Based on a comparison of coronavirus deaths in 210 countries relative to their population, Peru had the most losses to COVID-19 up until July 13, 2022. As of the same date, the virus had infected over 557.8 million people worldwide, and the number of deaths had totaled more than 6.3 million. Note, however, that COVID-19 test rates can vary per country. Additionally, big differences show up between countries when combining the number of deaths against confirmed COVID-19 cases. The source seemingly does not differentiate between "the Wuhan strain" (2019-nCOV) of COVID-19, "the Kent mutation" (B.1.1.7) that appeared in the UK in late 2020, the 2021 Delta variant (B.1.617.2) from India or the Omicron variant (B.1.1.529) from South Africa.

The difficulties of death figures

This table aims to provide a complete picture on the topic, but it very much relies on data that has become more difficult to compare. As the coronavirus pandemic developed across the world, countries already used different methods to count fatalities, and they sometimes changed them during the course of the pandemic. On April 16, for example, the Chinese city of Wuhan added a 50 percent increase in their death figures to account for community deaths. These deaths occurred outside of hospitals and went unaccounted for so far. The state of New York did something similar two days before, revising their figures with 3,700 new deaths as they started to include “assumed” coronavirus victims. The United Kingdom started counting deaths in care homes and private households on April 29, adjusting their number with about 5,000 new deaths (which were corrected lowered again by the same amount on August 18). This makes an already difficult comparison even more difficult. Belgium, for example, counts suspected coronavirus deaths in their figures, whereas other countries have not done that (yet). This means two things. First, it could have a big impact on both current as well as future figures. On April 16 already, UK health experts stated that if their numbers were corrected for community deaths like in Wuhan, the UK number would change from 205 to “above 300”. This is exactly what happened two weeks later. Second, it is difficult to pinpoint exactly which countries already have “revised” numbers (like Belgium, Wuhan or New York) and which ones do not. One work-around could be to look at (freely accessible) timelines that track the reported daily increase of deaths in certain countries. Several of these are available on our platform, such as for Belgium, Italy and Sweden. A sudden large increase might be an indicator that the domestic sources changed their methodology.

Where are these numbers coming from?

The numbers shown here were collected by Johns Hopkins University, a source that manually checks the data with domestic health authorities. For the majority of countries, this is from national authorities. In some cases, like China, the United States, Canada or Australia, city reports or other various state authorities were consulted. In this statistic, these separately reported numbers were put together. For more information or other freely accessible content, please visit our dedicated Facts and Figures page.

United Kingdom UK: Mortality Rate: Adult: Female: per 1000 Female Adults data was reported at 53.693 Ratio in 2014. This records a decrease from the previous number of 53.890 Ratio for 2013. United Kingdom UK: Mortality Rate: Adult: Female: per 1000 Female Adults data is updated yearly, averaging 83.533 Ratio from Dec 1960 (Median) to 2014, with 55 observations. The data reached an all-time high of 111.369 Ratio in 1963 and a record low of 53.693 Ratio in 2014. United Kingdom UK: Mortality Rate: Adult: Female: per 1000 Female Adults data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s United Kingdom – Table UK.World Bank.WDI: Health Statistics. Adult mortality rate, female, is the probability of dying between the ages of 15 and 60--that is, the probability of a 15-year-old female dying before reaching age 60, if subject to age-specific mortality rates of the specified year between those ages.; ; (1) United Nations Population Division. World Population Prospects: 2017 Revision. (2) University of California, Berkeley, and Max Planck Institute for Demographic Research. The Human Mortality Database.; Weighted average;

COVID-19 rate of death, or the known deaths divided by confirmed cases, was over ten percent in Yemen, the only country that has 1,000 or more cases. This according to a calculation that combines coronavirus stats on both deaths and registered cases for 221 different countries. Note that death rates are not the same as the chance of dying from an infection or the number of deaths based on an at-risk population. By April 26, 2022, the virus had infected over 510.2 million people worldwide, and led to a loss of 6.2 million. The source seemingly does not differentiate between "the Wuhan strain" (2019-nCOV) of COVID-19, "the Kent mutation" (B.1.1.7) that appeared in the UK in late 2020, the 2021 Delta variant (B.1.617.2) from India or the Omicron variant (B.1.1.529) from South Africa.

Where are these numbers coming from?

The numbers shown here were collected by Johns Hopkins University, a source that manually checks the data with domestic health authorities. For the majority of countries, this is from national authorities. In some cases, like China, the United States, Canada or Australia, city reports or other various state authorities were consulted. In this statistic, these separately reported numbers were put together. Note that Statista aims to also provide domestic source material for a more complete picture, and not to just look at one particular source. Examples are these statistics on the confirmed coronavirus cases in Russia or the COVID-19 cases in Italy, both of which are from domestic sources. For more information or other freely accessible content, please visit our dedicated Facts and Figures page.

A word on the flaws of numbers like this

People are right to ask whether these numbers are at all representative or not for several reasons. First, countries worldwide decide differently on who gets tested for the virus, meaning that comparing case numbers or death rates could to some extent be misleading. Germany, for example, started testing relatively early once the country’s first case was confirmed in Bavaria in January 2020, whereas Italy tests for the coronavirus postmortem. Second, not all people go to see (or can see, due to testing capacity) a doctor when they have mild symptoms. Countries like Norway and the Netherlands, for example, recommend people with non-severe symptoms to just stay at home. This means not all cases are known all the time, which could significantly alter the death rate as it is presented here. Third and finally, numbers like this change very frequently depending on how the pandemic spreads or the national healthcare capacity. It is therefore recommended to look at other (freely accessible) content that dives more into specifics, such as the coronavirus testing capacity in India or the number of hospital beds in the UK. Only with additional pieces of information can you get the full picture, something that this statistic in its current state simply cannot provide.

United Kingdom UK: Mortality Rate: Adult: Male: per 1000 Male Adults data was reported at 84.007 Ratio in 2014. This records a decrease from the previous number of 85.183 Ratio for 2013. United Kingdom UK: Mortality Rate: Adult: Male: per 1000 Male Adults data is updated yearly, averaging 137.527 Ratio from Dec 1960 (Median) to 2014, with 55 observations. The data reached an all-time high of 189.602 Ratio in 1963 and a record low of 83.932 Ratio in 2012. United Kingdom UK: Mortality Rate: Adult: Male: per 1000 Male Adults data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s United Kingdom – Table UK.World Bank.WDI: Health Statistics. Adult mortality rate, male, is the probability of dying between the ages of 15 and 60--that is, the probability of a 15-year-old male dying before reaching age 60, if subject to age-specific mortality rates of the specified year between those ages.; ; (1) United Nations Population Division. World Population Prospects: 2017 Revision. (2) University of California, Berkeley, and Max Planck Institute for Demographic Research. The Human Mortality Database.; Weighted average;

The SHMI is the ratio between the actual number of patients who die following hospitalisation at the trust and the number that would be expected to die on the basis of average England figures, given the characteristics of the patients treated there. It includes deaths which occurred in hospital and deaths which occurred outside of hospital within 30 days (inclusive) of discharge. The SHMI gives an indication for each non-specialist acute NHS trust in England whether the observed number of deaths within 30 days of discharge from hospital was 'higher than expected' (SHMI banding=1), 'as expected' (SHMI banding=2) or 'lower than expected' (SHMI banding=3) when compared to the national baseline. Trusts may be located at multiple sites and may be responsible for 1 or more hospitals. A breakdown of the data by site of treatment is also provided. The SHMI is composed of 144 different diagnosis groups and these are aggregated to calculate the overall SHMI value for each trust. The number of finished provider spells, observed deaths and expected deaths at diagnosis group level for each trust is available in the SHMI diagnosis group breakdown files. For a subset of diagnosis groups, an indication of whether the observed number of deaths within 30 days of discharge from hospital was 'higher than expected', 'as expected' or 'lower than expected' when compared to the national baseline is also provided. Details of the 144 diagnosis groups can be found in Appendix A of the SHMI specification. Notes: 1. For discharges in the reporting period April 2024 - May 2024, most of the records for Wirral University Teaching Hospital NHS Foundation Trust (trust code RBL) have been submitted without an NHS number. This will have affected the linkage of the HES data to the ONS death registrations data and may have resulted in a smaller number of deaths occurring outside hospital within 30 days of discharge being identified for this trust than would have otherwise been the case. The results for this trust should therefore be interpreted with caution. 2. Northern Lincolnshire and Goole NHS Foundation Trust (trust code RJL) has a high percentage of records with no NHS Number. This is resulting in around 40% of their spells not having a value for Age or Deprivation rank. As Age is a component of the statistical models used to calculate the SHMI, values for this trust should therefore be interpreted with caution. 3. There is a shortfall in the number of records for North Middlesex University Hospital NHS Trust (trust code RAP), Northumbria Healthcare NHS Foundation Trust (trust code RTF), The Rotherham NHS Foundation Trust (trust code RFR), and The Shrewsbury and Telford Hospital NHS Trust (trust code RXW). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 4. There is a high percentage of records with missing data for the Sex field for Guy’s and St Thomas’ NHS Foundation Trust (trust code RJ1) and University Hospitals Dorset NHS Foundation Trust (trust code R0D). Values for these trusts should therefore be interpreted with caution. 5. There is a high percentage of invalid diagnosis codes for Bradford Teaching Hospitals NHS Foundation Trust (trust code RAE), Chesterfield Royal Hospital NHS Foundation Trust (trust code RFS), East Lancashire Hospitals NHS Trust (trust code RXR), Harrogate and District NHS Foundation Trust (trust code RCD), Portsmouth Hospitals University NHS Trust (trust code RHU), University Hospitals of North Midlands NHS Trust (trust code RJE), and University Hospitals Plymouth NHS Trust (trust code RK9). Values for these trusts should therefore be interpreted with caution. 6. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the Background Quality Report. 7. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

These indicators are designed to accompany the SHMI publication. The SHMI methodology does not make any adjustment for deprivation. This is because adjusting for deprivation might create the impression that a higher death rate for those who are more deprived is acceptable. Patient records are assigned to 1 of 5 deprivation groups (called quintiles) using the Index of Multiple Deprivation (IMD). The deprivation quintile cannot be calculated for some records e.g. because the patient's postcode is unknown or they are not resident in England. Contextual indicators on the percentage of provider spells and deaths reported in the SHMI belonging to each deprivation quintile are produced to support the interpretation of the SHMI. Notes: 1. As of the July 2020 publication, COVID-19 activity has been excluded from the SHMI. The SHMI is not designed for this type of pandemic activity and the statistical modelling used to calculate the SHMI may not be as robust if such activity were included. Activity that is being coded as COVID-19, and therefore excluded, is monitored in the contextual indicator 'Percentage of provider spells with COVID-19 coding' which is part of this publication. 2. Please note that there has been a fall in the number of spells for most trusts due to COVID-19 impacting on activity from March 2020 onwards and this appears to be an accurate reflection of hospital activity rather than a case of missing data. Further information is available in the contextual indicator ‘Provider spells compared to the pre-pandemic period’ which is part of this publication. 3. A large proportion of records for Mid and South Essex NHS Foundation Trust (trust code RAJ) have missing or incorrect information for the main condition the patient was in hospital for (their primary diagnosis) and this will have affected the calculation of the expected number of deaths. Values for this trust should therefore be interpreted with caution. 4. Day cases and regular day attenders are excluded from the SHMI. However, some day cases for University College London Hospitals NHS Foundation Trust (trust code RRV) have been incorrectly classified as ordinary admissions meaning that they have been included in the SHMI. Maidstone and Tunbridge Wells NHS Trust (trust code RWF) has submitted a number of records with a patient classification of ‘day case’ or ‘regular day attender’ and an intended management value of ‘patient to stay in hospital for at least one night’. This mismatch has resulted in the patient classification being updated to ‘ordinary admission’ by the Hospital Episode Statistics (HES) data cleaning rules. This may have resulted in the number of ordinary admissions being overstated. The trust has been contacted to clarify what the correct patient classification is for these records. Values for these trusts should therefore be interpreted with caution. 5. There is a shortfall in the number of records for North Cumbria Integrated Care NHS Foundation Trust (trust code RNN) meaning that values for this trust are based on incomplete data and should therefore be interpreted with caution. 6. An issue with HES reference data has resulted in some records for Guy’s and St Thomas’ NHS Foundation Trust (trust code RJ1) being flagged as invalid. This has led to a shortfall in spells, meaning that values for this trust are based on incomplete data and should therefore be interpreted with caution. 7. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of the publication page.

This indicator is designed to accompany the SHMI data at site of treatment level. The SHMI is calculated at the level of the provider spell, which is a continuous period of time spent as a patient within a single trust (provider). A spell may be composed of more than 1 episode (a single period of care under 1 consultant). If a patient is moved between hospitals or sites within the same trust, the provider spell continues. Most spells consist of a single episode and so there is no complication when presenting SHMI data at site level because the entire provider spell occurred at a single site. However, spells consisting of multiple episodes may have occurred over multiple sites and only 1 of these sites can be associated with the spell. This has been chosen to be the site of the 1st episode in the spell. This may result in hospital deaths being attributed to a site other than the one in which they occurred, with an impact on the SHMI values presented for the sites concerned. This impact is likely to be greater for sites within trusts showing higher percentages for this contextual indicator. Notes: 1. On 1st January 2025, North Middlesex University Hospital NHS Trust (trust code RAP) was acquired by Royal Free London NHS Foundation Trust (trust code RAL). This new organisation structure is reflected from this publication onwards. 2. There is a shortfall in the number of records for Northumbria Healthcare NHS Foundation Trust (trust code RTF), The Rotherham NHS Foundation Trust (trust code RFR), The Shrewsbury and Telford Hospital NHS Trust (trust code RXW), and Wirral University Teaching Hospital NHS Foundation Trust (trust code RBL). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 3. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the Background Quality Report. 4. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

Abstract copyright UK Data Service and data collection copyright owner.

The Great Britain Historical Database has been assembled as part of the ongoing Great Britain Historical GIS Project. The project aims to trace the emergence of the north-south divide in Britain and to provide a synoptic view of the human geography of Britain at sub-county scales. Further information about the project is available on A Vision of Britain webpages, where users can browse the database's documentation system online.

These data were originally published in the reports of the Registrar-General for England and Wales. They were computerised by the Great Britain Historical GIS Project and its collaborators. They form part of the Great Britain Historical Database, which contains a wide range of geographically-located statistics, selected to trace the emergence of the north-south divide in Britain and to provide a synoptic view of the human geography of Britain, generally at sub-county scales.

This study mainly comprises data from the RG's Annual Reports, with some data from the Quarterly Returns. A very extensive transcription from the Decennial Supplements forms a separate study.

Latest edition information

For the second edition (December 2022) the previous data and documentation files were replaced with new versions, and access conditions were changed from safeguarded to open access.

Annual counts of births and deaths for all Registration Districts in all years 1850 to 1910, with marriages for some years.

Annual cause-of-death data for all Registration Districts in all years, 1856 to 1910. The causes of death focus on epidemic diseases.

Annual age-specific mortality data for all Registration Districts for 1840-42, 1850-52, 1860-1882, 1890-92, 1900-02, 1908-1910 (i.e. for most of the period, census years plus immediately adjacent years).

Quarterly counts of births, deaths and selected causes of death from the Registrar-General's Quarterly Returns, for Registration sub-Districts. This is limited to (1) a full transcription of all four quarters for each census year within the period covered by the Quarterly Returns: 1871, 1881, 1891, 1901 and 1911; (2) numbers of births and infant deaths in all sub-districts in the County of London from the full run of reports from 1871 to 1911; and (3) a full transcription of all four quarters of 1876, but limited to the north-west of England, defined as Cheshire, Lancashire and Westmorland plus Chapel-en-le-Frith and Hayfield Registration Districts in Derbyshire and Saddleworth in the West Riding.

Individual cholera deaths in London in summer and autumn 1866 arranged by date and causes of death, plus a variant which is adjusted for deaths in hospitals (these data were created by Graham Mooney).

A separate UKDS study contains decennial age-specific cause of death data for all Registration Districts in all decades from 1851-60 to 1901-10.

Please note: this study does not include information on named individuals and would therefore not be useful for personal family history research.

These indicators are designed to accompany the SHMI publication. The SHMI methodology includes an adjustment for admission method. This is because crude mortality rates for elective admissions tend to be lower than crude mortality rates for non-elective admissions. Contextual indicators on the crude percentage mortality rates for elective and non-elective admissions where a death occurred either in hospital or within 30 days (inclusive) of being discharged from hospital are produced to support the interpretation of the SHMI. Notes: 1. As of the July 2020 publication, COVID-19 activity has been excluded from the SHMI. The SHMI is not designed for this type of pandemic activity and the statistical modelling used to calculate the SHMI may not be as robust if such activity were included. Activity that is being coded as COVID-19, and therefore excluded, is monitored in the contextual indicator 'Percentage of provider spells with COVID-19 coding' which is part of this publication. 2. Please note that there has been a fall in the number of spells for most trusts due to COVID-19 impacting on activity from March 2020 onwards and this appears to be an accurate reflection of hospital activity rather than a case of missing data. Further information is available in the contextual indicator ‘Provider spells compared to the pre-pandemic period’ which is part of this publication. 3. A large proportion of records for Mid and South Essex NHS Foundation Trust (trust code RAJ) have missing or incorrect information for the main condition the patient was in hospital for (their primary diagnosis) and this will have affected the calculation of the expected number of deaths. Values for this trust should therefore be interpreted with caution. 4. Day cases and regular day attenders are excluded from the SHMI. However, some day cases for University College London Hospitals NHS Foundation Trust (trust code RRV) have been incorrectly classified as ordinary admissions meaning that they have been included in the SHMI. Maidstone and Tunbridge Wells NHS Trust (trust code RWF) has submitted a number of records with a patient classification of ‘day case’ or ‘regular day attender’ and an intended management value of ‘patient to stay in hospital for at least one night’. This mismatch has resulted in the patient classification being updated to ‘ordinary admission’ by the Hospital Episode Statistics (HES) data cleaning rules. This may have resulted in the number of ordinary admissions being overstated. The trust has been contacted to clarify what the correct patient classification is for these records. Values for these trusts should therefore be interpreted with caution. 5. There is a shortfall in the number of records for North Cumbria Integrated Care NHS Foundation Trust (trust code RNN) meaning that values for this trust are based on incomplete data and should therefore be interpreted with caution. 6. An issue with HES reference data has resulted in some records for Guy’s and St Thomas’ NHS Foundation Trust (trust code RJ1) being flagged as invalid. This has led to a shortfall in spells, meaning that values for this trust are based on incomplete data and should therefore be interpreted with caution. 7. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of the publication page.

This indicator is designed to accompany the SHMI publication. The SHMI includes all deaths reported of patients who were admitted to non-specialist acute trusts in England and either died while in hospital or within 30 days of discharge. Deaths related to COVID-19 are excluded from the SHMI. A contextual indicator on the percentage of deaths reported in the SHMI which occurred in hospital and the percentage which occurred outside of hospital is produced to support the interpretation of the SHMI. Notes: 1. As of the July 2020 publication, COVID-19 activity has been excluded from the SHMI. The SHMI is not designed for this type of pandemic activity and the statistical modelling used to calculate the SHMI may not be as robust if such activity were included. Activity that is being coded as COVID-19, and therefore excluded, is monitored in the contextual indicator 'Percentage of provider spells with COVID-19 coding' which is part of this publication. 2. Please note that there has been a fall in the number of spells for most trusts due to COVID-19 impacting on activity from March 2020 onwards and this appears to be an accurate reflection of hospital activity rather than a case of missing data. Further information is available in the contextual indicator ‘Provider spells compared to the pre-pandemic period’ which is part of this publication. 3. A large proportion of records for Mid and South Essex NHS Foundation Trust (trust code RAJ) have missing or incorrect information for the main condition the patient was in hospital for (their primary diagnosis) and this will have affected the calculation of the expected number of deaths. Values for this trust should therefore be interpreted with caution. 4. Day cases and regular day attenders are excluded from the SHMI. However, some day cases for University College London Hospitals NHS Foundation Trust (trust code RRV) have been incorrectly classified as ordinary admissions meaning that they have been included in the SHMI. Maidstone and Tunbridge Wells NHS Trust (trust code RWF) has submitted a number of records with a patient classification of ‘day case’ or ‘regular day attender’ and an intended management value of ‘patient to stay in hospital for at least one night’. This mismatch has resulted in the patient classification being updated to ‘ordinary admission’ by the Hospital Episode Statistics (HES) data cleaning rules. This may have resulted in the number of ordinary admissions being overstated. The trust has been contacted to clarify what the correct patient classification is for these records. Values for these trusts should therefore be interpreted with caution. 5. There is a shortfall in the number of records for North Cumbria Integrated Care NHS Foundation Trust (trust code RNN) meaning that values for this trust are based on incomplete data and should therefore be interpreted with caution. 6. An issue with HES reference data has resulted in some records for Guy’s and St Thomas’ NHS Foundation Trust (trust code RJ1) being flagged as invalid. This has led to a shortfall in spells, meaning that values for this trust are based on incomplete data and should therefore be interpreted with caution. 7. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of the publication page.

These indicators are designed to accompany the SHMI publication. As well as information on the main condition the patient is in hospital for (the primary diagnosis), the SHMI data contain up to 19 secondary diagnosis codes for other conditions the patient is suffering from. This information is used to calculate the expected number of deaths. 'Depth of coding' is defined as the number of secondary diagnosis codes for each record in the data. A higher mean depth of coding may indicate a higher proportion of patients with multiple conditions and/or comorbidities, but may also be due to differences in coding practices between trusts. Contextual indicators on the mean depth of coding for elective and non-elective admissions are produced to support the interpretation of the SHMI. Notes: 1. As of the July 2020 publication, COVID-19 activity has been excluded from the SHMI. The SHMI is not designed for this type of pandemic activity and the statistical modelling used to calculate the SHMI may not be as robust if such activity were included. Activity that is being coded as COVID-19, and therefore excluded, is monitored in the contextual indicator 'Percentage of provider spells with COVID-19 coding' which is part of this publication. 2. Please note that there was a fall in the overall number of spells for England from March 2020 due to COVID-19 impacting on activity and the number has not returned to pre-pandemic levels. Further information at Trust level is available in the contextual indicator ‘Provider spells compared to the pre-pandemic period’ which is part of this publication. 3. There is a shortfall in the number of records for Frimley Health NHS Foundation Trust (trust code RDU), Manchester University NHS Foundation Trust (trust code R0A), Royal Surrey County Hospital NHS Foundation Trust (trust code RA2), and Wrightington, Wigan and Leigh NHS Foundation Trust (trust code RRF). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 4. There is a high percentage of invalid diagnosis codes for Hampshire Hospitals NHS Foundation Trust (trust code RN5). Values for this trust should therefore be interpreted with caution. 5. A number of trusts are currently engaging in a pilot to submit Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS), rather than the Admitted Patient Care (APC) dataset. As the SHMI is calculated using APC data, this does have the potential to impact on the SHMI value for these trusts. Trusts with SDEC activity removed from the APC data have generally seen an increase in the SHMI value. This is because the observed number of deaths remains approximately the same as the mortality rate for this cohort is very low; secondly, the expected number of deaths decreases because a large number of spells are removed, all of which would have had a small, non-zero risk of mortality contributing to the expected number of deaths. We are working to better understand the planned changes to the recording of SDEC activity and the potential impact on the SHMI. The trusts affected in this publication are: Barts Health NHS Trust (trust code R1H), Cambridge University Hospitals NHS Foundation Trust (trust code RGT), Croydon Health Services NHS Trust (trust code RJ6), Epsom and St Helier University Hospitals NHS Trust (trust code RVR), Frimley Health NHS Foundation Trust (trust code RDU), Imperial College Healthcare NHS Trust (trust code RYJ), Manchester University NHS Foundation Trust (trust code R0A), Norfolk and Norwich University Hospitals NHS Foundation Trust (trust code RM1), and University Hospitals of Derby and Burton NHS Foundation Trust (trust code RTG). 6. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of the publication page.

These indicators are designed to accompany the SHMI publication. The SHMI methodology does not make any adjustment for patients who are recorded as receiving palliative care. This is because there is considerable variation between trusts in the way that palliative care is recorded. Contextual indicators on the percentage of provider spells and deaths reported in the SHMI where palliative care was recorded at either treatment or specialty level are produced to support the interpretation of the SHMI. Notes: 1. As of the July 2020 publication, COVID-19 activity has been excluded from the SHMI. The SHMI is not designed for this type of pandemic activity and the statistical modelling used to calculate the SHMI may not be as robust if such activity were included. Activity that is being coded as COVID-19, and therefore excluded, is monitored in the contextual indicator 'Percentage of provider spells with COVID-19 coding' which is part of this publication. 2. Please note that there has been a fall in the number of spells for most trusts due to COVID-19 impacting on activity from March 2020 onwards and this appears to be an accurate reflection of hospital activity rather than a case of missing data. Further information is available in the contextual indicator ‘Provider spells compared to the pre-pandemic period’ which is part of this publication. 3. A large proportion of records for Mid and South Essex NHS Foundation Trust (trust code RAJ) have missing or incorrect information for the main condition the patient was in hospital for (their primary diagnosis) and this will have affected the calculation of the expected number of deaths. Values for this trust should therefore be interpreted with caution. 4. Day cases and regular day attenders are excluded from the SHMI. However, some day cases for University College London Hospitals NHS Foundation Trust (trust code RRV) have been incorrectly classified as ordinary admissions meaning that they have been included in the SHMI. Maidstone and Tunbridge Wells NHS Trust (trust code RWF) has submitted a number of records with a patient classification of ‘day case’ or ‘regular day attender’ and an intended management value of ‘patient to stay in hospital for at least one night’. This mismatch has resulted in the patient classification being updated to ‘ordinary admission’ by the Hospital Episode Statistics (HES) data cleaning rules. This may have resulted in the number of ordinary admissions being overstated. The trust has been contacted to clarify what the correct patient classification is for these records. Values for these trusts should therefore be interpreted with caution. 5. There is a shortfall in the number of records for North Cumbria Integrated Care NHS Foundation Trust (trust code RNN) meaning that values for this trust are based on incomplete data and should therefore be interpreted with caution. 6. An issue with HES reference data has resulted in some records for Guy’s and St Thomas’ NHS Foundation Trust (trust code RJ1) being flagged as invalid. This has led to a shortfall in spells, meaning that values for this trust are based on incomplete data and should therefore be interpreted with caution. 7. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of the publication page.

This is an indicator designed to accompany the Summary Hospital-level Mortality Indicator (SHMI). As of the July 2020 publication, COVID-19 activity has been excluded from the SHMI. The SHMI is not designed for this type of pandemic activity and the statistical modelling used to calculate the SHMI may not be as robust if such activity were included. This indicator shows the number of provider spells which are coded as COVID-19, and therefore excluded from the SHMI, as a percentage of all provider spells in the SHMI (prior to the exclusion). This indicator is being published as an experimental statistic. Experimental statistics are official statistics which are published in order to involve users and stakeholders in their development and as a means to build in quality at an early stage. Notes: 1. Please note that there has been a fall in the number of spells for most trusts between this publication and the previous SHMI publication, ranging from 0 per cent to 5 per cent. This is due to COVID-19 impacting on activity from March 2020 onwards and appears to be an accurate reflection of hospital activity rather than a case of missing data. 2. The data for St Helens and Knowsley Teaching Hospitals NHS Trust (trust code RBN) has incomplete information on secondary conditions that the patients suffers from, and this will have affected the calculation of this indicator. Values for this trust should therefore be interpreted with caution. Please note, this issue was not identified until after this publication was initially released on 13th May 2021. Data quality notices were later added to this publication in July 2021. 3. Day cases and regular day attenders are excluded from the SHMI. However, some day cases for University College London Hospitals NHS Foundation Trust (trust code RRV) have been incorrectly classified as ordinary admissions meaning that they have been included in the SHMI. Maidstone and Tunbridge Wells NHS Trust (trust code RWF) has submitted a number of records with a patient classification of ‘day case’ or ‘regular day attender’ and an intended management value of ‘patient to stay in hospital for at least one night’. This mismatch has resulted in the patient classification being updated to ‘ordinary admission’ by the HES data cleaning rules. This may have resulted in the number of ordinary admissions being overstated. The trust has been contacted to clarify what the correct patient classification is for these records. Values for these trusts should therefore be interpreted with caution. 4. There is a shortfall in the number of records for Mid Cheshire Hospitals NHS Foundation Trust (trust code RBT), meaning that values for this trust are based on incomplete data and should therefore be interpreted with caution. 5. We recommend that values for Guy’s and St Thomas’ NHS Foundation Trust (trust code RJ1) are interpreted with caution as there is a possible shortfall in the number of records which is currently under investigation. 6. On 1 April 2021 Western Sussex Hospitals NHS Foundation Trust (trust code RYR) merged with Brighton and Sussex University Hospitals NHS Trust (trust code RXH). The new trust is called University Hospitals Sussex NHS Foundation Trust (trust code RYR). However, as we received notification of this change after data processing for this publication began, separate indicator values have been produced for this publication. The next publication in this series will reflect the updated organisation structure. 7. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of the publication page.

These indicators are designed to accompany the SHMI publication. As of the July 2020 publication, COVID-19 activity has been excluded from the SHMI. The SHMI is not designed for this type of pandemic activity and the statistical modelling used to calculate the SHMI may not be as robust if such activity were included. There has been a fall in the number of spells for most trusts due to COVID-19 impacting on activity from March 2020 onwards and this appears to be an accurate reflection of hospital activity rather than a case of missing data. Contextual indicators on the number of provider spells which are excluded from the SHMI due to them being related to COVID-19 and on the number of provider spells as a percentage of pre-pandemic activity (January 2019 – December 2019) are produced to support the interpretation of the SHMI. These indicators are being published as experimental statistics. Experimental statistics are official statistics which are published in order to involve users and stakeholders in their development and as a means to build in quality at an early stage. Notes: 1. A large proportion of records for Mid and South Essex NHS Foundation Trust (trust code RAJ) have missing or incorrect information for the main condition the patient was in hospital for (their primary diagnosis) and this will have affected the calculation of the expected number of deaths. Values for this trust should therefore be interpreted with caution. 2. Day cases and regular day attenders are excluded from the SHMI. However, some day cases for University College London Hospitals NHS Foundation Trust (trust code RRV) have been incorrectly classified as ordinary admissions meaning that they have been included in the SHMI. Maidstone and Tunbridge Wells NHS Trust (trust code RWF) has submitted a number of records with a patient classification of ‘day case’ or ‘regular day attender’ and an intended management value of ‘patient to stay in hospital for at least one night’. This mismatch has resulted in the patient classification being updated to ‘ordinary admission’ by the Hospital Episode Statistics (HES) data cleaning rules. This may have resulted in the number of ordinary admissions being overstated. The trust has been contacted to clarify what the correct patient classification is for these records. Values for these trusts should therefore be interpreted with caution. 3. There is a shortfall in the number of records for North Cumbria Integrated Care NHS Foundation Trust (trust code RNN) meaning that values for this trust are based on incomplete data and should therefore be interpreted with caution. 4. An issue with HES reference data has resulted in some records for Guy’s and St Thomas’ NHS Foundation Trust (trust code RJ1) being flagged as invalid. This has led to a shortfall in spells, meaning that values for this trust are based on incomplete data and should therefore be interpreted with caution. 5. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of the publication page.