The influenza pandemic of 1918, known as the Spanish Flu, was one of the deadliest and widespread pandemics in human history. The scale of the outbreak, as well as limitations in technology, medicine and communication, create difficulties when trying to uncover accurate figures relating to the pandemic. Estimates suggest that the virus, known as the H1N1 influenza virus, infected more than one quarter of the global population, which equated to approximately 500 million people in 1920. It was responsible for roughly 25 million fatalities, although some projections suggest that it could have caused double this number of deaths. The exact origins of this strain of influenza remain unclear to this day, however it was first noticed in Western Europe in the latter stages of the First World War. Wartime censorship in Europe meant that the severity of the pandemic was under-reported, while news outlets in neutral Spain were free to report openly about the impact of the virus; this gave the illusion that the virus was particularly strong in Spain, giving way to the term "Spanish Flu".

Effects of the virus

By late summer 1918, the pandemic had spread across the entire continent, and the H1N1 virus had mutated into a deadlier strain that weakened the infected's immune system more than traditional influenzas. Some studies suggest that, in contrast to these traditional influenza viruses, having a stronger immune system was actually a liability in the case of the H1N1 virus as it triggered what is known as a "cytokine storm". This is where white blood cells release proteins called cytokines, which signal the body to attack the virus, in turn releasing more white blood cells which release more cytokines. This cycle over-works and greatly weakens the immune system, often giving way to other infections; most commonly pneumonia in the case of the Spanish Flu. For this reason, the Spanish Flu had an uncommonly high fatality rate among young adults, who are traditionally the healthiest group in society. Some theories for the disproportionate death-rate among young adults suggest that the elderly's immune systems benefitted from exposure to earlier influenza pandemics, such as the "Asiatic/Russian Flu" pandemic of 1889.

Decrease in life expectancy As the war in Europe came to an end, soldiers returning home brought the disease to all corners of the world, and the pandemic reached global proportions. Isolated and under-developed nations were especially vulnerable; particularly in Samoa, where almost one quarter of the population died within two months and life expectancy fell to just barely over one year for those born in 1918; this was due to the arrival of a passenger ship from New Zealand in November 1918, where the infected passengers were not quarantined on board, allowing the disease to spread rapidly. Other areas where life expectancy dropped below ten years for those born in 1918 were present-day Afghanistan, the Congo, Fiji, Guatemala, Kenya, Micronesia, Serbia, Tonga and Uganda. The British Raj, now Bangladesh, India and Pakistan, saw more fatalities than any other region, with as many as five percent of the entire population perishing as a result of the pandemic. The pandemic also had a high fatality rate among pregnant women and infants, and greatly impacted infant mortality rates across the world. There were several waves of the pandemic until late 1920, although they decreased in severity as time progressed, and none were as fatal as the outbreak in 1918. A new strain of the H1N1 influenza virus did re-emerge in 2009, and was colloquially known as "Swine Flu"; thankfully it had a much lower fatality rate due to medical advancements across the twentieth century.

This statistic shows the deaths with influenza as an underlying cause in England and Wales in 2023, by age and gender. In this year, influenza was the underlying cause of *** deaths for women aged 90 years and over. Respiratory disease burden in the UK As of 2023, tuberculosis cases had also been on the rise, with ***** new cases and relapses reported in 2023. The ***** age group was most affected by this respiratory disease, accounting for approximately ***** cases. Pneumonia, another serious respiratory condition, caused over ***** deaths among women aged 90 and older in the same year, with a further ***** men in the same age group having pneumonia as their underlying cause of death. Vaccination prevalence and accessibility In the years 2014-2015, **** percent of individuals aged 65 and over in the North West of England were immunized against influenza. This was the region with the highest share of elderly vaccinated against influenza, while this figure was the lowest in London, around **** percent. Community pharmacies have played a crucial role in providing seasonal influenza vaccination services – as of 2023/24, ** percent of community pharmacies in the South of England offered influenza vaccination advanced service, while in London, the figure reached ** percent.

Provisional counts of the number of death occurrences in England and Wales due to coronavirus (COVID-19) and influenza and pneumonia, by age, sex and place of death.

Between January and August 2020, there has been approximately 48.2 thousand deaths in England and Wales with COVID-19 as an underlying cause. As illustrated in the table, the number of deaths as a result of COVID-19 are much higher than from either pneumonia or influenza. There has been over three times the number of deaths from COVID-19 than pneumonia and influenza so far in 2020. The overall number of confirmed COVID-19 cases in the UK can be found here. For further information about the coronavirus (COVID-19) pandemic, please visit our dedicated Facts and Figures page.

Forecast: Influenza Mortality in the UK 2023 - 2027 Discover more data with ReportLinker!

Over 12 million people in the United States died from all causes between the beginning of January 2020 and August 21, 2023. Over 1.1 million of those deaths were with confirmed or presumed COVID-19.

Vaccine rollout in the United States Finding a safe and effective COVID-19 vaccine was an urgent health priority since the very start of the pandemic. In the United States, the first two vaccines were authorized and recommended for use in December 2020. One has been developed by Massachusetts-based biotech company Moderna, and the number of Moderna COVID-19 vaccines administered in the U.S. was over 250 million. Moderna has also said that its vaccine is effective against the coronavirus variants first identified in the UK and South Africa.

The aim of this project was to examine various aspects of the 1918-1919 influenza pandemic in Britain, particularly in England and Wales. The research was undertaken as part of the depositor's PhD project entitled Aspects of the historical geography of the 1918-19 influenza pandemic in Britain for the University of Cambridge.

Very different influenza seasons have been observed from 2008/09–2011/12 in England and Wales, with the reported burden varying overall and by age group. The objective of this study was to estimate the impact of influenza on all-cause and cause-specific mortality during this period. Age-specific generalised linear regression models fitted with an identity link were developed, modelling weekly influenza activity through multiplying clinical influenza-like illness consultation rates with proportion of samples positive for influenza A or B. To adjust for confounding factors, a similar activity indicator was calculated for Respiratory Syncytial Virus. Extreme temperature and seasonal trend were controlled for. Following a severe influenza season in 2008/09 in 65+yr olds (estimated excess of 13,058 influenza A all-cause deaths), attributed all-cause mortality was not significant during the 2009 pandemic in this age group and comparatively low levels of influenza A mortality were seen in post-pandemic seasons. The age shift of the burden of seasonal influenza from the elderly to young adults during the pandemic continued into 2010/11; a comparatively larger impact was seen with the same circulating A(H1N1)pdm09 strain, with the burden of influenza A all-cause excess mortality in 15–64 yr olds the largest reported during 2008/09–2011/12 (436 deaths in 15–44 yr olds and 1,274 in 45–64 yr olds). On average, 76% of seasonal influenza A all-age attributable deaths had a cardiovascular or respiratory cause recorded (average of 5,849 influenza A deaths per season), with nearly a quarter reported for other causes (average of 1,770 influenza A deaths per season), highlighting the importance of all-cause as well as cause-specific estimates. No significant influenza B attributable mortality was detected by season, cause or age group. This analysis forms part of the preparatory work to establish a routine mortality monitoring system ahead of introduction of the UK universal childhood seasonal influenza vaccination programme in 2013/14.

For the week ending August 29, 2025, weekly deaths in England and Wales were 985 below the number expected, compared with 855 below what was expected in the previous week. In late 2022 and through early 2023, excess deaths were elevated for a number of weeks, with the excess deaths figure for the week ending January 13, 2023, the highest since February 2021. In the middle of April 2020, at the height of the COVID-19 pandemic, there were almost 12,000 excess deaths a week recorded in England and Wales. It was not until two months later, in the week ending June 19, 2020, that the number of deaths began to be lower than the five-year average for the corresponding week. Most deaths since 1918 in 2020 In 2020, there were 689,629 deaths in the United Kingdom, making that year the deadliest since 1918, at the height of the Spanish influenza pandemic. As seen in the excess death figures, April 2020 was by far the worst month in terms of deaths during the pandemic. The weekly number of deaths for weeks 16 and 17 of that year were 22,351, and 21,997 respectively. Although the number of deaths fell to more usual levels for the rest of that year, a winter wave of the disease led to a high number of deaths in January 2021, with 18,676 deaths recorded in the fourth week of that year. For the whole of 2021, there were 667,479 deaths in the UK, 22,150 fewer than in 2020. Life expectancy in the UK goes into reverse In 2022, life expectancy at birth for women in the UK was 82.6 years, while for men it was 78.6 years. This was the lowest life expectancy in the country for ten years, and came after life expectancy improvements stalled throughout the 2010s, and then declined from 2020 onwards. There is also quite a significant regional difference in life expectancy in the UK. In the London borough of Kensington and Chelsea, for example, the life expectancy for men was 81.5 years, and 86.5 years for women. By contrast, in Blackpool, in North West England, male life expectancy was just 73.1 years, while for women, life expectancy was lowest in Glasgow, at 78 years.

IntroductionDuring the 2013–2014 influenza season, Public Health England extended routine influenza vaccination to all 2- and 3-year-old children in England. To estimate the impact of this change in policy on influenza-related morbidity and mortality, we developed a disease transmission and surveillance model informed by real-world data.MethodsWe combined real-world and literature data sources to construct a model of influenza transmission and surveillance in England. Data were obtained for four influenza seasons, starting with the 2010–2011 season. Bayesian inference was used to estimate model parameters on a season-by-season basis to assess the impact of targeting 2- and 3-year-old children for influenza vaccination. This provided the basis for the construction of counterfactual scenarios comparing vaccination rates of ~2% and ~35% in the 2- and 3- year-old population to estimate reductions in general practitioner (GP) influenza-like-illness (ILI) consultations, respiratory hospitalizations and deaths in the overall population.ResultsOur model was able to replicate the main patterns of influenza across the four seasons as observed through laboratory surveillance data. Targeting 2- and 3-year-old children for influenza vaccination resulted in reductions in the general population of between 6.2–9.9% in influenza-attributable GP ILI consultations, 6.1–10.7% in influenza-attributable respiratory hospitalizations, and 5.7–9.4% in influenza-attributable deaths. The decrease in influenza-attributable ILI consultations represents a reduction of between 4.5% and 7.3% across all ILI consultations. The reduction in influenza-attributable respiratory hospitalizations represents a reduction of between 1.2% and 2.3% across all respiratory hospitalizations. Reductions in influenza-attributable respiratory deaths represent a reduction of between 0.9% and 2.4% in overall respiratory deaths.ConclusionThis study has provided evidence that extending routine influenza vaccination to all healthy children aged 2 and 3 years old leads to benefits in terms of reduced utilization of healthcare resources and fewer respiratory health outcomes and deaths.

The 1918 influenza pandemic was characterized by multiple epidemic waves. We investigated reactive social distancing, a form of behavioral response where individuals avoid potentially infectious contacts in response to available information on an ongoing epidemic or pandemic. We modelled its effects on the three influenza waves in the United Kingdom. In previous studies, human behavioral response was modelled by a Power function of the proportion of recent influenza mortality in a population, and by a Hill function, which is a function of the number of recent influenza mortality. Using a simple epidemic model with a Power function and one common set of parameters, we provided a good model fit for the observed multiple epidemic waves in London boroughs, Birmingham and Liverpool. We further applied the model parameters from these three cities to all 334 administrative units in England and Wales and including the population sizes of individual administrative units. We computed the Pearson’s correlation between the observed and simulated for each administrative unit. We found a median correlation of 0.636, indicating that our model predictions are performing reasonably well. Our modelling approach is an improvement from previous studies where separate models are fitted to each city. With the reduced number of model parameters used, we achieved computational efficiency gain without over-fitting the model. We also showed the importance of reactive behavioral distancing as a potential non-pharmaceutical intervention during an influenza pandemic. Our work has both scientific and public health significance.

In 2023 life expectancy for both males and females at birth rose when compared to 2022. Male life expectancy increased from 78.58 years to 78.82 years, and from 82.57 years to 82.77 years for females. Throughout most of this period, there is a steady rise in life expectancy for both males and females, with improvements in life expectancy beginning to slow in the 2010s and then starting to decline in the 2020s. Life expectancy since the 18th Century Although there has been a recent dip in life expectancy in the UK, long-term improvements to life expectancy stretch back several centuries. In 1765, life expectancy was below 39 years, and only surpassed 40 years in the 1810s, 50 years by the 1910s, 60 years by the 1930s and 70 by the 1960s. While life expectancy has broadly improved since the 1700s, this trajectory was interrupted at various points due to wars and diseases. In the early 1920s, for example, life expectancy suffered a noticeable setback in the aftermath of the First World War and Spanish Flu Epidemic. Impact of COVID-19 While improvements to UK life expectancy stalled during the 2010s, it wasn't until the 2020s that it began to decline. The impact of COVID-19 was one of the primary factors in this respect, with 2020 seeing the most deaths in the UK since 1918. The first wave of the pandemic in Spring of that year was a particularly deadly time, with weekly death figures far higher than usual. A second wave that winter saw a peak of almost 5,700 excess deaths a week in late January 2021, with excess deaths remaining elevated for several years afterward.

This data shows premature deaths (Age under 75) from Respiratory Disease, numbers and rates by gender, as 3-year range.

Smoking is the major cause of chronic obstructive pulmonary disease (COPD), one of the major Respiratory diseases. COPD (which includes chronic bronchitis and emphysema) results in many hospital admissions. Respiratory diseases can also be caused by environmental factors (such as pollution, or housing conditions) and influenza. Respiratory disease mortality rates show a socio-economic gradient.

Directly Age-Standardised Rates (DASR) are shown in the data, where numbers are sufficient, so that death rates can be directly compared between areas. The DASR calculation applies Age-specific rates to a Standard (European) population to cancel out possible effects on crude rates due to different age structures among populations, thus enabling direct comparisons of rates.

A limitation on using mortalities as a proxy for prevalence of health conditions is that mortalities may give an incomplete view of health conditions in an area, as ill-health might not lead to premature death.

Data source: Office for Health Improvement and Disparities (OHID) Public Health Outcomes Framework (PHOF) indicator 4.07i. This data is updated annually.

3.84 (per 100,000 inhabitants) in 2018.

Between October 2021 and September 2023, over 100,000 carcasses of wild birds, primarily waterbirds and seabirds, were reported from the UK and Crown Dependencies during a high pathogenicity H5N1 avian influenza (HPAI) outbreak. To document the spatial and temporal mortality in wild birds in the UK, Isle of Man and the Channel Islands during an outbreak of HPAI. Counts of dead birds (mortality data) were collated from UK statutory animal health and nature conservation bodies, online bird recording platforms and conservation organizations, and compared with national avian influenza surveillance data and subsequent population counts at seabird colonies. A total of 103,497 dead individuals (90,062 full grown and 13,435 chicks) of 155 species, plus another 3,976 individuals where the species could not be ascertained, were contained within 11,453 reports of dead birds received during the two-year period. Scotland and England accounted for most of the deaths, with the Northern Gannet Morus bassanus, Black-headed Gull Chroicocephalus ridibundus and Barnacle Goose Branta leucopsis among the most affected species. Over 7,500 bird carcasses were tested for HPAI, with 80 species testing positive. Mortality data closely matched the species testing positive, and there was a positive correlation between the seabird carcasses recorded and population changes observed in 2023. The study demonstrates that mortality data can estimate disease impact, aid in real-time outbreak assessments and support better coordination during future events. Standardizing data collection and linking to disease surveillance systems is recommended for an improved understanding of wild bird health.

Smoking is a leading preventable cause of chronic diseases, including circulatory disease, cancer, and chronic lung conditions, and worsens outcomes in acute illnesses. Despite public health efforts, 13-16% of the UK population still smoke, with higher rates among hospital admissions, especially in older adults who also experience poorer outcomes.

Influenza can cause severe complications, such as ICU admission and death, particularly in older adults and those with chronic respiratory conditions. Smoking further increases the risks of mortality and ICU admission, yet UK-specific data on seasonal influenza in this context remains limited.

This dataset includes 13,524 influenza-related hospital admissions from January 2018 to July 2024, focusing on individuals aged 65 and older. It contains demographics, serial physiology, clinical assessments, diagnostic codes (ICD-10 and SNOMED-CT), initial presentations, ventilation, ICU transfers, prescriptions, and outcomes. While a dataset for all ages is available, this subset emphasizes older adults, who are at greater risk of severe complications, particularly from smoking.

Geography: The West Midlands has a population of 6 million & includes a diverse ethnic & socio-economic mix. UHB is one of the largest NHS Trusts in England, providing direct acute services & specialist care across four hospital sites, with 2.2 million patient episodes per year, 2750 beds & > 120 ITU bed capacity. UHB runs a fully electronic healthcare record (PICS; Birmingham Systems), a shared primary & secondary care record (Your Care Connected) & a patient portal “My Health”.

Data set availability: Data access is available via the PIONEER Hub for projects which will benefit the public or patients. This can be by developing a new understanding of disease, by providing insights into how to improve care, or by developing new models, tools, treatments, or care processes. Data access can be provided to NHS, academic, commercial, policy and third sector organisations. Applications from SMEs are welcome. There is a single data access process, with public oversight provided by our public review committee, the Data Trust Committee. Contact pioneer@uhb.nhs.uk or visit www.pioneerdatahub.co.uk for more details.

Available supplementary data: Matched controls; ambulance and community data. Unstructured data (images). We can provide the dataset in OMOP and other common data models and can build synthetic data to meet bespoke requirements.

Available supplementary support: Analytics, model build, validation & refinement; A.I. support. Data partner support for ETL (extract, transform & load) processes. Bespoke and “off the shelf” Trusted Research Environment build and run. Consultancy with clinical, patient & end-user and purchaser access/ support. Support for regulatory requirements. Cohort discovery. Data-driven trials and “fast screen” services to assess population size.