Winter mortality
Winter mortality in the UK is higher than in some colder European countries. How are deaths during winter monitored, and what evidence exists for interventions to prevent these deaths?
DOI: https://doi.org/10.58248/PN752
Winter mortality in the UK is higher than in some colder European countries, suggesting some of these deaths may be preventable. Recent winters have had fluctuating numbers of excess winter deaths (EWD), with the highest EWD recorded during the covid-19 pandemic.
Cold temperatures, infections, fuel poverty and poor housing contribute to winter mortality, particularly among older adults, children and people with long-term health conditions.
Winter mortality in the UK has been linked to fuel poverty, changes to welfare and pressures on the NHS.
The Office for National Statistics (ONS) reported EWD from 1950 to 2022. Between 2000 and 2019, EWD ranged from 20,000 to 50,000 a year. The winter of 2020–21 had a record 60,760 EWD, partly due to covid-19.
Since 2023, the ONS, the Office for Health Improvement and Disparities (OHID), and the UK Health Security Agency have used different statistical models to monitor excess mortality. OHID’s model has not detected excess mortality during winter months since July 2023, though seasonal EWD comparisons continue to show higher numbers of deaths during winter than other times of year.
Cold exposure increases mortality. Most cold-related deaths occur on moderately cold days, as these are more frequent than extremely cold days.
Cold weather exacerbates chronic conditions such as cardiovascular disease, respiratory illnesses and dementia. Respiratory infections including flu, covid-19 and respiratory syncytial virus (RSV) are more prevalent in winter and can also exacerbate chronic conditions.
In 2024–25, flu hospitalisations reached record levels, while covid-19 admissions and deaths were lower than in previous years. RSV remained a significant cause of hospitalisation and death in young children and older adults. Falls-related injuries also increase in winter.
Older adults, particularly those over 90, and children under one year are especially vulnerable. It has been estimated that 10% of EWD are attributable to fuel poverty and 21.5% to cold homes. Rough sleepers, people with multiple health conditions and pregnant women are also at greater risk. Social isolation and NHS winter pressures further contribute to vulnerability.
Winter mortality varies across England. Cold-related deaths are more common in socioeconomically deprived areas. In 2023–24, Northern Ireland had a slightly higher winter mortality index than other UK nations. International comparisons show lower winter mortality in colder countries like Sweden and Finland, which has been attributed to better housing and behavioural adaptations.
Cold-related deaths outnumber heat-related deaths in England. Between 2000 and 2019, cold temperatures were linked to over 60,000 deaths annually, compared with fewer than 800 heat-related deaths.
Climate change is expected to reduce the number of extremely cold days. Cold-related mortality is still predicted to increase over the first half of this century due to population ageing and growth. Respiratory infections may become less seasonal, increasing year-round illness.
Short-term and long-term interventions to address winter mortality span health, housing and energy sectors. Vaccination programmes for flu, covid-19 and RSV are effective in reducing winter illness and death, though uptake remains low in some groups. A range of financial support and energy efficiency schemes have been used to target fuel-poor homes, with some evidence of positive effects on health.
Stakeholders highlighted the need for improved data collection, targeted interventions and cross-sector coordination. Suggestions included addressing barriers to vaccination, tackling the underlying causes of fuel poverty and expanding the roll-out of home energy efficiency interventions alongside ensuring adequate ventilation. Climate resilience and the need for robust evaluation of interventions were also raised.
This briefing was produced in consultation with experts and stakeholders, who are listed at the end of the briefing. The briefing was co-funded by the Medical Research Council. POST would like to thank everyone who contributed their expertise.