality statistics for the years 2016 and 2017.

Due to the Irish custom of holding funerals within two to three days following death, these notices are usually placed in a fast and efficient manner, providing a valuable crowd-sourced means of tracking deaths. The notices are placed close to 'real time', we found that the average length of time between date of death and publication is about 1.1 days. When compared with the statutory time limit of three months¹ for the registrations of deaths in the State, this is a timelier data source for monitoring trends in mortality.

Analysis of death notices was conducted as far back as 1 October 2019, to include the last month before the first global cases of COVID-19 were notified. This updated release covers the period October 2019 to September 2020 providing a full year analysis of trends in mortality using death notices.

Measuring Excess Mortality

The COVID-19 pandemic has highlighted the challenges in obtaining timely statistics on mortality and, in particular, excess mortality (deaths over and above what would be expected under normal circumstances). Measuring the impact of such events on mortality trends can play an important role in policy and response efforts and in determining any additional impact on mortality related to the COVID-19 pandemic and its effects. However, measurement of excess mortality is not straightforward. In order to most accurately measure excess mortality due to COVID-19 as part of this study, it would be necessary to clean and classify death notices on RIP.ie compared with the GRO for several previous years. Adjustments might be required for broadband penetration, differing levels of expatriate usage and controlling for potential changes in road traffic fatalities due to changes in vehicular activity and influenza deaths due to fewer personal interactions.

Figure 3 below shows the monthly recorded death notices for October 2019 – September 2020, this is compared with CSO mortality figures for the same period for the years 2014 to 2019. While there are observable seasonal peaks, there is significant variance year on year. However, a clear increase can be seen in the level of death notices observed in April of this year which contrasts with observed dips in mortality levels in April of all previous years. A total of 3,503 death notices were recorded in April, which is over 900 higher than the next highest number of deaths recorded in April in any of the previous five years (2,594 in April 2018). The number of death notices decreased in May and June (to 2,639 and 2,205 respectively) and has begun to rise slowly between July and September 2020 in line with the trends seen in previous years.

Total Death Notices and COVID-19

The changing structure of death notices by gender over the period October 2019 to September 2020 can be seen by clicking on a month below:

Oct 2019 Nov 2019 Dec 2019 Jan 2020 Feb 2020 Mar 2020
Apr 2020 May 2020 Jun 2020 Jul 2020 Aug 2020 Sep 2020

Death Notices and Place of Death

The death notice often contains information about the place of death. For example, the death notice often indicates that the deceased died

• suddenly, at home
• in the tender loving care of the staff of a named nursing home
• unexpectedly, under the care of the doctors and nurses of a named hospital
• tragically, following an accident
• peacefully, at a named hospice
• on holiday, in a named foreign country
• at home, in a named foreign country

From the information in the death notice it was possible to compile the place of death for more than 80% of cases. It was also possible to identify a death on holiday, an expatriate (emigrant) death and the death of a citizen of Northern Ireland. Care was taken for deaths around the border between Ireland and Northern Ireland, as there are cases where it remains unclear which side of the border the deceased resided, despite the place of death. It appears possible that for those living close to the border, their funeral mass may be celebrated on one side, with burial on the other. Those dying on holiday have been classified as if they had died in Ireland, whereas Northern Ireland and expatriate deaths have been grouped together.

Often, the place of death was suggested or ambiguous, but not explicitly stated. For example, the deceased may have died 'surrounded by their loving family', without stating the setting. Another implication of the place of death was the suggestion of a donation to a named facility, e.g. hospice or community hospital patient comfort fund. However, these were often ambiguous, e.g. two or more donation recipients being suggested simultaneously. In the absence of an explicit place of death, notices were deemed to be other/unstated⁵.

Death Notices and Older Persons' Facilities

It was also possible to derive information on deaths in facilities for older people, (e.g. 'in the care of the staff of named facility'), most of which are registered with the Health Information and Quality Authority (HIQA). HIQA's Older People's inspection team are legally responsible for the monitoring, inspection and registration of designated centres for older people, such as nursing homes, in Ireland⁶. This analysis focussed on mentions of HIQA-registered older persons' facilities⁷.

Although the total number of residents at the beginning of the pandemic in Ireland has not been possible to ascertain, the populations of nursing homes according to the national censuses in 2011 and 2016 were 20,802 and 22,762 respectively⁸. The definition of a census nursing home may differ slightly from the definition used for this study. According to Census 2016, approximately 66.4% of nursing home residents were female with an average age of approximately 85, while males with an average age of around 81 accounted for the remaining 33.6%. Therefore, in 2016, there were almost twice as many women as men in nursing homes, and women were on average around four years older than men. As such, it is not unusual to see a greater proportion of deaths amongst females. For the period October 2019 to February 2020, between 56.2% and 60.6% of death notices in a HIQA registered older persons’ facilities were females. For the months of March-September this figure was between 56.8% and 64.2%.

Acknowledgements

The CSO would like to acknowledge the contribution to this publication of Dr. Mary Hall (Dublin City University) and Dr. Shane Whelan (University College Dublin). The CSO is grateful to RIP.ie for the use of their website.

For further COVID-19 related information go to the CSO COVID-19 Information Hub

Methodological Notes

To calculate excess mortality, we subtract the number of death notices we would have expected to see in the absence of the pandemic from the number of death notices we observed. 

Observed Death Notices

Each death notice pertaining to a date of death between October 1st 2019 and September 30th 2020 (the period under investigation) was read, cleaned and classified. Cleaning involves removing:

• Death notices pertaining to expatriate deaths
• Death notices pertaining to Northern Irish citizens
• Nulls – these are empty records which contain no information, a result of the web-scraping process
• Duplicates, which are so rare as to be negligible

The high-level results of this work are below, showing the proportions of valid death notices, expatriate and Northern Irish death notices and nulls. It is broken down into pre-COVID (October 2019 to February 2020) and post-COVID (March 2020 to September 2020) periods as it was assumed, due to the increased levels of mortality in expatriate centres such as the UK and US, that there would be a greater proportion of expatriate/NI death notices than would be observed in the absence of the pandemic.

As can be seen, the proportion of Irish death notices for the period before the pandemic is approximately 92.2%.

Expected Death Notices

Expected death notices are calculated as the death notices we would be have expected to see during the period March to September 2020 in the absence of the pandemic. We calculated expected death notices in three different ways:

• The same as the number of death notices in the previous year
• The average of the last 2 years
• The average of the last 3 years

It took considerable resources to read the more than 34,000 death notices for the twelve months period under investigation. It was not possible to repeat the process for the previous five years, so another method was used. The web address (or webpage or URL) of each death notice on rip.ie is constructed using an incremental number. As the landing page allows one to search and sort by date, it was possible to reference these incremental numbers against the death notice publication dates and determine an index. The results of this exercise are below. Furthermore, the proportion of Irish death notices has been determined by multiplying this figure by the 92.2% calculated earlier. This is first shown for the usual calendar year of January to December, for the years 2015 to 2019 inclusive. This allowed us to compare the results against a similar exercise carried out by HIQA in July. They used the same data, but a different method.

While its application to earlier years assumes the distribution is uniform across time, the figure of 92.2% was arrived at through rigorously reading through every record for a 12 month period. As there was also an element of modelling to arrive at the independently-calculated HIQA values, the values calculated in this method were considered to be acceptable. This exercise was repeated back to the beginning of October 2014 to align with the period under investigation. The resulting data is referred to as the Death Notices and can be seen in Figure 2.

Comparison of Death Notices to Deaths by Occurrence

Deaths by Occurrence measure deaths by the date on which they occurred. Death notices were also analysed by date of death. At the time of writing, the CSO had published monthly deaths by occurrence up to and including December 2017. Furthermore, the CSO had published annual provisional deaths by occurrence for the calendar years 2018 and 2019. A monthly series of 24 months was constructed from the provisional annual data for 2018 and 2019, extending the monthly series of deaths from October 2014 to September 2019. The annual provisional figures were apportioned to months using death registrations with the General Register Office (by date of death) for the years 2018 and 2019. This was on the basis that this was the best indication available at the time of writing of a monthly distribution for the years 2018 and 2019. It is important to have an accurate monthly distribution as we are calculating an excess death notice figure for a period of months – in this case, the seven-month period March to September 2020.

Although the CSO deaths by occurrence are not being used to calculate excess mortality at this time, they are singular as an official benchmark to measure death notices against. As noted in the HIQA report, there is an undercount of death notices relative to deaths by date of occurrence the further one goes back in time. Reasons for this phenomenon may be explained by market penetration, regional variations, use of competing services, broadband usage and IT literacy. Other complexities ignored in this analysis are the different timing of the flu seasons in different countries and the mortality of expatriates, which could impact the proportion of expatriate death notices in different months. It is noted that the resulting expected death notices are lower than if we were to adjust for this undercount. Part of the discrepancy in 2018 and 2019 may be attributable to the fact that the annual data from which the months are derived, are provisional.

The ad hoc and experimental nature of this updated analysis is noted; however, death notices continue to competently track registrations, albeit with a mean lag of one day compared with a mean lag of 63 days for registrations.

---

Footnotes

¹Registering a Death in Ireland

²The analysis of COVID-19 confirmed deaths by date does not include numbers for probable COVID-19 deaths (which are included in totals provided by the National Public Health Emergency Team). It was not possible to provide analysis of probable COVID-19 deaths by date. For full analysis of COVID-19 confirmed and probable deaths please see the COVID-19 Deaths and Case Statistics releases.

³Death Events Service, contains details on all deaths notified to the General Register Office 

⁴Statement from the National Public Health Emergency Team (NPHET), 01 October 2020

⁵Cases where the place of death was unclear or unstated have been combined with cases where the circumstances of death are potentially identifiable. These low-frequency instances include: 1) there were a small number of deaths at residential facilities for retirees of religious vocations that are not regulated by HIQA; 2) deaths due to accident; 3) deaths at residential facilities caring for people living with mental health issue.

⁶HIQA - Older People's Services

⁷Register of Older Person's Facilities (CSV download)

⁸StatBank E3008 (Age Profile of Ireland)

---