Child Mortality During Winter Periods

by | Sep 3, 2025

This analysis focuses on the number of child deaths that occurred during winter periods between 2019-20 and 2023-24 in comparison to non-winter periods.

Summary:

Overall, in the 5 year period between August 2019 and July 2024:

  • There were 369 more deaths that occurred in the winter periods (December to March) over 5 years compared with the average of the non-winter periods (August to November and April to July). The year was divided into three four-month periods: one winter (December to March) and two non-winter (August to November and April to July). The total ‘winter’ deaths was compared to an average of the ‘non-winter’ period deaths (as these non-winter periods included twice as many months as the winter periods).
  • The Winter Mortality (WM) Index over the 5 year period was 6.5%. This fluctuated across the years, with the WM Index at 8.0% in 2019-20, decreasing in 2020-21 and 2021-22 (3.0% and 0.8%, respectively), before increasing again in 2022-23 and 2023-24 (11.0% and 9.4%, respectively). The two lowest years were the main COVID-19 pandemic years, where a reduction in child mortality was seen[1-4]. The patterns, characteristics, and learning from child deaths due to SARS-CoV-2 infection[5-6] and all infection related deaths had previously been reported[7].
  • There were 5.3% more infant deaths occurring in the winter periods than the non-winter periods, 16.8% more deaths of children aged 1 – 9 years, and 1.3% more deaths of children aged 10 – 17 years.
  • There were 11.5% more deaths of children from Asian or Asian British ethnic backgrounds and 10.2% more deaths of children from black or black British backgrounds during winter periods compared to non-winter periods. This proportion was higher than that of mixed ethnicities (5.8%) and white (5.3%).
  • There were 7.2% more deaths of children living in the most deprived areas of England during winter periods compared to non-winter periods, compared to 2.2% for those living in the least deprived areas.
  • Across regions, the WM Index varied from 11.0% (North East) more deaths occurring in winter periods compared to non-winter periods, to 2.2% in the East Midlands.
  • The leading cause of winter mortality was deaths due to infection, where 70.4% more deaths occurred during the winter periods compared to non-winter periods. In contrast, there were 24.0% fewer deaths due to traumatic causes and 16.1% fewer deaths due to intrapartum events during winter compared to non-winter.

Relevant Existing Policy Recommendations:

The major driver for excess winter mortality in children was infection, particularly in individuals with underlying health conditions and vulnerabilities.

Recommendations 1-12 in the NCMD Thematic report on Infection Related Deaths in Children[7] are pertinent to informing an integrated government strategy for reducing the excess winter mortality in children.

Methodology:

Data was extracted from the National Child Mortality Database on 6 June 2025 and represents all children who died where a Child Death Overview Panel in England was reviewing or had reviewed the death. This includes all live-born children (including all gestational ages) who died aged 0 up to their 18th birthday, excluding stillbirths and planned terminations of pregnancy carried out within the law.

The methodology used for this work reflects the methodology derived by the Office for National Statistics in the publication ‘Winter mortality in England and Wales’, available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/excesswintermortalityinenglandandwales/2021to2022provisionaland2020to2021final

Social deprivation measure is presented using the Index of Multiple Deprivation: https://www.gov.uk/government/statistics/english-indices-of-deprivation-2019

Suspected category of death is derived using the information present at the initial notifcation of death, and therefore may differ to the final cause. The methodology used to derive this is described elsewhere[4].

Excess mortality has not been calculated where the demographic was not known, and is represented with a ‘-‘ in the tables.

This work has limitations. This work is based on statutory data reported to NCMD, and previous work has shown good validation and coverage. However, the suspected category of death used to identify the deaths in this work is provisional, based on information available at 48 hours, and final underlying cause of death assigned by the CDOP may differ in some cases.

Definitions:

Winter deaths compared to non-winter deaths: the winter period is defined as December to March, and compares the number of deaths that occurred in this winter period with the average number of deaths occurring in the preceding August to November and the following April to July.

Winter mortality index: The winter mortality index is expressed as a percentage and is calculated so that comparisons can be made between groups such as sexes, age groups and regions. This is calculated as: Winter mortality index = winter deaths compared to non-winter deaths / average of non-winter deaths x 100. For example, a winter mortality index of 20 shows that there were 20% more deaths in winter compared with the non-winter period.

Download the data tables here

References:

1. Odd D, Stoianova S, Williams T, Sleap V, Blair P, Fleming P, Wolfe I, Luyt K. Child mortality in England during the COVID-19 pandemic. Arch Dis Child. 2022 Jan;107(1):14-20. doi: 10.1136/archdischild-2020-320899. Epub 2021 Jun 21. PMID: 34911683; PMCID: PMC8219479.

2. Odd D, Stoianova S, Williams T, Fleming P, Luyt K. Child mortality in England during the first year of the COVID-19 pandemic. Arch Dis Child. 2022 Mar;107(3):e22. doi: 10.1136/archdischild-2021-323370. Epub 2021 Dec 6. PMID: 34872905; PMCID: PMC8662663.

3. Odd D, Stoianova S, Williams T, Fleming P, Luyt K. Child Mortality in England During the First 2 Years of the COVID-19 Pandemic. JAMA Netw Open. 2023 Jan 3;6(1):e2249191. doi: 10.1001/jamanetworkopen.2022.49191. PMID: 36622676; PMCID: PMC9857017.

4. Odd D, Stoianova S, Williams T, Fleming P, Luyt K. Child mortality in England after national lockdowns for COVID-19: An analysis of childhood deaths, 2019-2023. PLoS Med. 2025 Jan 23;22(1):e1004417. doi: 10.1371/journal.pmed.1004417. PMID: 39847573; PMCID: PMC11756792.

5. Smith C, Odd D, Harwood R, Ward J, Linney M, Clark M, Hargreaves D, Ladhani SN, Draper E, Davis PJ, Kenny SE, Whittaker E, Luyt K, Viner R, Fraser LK. Deaths in children and young people in England after SARS-CoV-2 infection during the first pandemic year. Nat Med. 2022 Jan;28(1):185-192. doi: 10.1038/s41591-021-01578-1. Epub 2021 Nov 11. PMID: 34764489.

6. Odd D, Stoianova S, Williams T, Thursby-Pelham A, Ladhani SN, Oligbu G, Fleming P, Luyt K. Deaths in children in England from SARS-CoV-2 infection during the first 2 years of the pandemic: a cohort study. BMJ Open. 2025 Feb 5;15(2):e092627. doi: 10.1136/bmjopen-2024-092627. PMID: 39909515; PMCID: PMC11800287.

7. Hoy B, Stoianova S, Williams T, Odd D, Fraser J, Sleap V, Finn A, Fleming P, Sharp A, Demirjian A, Lamagni T, Ladhani S, Daniels R, Plumb O, Donovan C, Ward J, Rowlands R, Naish K, Handley-Cole E, Whait L, Luyt K. Infection related deaths of children and young people in England. Available at: https://www.ncmd.info/publications/child-death-infection/

 

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