Introduction

The CSO has a policy of careful and considered investigation of a data source before employing it to inform official statistics. However, as a result of the COVID-19 pandemic, the CSO began to explore experimental ways of obtaining up-to-date mortality data. Since the end of March 2020, therefore, the website www.RIP.ie has been used to keep track of death notices.

For reference, analysis of death notices was conducted back as far as 1 October 2019, to include the last month before the first global cases of COVID-19 were notified. The Death Events Publishing Service¹ (DEPS) of the General Register Office (GRO) has been monitored in tandem, to validate the volumes of death notices published (see Benchmarking below).

This note represents an initial experimental analysis designed to indicate trends in mortality. When published, official statistics on mortality will allow for more thorough and definitive analysis and it is only in the context of full year statistics for 2020 that the full impact of the COVID-19 pandemic on mortality might be understood.

Key Findings

• Comparing CSO data with RIP.ie death notices for 2016 and 2017 showed a strong correlation of over 99%. This indicates that the number of death notices on RIP.ie can be used to accurately indicate trends in mortality (see Figure 2).
• There was a pronounced increase in death notices in April 2020. The numbers of death notices rose from 2,861 in March to 3,502 in April and decreased to 2,635 in May and 2,155 in June² (see Figure 4).
• Death notices related to older persons’ facilities increased from 722 in March to 1,237 in April (see Figure 12).
• The COVID-19 pandemic has highlighted the challenges in obtaining timely statistics on mortality and in particular excess mortality (deaths over and above what would be expected under normal circumstances). Measuring the impact of such events on mortality trends can play an important role in policy and response efforts and in determining any additional impact on mortality related to the COVID-19 pandemic and its effects. Research by the Office of National Statistics in the UK for example, for the year to 19 June 2020, found an increase in mortality in England and Wales of 54,338 (over the previous five-year average), of which 49,371 mentioned COVID-19 on the death certificate³.
• In Ireland, the CSO currently estimates that there are 1,072 deaths above those likely to be experienced under normal circumstances (based on this experimental analysis of RIP.ie death notices). The 1,736 deaths⁴ reported as COVID-19 related are not excluded from this figure. This estimate appears to indicate that Department of Health data on COVID-19 related deaths in Ireland comprehensively capture the impact of the pandemic on mortality (see further discussion on Excess Mortality below).
• Information contained in the death notice shows that Dublin and surrounding counties were heavily impacted, while there were also rises in death notices for Cavan, Donegal and Monaghan (see Figures 7-10).
• Examining the gender of the deceased in the death notice showed that in April 51.2% were male while 48.8% were female. However, in older persons' facilities only 41.9% were male while 58.1% were female. This difference can be directly linked to the composition of these facilities where Census figures indicate that about two-thirds of the population are women (see Table 1 and Table 3).
• The use of terms such as ‘private’, 'broadcast' and 'webcam' in death notices increased significantly from March 2020, with ‘webcam’ mentioned almost 500 times between March and May 2020 compared with only 30 mentions in the five months to the end of February (see Changing Language of Funerals below).

Rationale

The website RIP.ie is a privately-owned company and over the last decade or so has become a popular website to notify deaths and provide funeral details, both for Irish and Northern Irish citizens and expatriates. Funeral directors have a secure login and can post a notice without cost on the website. Only funeral directors can post a notice, ensuring the data is of good quality and duplicates are rare. Due to the Irish custom of holding funerals within two to three days following death, these notices are usually placed in a fast and efficient manner. The combination of these market and cultural forces have made RIP.ie a valuable crowd-sourced means of tracking deaths. These notices are close to 'real time' - the average length of time between date of death and publication is about 1.1 days. When compared with the statutory time limit of three months⁵ for the registrations of deaths in the State, this is a timelier data source for monitoring trends in mortality.

Data Cleaning Process

The data on RIP.ie had to be cleaned before use, which involved removing duplicates and missing data. Northern Irish (NI) notices were identified by checking for mentions of the six counties or the postcode prefix of ‘BT’ used for NI postal districts. However, this could be misleading, as occasionally the death did occur in Ireland. Two or three place names were often recorded for the deceased, to indicate previous residences⁶. Similarly, the death notices of expatriates who died were mentioned in the context of their birth county. As a result, the majority of approximately 26,000 death notices for the period under investigation were read. In addition to county or country, it was possible to determine the place of death in most cases. This was generally a nursing home, a private residence, a hospital or a hospice. Although reading each death notice is initially onerous, it allows for the building of a model for automatic classification.

Potential Exclusion of Minority Groups in Irish Society

Death notices placed on RIP.ie appear to accurately follow the increased mortality associated with COVID-19 but it is not used by everyone in Ireland. Higher reported COVID-19 associated fatality rates amongst the Black, Asian and Minority Ethnic communities in the UK and the African-American communities of the US were reminders of possible blind spots of deaths of minority groups, particularly those that traditionally may not use RIP.ie or be less frequent users⁹.

Measuring Excess Mortality

The COVID-19 pandemic has highlighted the challenges in obtaining timely statistics on mortality and in particular excess mortality (deaths over and above what would be expected under normal circumstances). Measuring the impact of such events on mortality trends can play an important role in policy and response efforts and in determining any additional impact on mortality related to the COVID-19 pandemic and its effects. However, measurement of excess mortality is not straightforward. In order to most accurately measure excess mortality due to COVID-19 as part of this study, it would be necessary to clean and classify death notices compared with the GRO for several previous years. Adjustments might be required for broadband penetration, differing levels of expatriate usage and controlling for potential changes in road traffic fatalities due to lower vehicular activity and influenza deaths due to fewer personal interactions.

Figure 4 below shows the monthly recorded death notices for October 2019 – June 2020, this is compared with CSO mortality figures for the same period for the years 2005 to 2017. While there are observable seasonal peaks, there is significant variance year on year. However, a clear increase can be seen in the level of death notices observed in April of this year which contrasts with observed dips in mortality levels in April of all previous years.

Death Notices and Gender

The gender of the deceased was inferred from death notices using forenames, personal pronouns, possessive pronouns and relative terms such as ‘beloved mother of’ and ‘husband to’. For the period under investigation, 51.3% death notices were for males while 48.7% were for females. Deaths reported by the CSO had a gender split of 51.1% male and 49.9% female for the years 2007 to 2017 inclusive. The highest percentage of death notices for males was in March 2020 (53.3%), when there were 89 deaths of males due to COVID-19 compared with 36 deaths of females. Of the 1,474 confirmed COVID-19 deaths⁷ for the months of March to June, 50.9% were male, while 49.1% were female.

The changing structure of deaths by gender over the period October 2019 to June 2020 can be seen by clicking on a month below:

Oct 2019 Nov 2019 Dec 2019 Jan 2020 Feb 2020
Mar 2020 Apr 2020 May 2020 Jun 2020

Death Notices by County

In addition to information on trends in mortality and gender in the death notice it was possible to analyse both the county and place of death based on the information contained in the death notice.

Figures 7 to 10 below provide an analysis of death notices by county for the period October 2019 to June 2020. Most notable increases can be clearly seen in the Leinster and Ulster regions during the COVID-19 impacted period of March and April.

Deaths notices for Dublin increased from 763 in March to 1,103 in April, an increase of 44.6% while Carlow, Kildare and Meath also experienced significant increases from March to April of 54.3%, 80.7% and 41.8%, respectively (see Figure 7). In Ulster, death notices for Monaghan increased from 35 in March to 82 in April, a rise of 134.3% (see Figure 10).

Death Notices and Place of Death

The death notice often contains information about the place of death. For example, the death notice often indicates that the deceased died

• suddenly, at home
• in the tender loving care of the staff of a named nursing home
• unexpectedly, under the care of the doctors and nurses of a named hospital
• tragically, following an accident
• peacefully, at a named hospice
• on holiday, in a named foreign country
• at home, in a named foreign country

From the information in the death notice it was possible to compile the place of death for more than 80% of cases. It was also possible to identify a death on holiday, an expatriate (emigrant) death and the death of a citizen of Northern Ireland. Care was taken for deaths around the border between Ireland and Northern Ireland, as there are cases where it remains unclear which side of the border the deceased resided, despite the place of death. It appears possible that for those living close to the border, their funeral mass may be celebrated on one side, with burial on the other. Those dying on holiday have been classified as if they had died in Ireland, whereas Northern Ireland and expatriate deaths have been grouped together.

Often, the place of death was suggested or ambiguous, but not explicitly stated. For example, the deceased may have died 'surrounded by their loving family', without stating the setting. Another implication of the place of death was the suggestion of a donation to a named facility, e.g. hospice or community hospital patient comfort fund. However, these were often ambiguous, e.g. two or more donation recipients being suggested simultaneously. In the absence of an explicit place of death, notices were deemed to be other/unstated¹⁰.

Death Notices and Older Persons' Facilities

It was also possible to derive information on deaths in facilities for older people, (e.g. 'in the care of the staff of named facility'), most of which are registered with the Health Information and Quality Authority (HIQA). HIQA's Older People's inspection team are legally responsible for the monitoring, inspection and registration of designated centres for older people, such as nursing homes, in Ireland¹¹. This analysis focussed on mentions of HIQA-registered older persons' facilities¹². At the time the study began there were 575 older person's facilities registered with HIQA (but at the time of publication, there were 577). The registered provider of 114 (20%) of the 575 HIQA-registered facilities is the Health Service Executive (HSE). These facilities are often referred to by names such as 'community hospitals' and 'community nursing units'. The remaining 463 (80%) of the 575 facilities have registered providers which include charitable organisations and limited companies. Worth noting in the context of this study is that some of these facilities contain hospices and palliative care functions where people with life-limiting illnesses spend their final weeks and days. This will have a significant effect on the level of mortality experienced.

Although the total number of residents at the beginning of the pandemic in Ireland has not been possible to ascertain, the populations of nursing homes according to the national censuses in 2011 and 2016 were 20,802 and 22,762 respectively¹³. The definition of a census nursing home may differ slightly from the definition used for this study. According to Census 2016, approximately 66.4% of nursing home residents were female with an average age of approximately 85, while males with an average age of around 81 accounted for the remaining 33.6%. Therefore, in 2016, there were almost twice as many women as men in nursing homes, and women were on average around four years older than men. As such, it is not unusual to see a greater proportion of deaths amongst females. For the period October 2019 to February 2020, between 56.2% and 64.1% of death notices in a HIQA registered older persons’ facilities were females. For the months of March, April, May and June this figure was between 56.8% and 64.1%.

The Changing Language of Funerals

In analysing death notices, it was possible to see not only the impact COVID-19 has had on mortality trends in Ireland but also the way in which it has shaped behaviour and responses to the effects of this pandemic. This impact was clear in the changing language observed in death notices on RIP.ie. References to 'private' gatherings increased dramatically from March onwards. References to 'corteges' increased, while references to 'rosary' decreased. The term ‘broadcast’ was used once between October 2019 and February 2020 but was mentioned more than 100 times between March and May 2020. ‘Webcam’ was used less than 30 times in the five months up to the end of February 2020, but was mentioned nearly 500 times between March and May.

Conclusion

The website RIP.ie has evolved to be a useful tool for monitoring mortality data, with an average lag of just over one day. The solemnity of the death event and professional relationship between funeral directors and RIP.ie ensures the quality of the data. The correlation between RIP.ie and the CSO death by occurrence for the months of 2016 and 2017, at over 99%, is promising. The website RIP.ie competently tracks the daily COVID-19 deaths, as notified to the government. Metadata provides useful information on the place of death, especially nursing homes, at such a critical time. Deaths notices are often succinct and have a traditional structure, as they originate in notices placed in newspapers, where they were paid for by the word. This topic is worthy of further research. The CSO is grateful to RIP.ie for the use their website.

For further COVID-19 related information go to the CSO COVID-19 Information Hub

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Footnotes

¹Death Events Service, contains details on all deaths notified to the General Register Office 

²Data is correct as at 30 June 2020, however given the average lag of 1.1 days between date of death and date of notice the data for June throughout this publication will exclude some deaths which occurred in June but were posted after 30 June 2020.

³Deaths registered weekly in England and Wales, provisional: week ending 19 June 2020, The Office of National Statistics (UK)

⁴National Public Health Emergency Team Statement, 30 June 2020

⁵Registering a Death in Ireland

⁶Where more than one address was given, the first county indicated was taken to be the address. Where an individual died in an Older Persons' Facility, the county of the facility was used to indicate the county of death. Further research is required here.

⁷The analysis of COVID-19 confirmed deaths by date does not include numbers for probable COVID-19 deaths (which are included in totals provided by the National Public Health Emergency Team). It was not possible to provide analysis of probable COVID-19 deaths by date. For full analysis of COVID-19 confirmed and probable deaths please see the COVID-19 Deaths and Case Statistics releases.

⁸Allowing for approximately 5% expatriate and Northern Ireland notices and 3% missing values.

⁹In order to ascertain the usage of RIP.ie contact was made with a number of organisations representing minority groups in Ireland. Twenty-two embassies were contacted, representing the largest 22 non-Irish nationalities in 2016. Of the 22 embassies contacted, five responses were received. Those that were able to respond have not noted a rise in deaths associated with COVID-19 amongst their citizens. According to Pavee Point, who represent the Traveller and Roma communities, most information about Traveller deaths are spread by word of mouth and by phone and social media. A small proportion of young Travellers use RIP.ie but the vast majority of older Travellers do not. At the time of contact (28^th May 2020) Pavee Point had recorded six deaths of the Roma community due to COVID-19 in Ireland. In the East of Ireland, they had recorded three Traveller deaths due to COVID-19. The Irish Refugee Council was contacted, in particular in relation to deaths of COVID-19 in Direct Provision in Ireland. At the time of contact they indicated they were not aware of any deaths due to COVID-19 but noted the difficulty in obtaining information on deaths in Direct Provision. The Islamic Foundation, based in Dublin recommended contacting Newcastle Burial Ground for numbers of burials of members of the Muslim Community. South Dublin County Council, who administer this burial ground, provided numbers of burials per month from January 2015 to April 2020 inclusive. Monthly numbers were too small to infer any significant change, however, burials for March and April 2020 appear to be in line with the same months in the previous five years.

¹⁰Cases where the place of death was unclear or unstated have been combined with cases where the circumstances of death are potentially identifiable. These low-frequency instances include: 1) there were a small number of deaths at residential facilities for retirees of religious vocations that are not regulated by HIQA; 2) deaths due to accident; 3) deaths at residential facilities caring for people living with mental health issue.

¹¹HIQA - Older People's Services

¹²Register of Older Person's Facilities (CSV download)

¹³StatBank E3008 (Age Profile of Ireland)

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