Deaths Registered as Occurring 'Elsewhere' 15 February 2011 - National End of Life Care Intelligence Network (NEoLCIN) / National End of Life Care Programme In the three year period between 2007 and 2009 by ONS 26,716 deaths (2% of all deaths) are described by ONS as occurring at "other private address or other place". This phrase means an address not recognised as a communal establishment and not the persons usual place of residence. This report analyses deaths registered as occurring elsewhere during that three year period.

1. National End of Life
Care Programme
Improving end of life care
Deaths Registered as Occurring
‘Elsewhere’
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www.endoflifecare-intelligence.org.uk
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2. Deaths Registered as Occurring ‘Elsewhere’
National End of Life Care Intelligence Network
Authors
Andy Pring, Senior Analyst, South West Public Health Observatory
Dr Julia Verne, Director, South West Public Health Observatory
Contents
1.
Introduction ................................................................................................................................. 2
1.2
Definition of terms .............................................................................................................. 2
1.3
Note on the source of data in this report ............................................................................ 2
2.
Number of deaths that occur „Elsewhere‟ .................................................................................. 2
3.
Variation with age ....................................................................................................................... 3
3.1
3.2
4.
The proportion of deaths that occur „Elsewhere‟ by age .................................................... 3
Distribution of deaths by age .............................................................................................. 3
Variation with gender .................................................................................................................. 4
4.1
5.
Gender and age ................................................................................................................. 4
Variation with cause of death ..................................................................................................... 4
5.1
Cause of death and age ..................................................................................................... 5
5.2
Cause of death and gender ................................................................................................ 5
Publication details
Published by: National End of Life Care Intelligence Network
Publication date: February 2011
ISBN: 978-0-9569225-8-8
1

3. Deaths Registered as Occurring ‘Elsewhere’
National End of Life Care Intelligence Network
1. Introduction
The deaths of 1,405,722 people were registered in the three year period between 2007 and 2009
by ONS, an average of 468,574 each year.
In these 3 years 26,716 deaths (2% of all deaths) are described by ONS as occurring at “other
private address or other place”. This phrase means an address not recognised as a communal
establishment and not the persons usual place of residence. Other places include other people‟s
residence, roads (traffic accidents), public venues (sports venues, shops, restaurants…), work
places, parks, woods, etc. People who are pronounced dead on arrival at hospital will also be in
this group.
The End of Life Care Intelligence Network reports and maps have routinely included all the nonmedical communal establishments together with all the places cited above into an elsewhere
category. This captures a further 1,937 deaths, totalling 28,653. The 1,937 deaths occurred at
convents, prisons, hostels, homes for the disabled etc.
This report has concentrated on the ONS defined 26,716 deaths.
It would have been useful to distinguish private from public addresses as place of death categories
with „Elsewhere‟ i.e. identify deaths which occurred at another person‟s home, however the
available place of death description does not make that easily possible. For ease of reporting, all
deaths are given a postcode, but it is not possible to be certain, for example, whether a death
occurred inside or outside of a building, or whether an address is a private residence or public
building or private business address.
1.2 Definition of terms
The definition of the term used throughout this report is given as;
Underlying cause of death: is the disease or injury that initiated the train of events directly linked
to death; or the circumstances of the accident or violence that produced the fatal injury.
1.3 Note on the source of data in this report
Information in this report has been derived from the Annual Public Health Mortality Extract (2010),
produced by the Office of National Statistics based on Death Certificate data.
2. Number of deaths that occur
‘Elsewhere’
Of the 1,405,722 deaths registered between 2007 and 2009, 26,716 (2%) died elsewhere.
2

4. Deaths Registered as Occurring ‘Elsewhere’
National End of Life Care Intelligence Network
3. Variation with age
3.1 The proportion of deaths that occur ‘Elsewhere’ by
age
Although 2% of all deaths occurred „Elsewhere‟, this proportion varies considerably by age.
16% of deaths of people aged 1-19 years and 19% of deaths of people aged 20-39 years occurred
„Elsewhere‟ (Table 1).
The proportion of deaths in the most elderly people (80 years or over) that occurred „Elsewhere‟
was the lowest (1%) of all age-bands other than 0 years.
Table 1: Proportion of all deaths that occur ‘Elsewhere’ by age
Age in years (%)
0
Elsewhere
1-19
1
20-39
40-59
60-79
16
19
5
80+
2
1
All
ages
2
Source: ONS Annual Public Health Mortality Extract (2010)
3.2 Distribution of deaths by age
Most deaths between 2007 and 2009 were aged 80 years or older (53%). Those deaths that occur
„Elsewhere‟ are much less dominated by the elderly, about half of all „Elsewhere‟ deaths were
under 60 years of age (49%) compared with 12% of all deaths (Table2).
Table 2: Proportion of deaths that occur in each age-band: ‘Elsewhere’ and all deaths
Age in years (%)
0
1-19
20-39
40-59
60-79
80+
Total
Elsewhere
0
4
20
25
30
21
100
All deaths
1
0
2
9
35
53
100
Source: ONS Annual Public Health Mortality Extract (2010)
3

5. Deaths Registered as Occurring ‘Elsewhere’
National End of Life Care Intelligence Network
4. Variation with gender
Most „Elsewhere‟ deaths occur in males (68%) compared with 48% of all deaths.
4.1 Gender and age
The variation with age is stronger within males than females – about a 1 in 5 of deaths in males
aged under 40 years occur „Elsewhere‟, compared to about 1 in 10 of deaths in females aged
under 40 (Figure 1).
Figure 1: Proportion of all deaths that occur Elsewhere by sex
Percentage of deaths
25%
20%
15%
10%
5%
0%
0
1-19
20-39
40-59
60-79
80+
All ages
Age in years
Male
Female
Source: ONS Annual Public Health Mortality Extract (2010)
5. Variation with cause of death
Many of the „Elsewhere‟ deaths have External Cause as the underlying cause of death (Table 3).
„Elsewhere‟ deaths will include many fatal transport accidents together with deaths caused by other
accidents, assaults and self harm many of which will occur outside the home, possibly in a public
place.
Table 3: Distribution of underlying cause of death
Cause of death
Acute cardio-vascular (inc stroke
and myocardial infarction)
Cancer
Other non-external causes
Self harm or Open
Transport Accident
External
Falls & Other
causes
accidents
Assault
All causes
Elsewhere
(%)
All deaths
(%)
28
30
18
16
15
14
28
38
1
1
7
2
2
100
<0.5
100
Source: ONS Annual Public Health Mortality Extract (2010)
4

6. Deaths Registered as Occurring ‘Elsewhere’
National End of Life Care Intelligence Network
5.1 Cause of death and age
Death „Elsewhere‟ caused by Transport accidents, Self harm or open verdict, assault and other
accidents are concentrated in younger people (20-60 years), see Table 4. While older people are
susceptible to falls that can occur „Elsewhere‟, they are likely to survive long enough to be moved
home or to hospital so the place of death is not “Elsewhere”.
Table 4: Proportion (%) of ‘Elsewhere’ deaths within each cause by age-band
Age in years (%)
0
Acute cardio-vascular (inc stroke and
myocardial infarction)
Cancer
Other non-external causes
Self harm or open
External
verdict
causes
Transport accident
Falls & other
accidents
Assault
All causes
1-19
20-39
40-59
60-79
80+
All
ages
0
0
1
0
0
2
2
3
18
22
14
24
48
46
25
28
37
30
100
100
100
0
0
4
15
41
43
41
27
12
11
2
4
100
100
0
0
0
7
16
4
45
48
20
34
25
25
9
9
30
5
2
21
100
100
100
Source: ONS Annual Public Health Mortality Extract (2010)
5.2 Cause of death and gender
The distribution of cause of deaths the occur „Elsewhere‟ differ between the genders (chart);
External causes are more common amongst males.
While among „Elsewhere‟ deaths acute cardio-vascular disease is more common in males than
females, both cancer and other non-external causes are more common in females. As women
tend to outlive their spouse, it could be that women are more likely than men to die in the home
of a relative i.e. in a place other than their usual residence.
Figure 2: The distribution of ‘Elsewhere’ deaths by cause of death for each gender
Percentage of deaths
40
20
0
20
40
Cardio-vascular
Cancer
External causes
Other non-external causes
Self harm or Open
Transport Accident
Falls and Other accidents
Assault
Male
Female
Source: Office of National Statistics Annual Public Health Mortality Extract (2010)
5

8. About the South West Public Health
Observatory
About the National End of Life Care
Intelligence Network
The South West Public Health Observatory (SWPHO)
is part of a network of regional public health
observatories in the UK and Ireland. These were
established in 2000 as outlined in the Government
White Paper Saving lives: our healthier nation. Key
tasks include: monitoring health and disease trends;
identifying gaps in health information; advising on
methods for health and health impact assessment;
drawing together information from different sources;
and carrying out projects on particular health issues.
The Department of Health’s National End of Life
Care Strategy, published in 2008, pledged to
commission a National End of Life Care Intelligence
Network (NEoLCIN). The Network was launched
in May 2010. It is tasked with collating existing
data and information on end of life care for adults
in England. This is with the aim of helping the
NHS and its partners commission and deliver high
quality end of life care, in a way that makes the
most efficient use of resources and responds to the
wishes of dying people and their families.
The SWPHO incorporates the National Drug
Treatment Monitoring System South West (NDTMSSW), and in April 2005 merged with the South West
Cancer Intelligence Service (SWCIS). The SWPHO
works in partnership with a wide range of agencies,
networks and organisations regionally and nationally
to provide ‘a seamless public health intelligence
service’ for the South West.
For more information about the SWPHO and its
partners, please visit www.swpho.nhs.uk.
Photograph on front cover supplied by Duchessa.
SWPHO is part of the UK & Ireland
Association of Public Health
Observatories.
Key partners include the National Cancer
Intelligence Network (NCIN), which will work
closely with the Network to improve end of life care
intelligence; and the South West Public Health
Observatory, lead public health observatory for end
of life care, which hosts the NEoLCIN website. The
SWPHO has been commissioned to produce key
outputs and analyses for the Network, including the
national End of Life Care Profiles.
See www.endoflifecare-intelligence.org.uk for
more information about the Network and its
partners.
© Crown Copyright 2011