State can't rest in peace without accurate death registration

Most European countries record deaths within a week — but, with its three-month window, Ireland is seriously out of step

We have to rely on a scan of the Rip.ie website to know that close to 10,000 people died here in the eight weeks from December 1, 2022, to January 25, 2023.

Because, as it stands, the State can’t offer a more concrete figure for the period.

Still, coroners, medics, academics, politicians, and even Joe and Jane Soaps across the country can sense there have been more deaths in the run-up to and aftermath of the festive period than normal.

In England and Wales, deaths must be registered within five days. In Scotland, it is eight days. This allows for weekly returns of death rates, published by the Office for National Statistics. In France, Greece, Luxemburg, Italy, and Spain, deaths must be registered within 24 hours.

However, in Ireland, there is a three-month time window to register under the Civil Registration Act 2004, leaving statisticians with a void in securing accurate death rates in real time.

Two years ago, the Department of Social Protection launched a public consultation on the process of death registration. It wanted to cut the time window to two working weeks admitting the time lag is contrary to “a range of international comparator countries”.

The department’s consultation document highlighted that only four out of five deaths are registered within the required timeframe.

“Without legal consequence, deaths can be registered at any time following death. Such time lags have implications for the compilation of population statistics and data to support public health actions and public health and medical research.”

Aontú leader Peadar Tóibín.  File picture: Leah Farrell/RollingNews

Today, the Department of Social Protection is still considering the options in relation to revising the process of death registration.

Therefore, while the department can tell us death rates for the past six years — an increase from 31,199 deaths in 2017 to 34,470 in 2021, the 31,075 for 2022 is an incomplete figure. 

“These figures do not represent the total number of deaths which have actually occurred, in particular those for the months of October, November, and December 2022, as this falls within the three-month period where a person can register a death, and are liable to change as more deaths continue to be registered throughout 2023.”

Startling statistics

Nonetheless, figures the Irish Examiner has garnered from trawling Rip.ie for the past five years make startling reading. 

There were 9,718 deaths published from December 1, 2022 to January 25, 2023 — up from 8,075 for the same period to January 25, 2022. The figure was also considerably higher than the 8,135 death notices published in the same period to January 25, 2021, despite that period being at the height of the pandemic. 

For the eight-week period to January 25, 2019, a total of 6,802 death notices were published.

In calling for an investigation into the apparent increase in death rates, Aontú leader Peadar Tóibín highlights that more concrete figures from Eurostat are available for last summer, showing that excess deaths in Ireland in July increased by 16%. 

The Meath West TD says the numbers dying in August 2022 were 17% higher than the average before Covid-19.

Limerick City Fianna Fáil TD Willie O'Dea says he noticed an apparent “huge upsurge in funerals” before Christmas and submitted a parliamentary question to the Minister for Health, Stephen Donnelly, in relation to excess death rates. 

He noticed wakes and removals taking place during the day because of the high occurrence of deaths.

Fianna Fáil Limerick City TD Willie O'Dea noticed an increase in funerals before Christmas, with some wakes and removals taking place during the day because of the high occurrence of deaths. File picture: Conor McCabe

In response, Mr Donnelly said that, while the Department of Health does not produce estimates of excess mortality, it closely monitors estimates of excess mortality which are published by a range of different sources. 

He added that a study published in 'The Lancet' last April showed that Ireland was among several European countries with some of the lowest rates in the world, with less than 50 excess deaths per 100,000 population. 

However, Mr O’Dea is concerned that deaths appear to be increasing in Ireland and believes that the process of death registration in Ireland needs to be more efficient.

“It is something that is centrally important to health policy. It is a significant worry. When officials and ministers are deciding a policy, they need to have the proper and up-to-date information.”

He added: “In the age of technology, it does seem very amateurish to be relying on Rip.ie.”

Prof Ivan Perry: 'We have taken for granted over decades that life expectancy will continue to improve year on year. In Ireland, it has...'

Sinn Féin’s health spokesman, David Cullinane, says it is a mistake not to have real-time figures available on death rates.

“We need to fully understand what is happening behind the numbers — obviously behind each number is someone that has passed away and a bereaved family, but there is also data that can inform learnings in terms of what is happening, in what areas are we seeing increased deaths, and what measures need to be put in place. 

If the analysis is not being done, then you can’t respond in a way that you could if you had that data. It is something that needs to be done in terms of anticipating what could happen.”

Professor Ivan Perry of University College Cork says Ireland did relatively well compared to other countries in respect of deaths related to Covid-19. 

He says it is unlikely that Covid deaths “contributed greatly” to death rates recently. He believes the recent increase could possibly be linked to influenza and other respiratory illnesses.

He added: “We have taken for granted over decades that life expectancy will continue to improve year on year. In Ireland, it has. 

"But in countries including the US, life expectancy has stopped improving — it has fallen by about two years over the past four to five years. 

"Some of that is due to the pandemic, some is due to the opiate epidemic and some is due to rising rates of heart disease linked to obesity and poor diet, for example.”

According to former Irish Medical Organisation president Peadar Gilligan an increased death rate is to be expected in winter months. But he says there was a significant increase in attendances at emergency departments during the Christmas period.

Former Irish Medical Organisation president Peadar Gilligan. File picture: Shane O'Neill

Dr Gilligan says flu and other respiratory illnesses had an influence on hospitalisations and there was a fear among the population at large about spending long hours in emergency departments awaiting admission to a ward.

“Undoubtedly as well, the public concern about attending hospitals has led people to leave things longer than they might have in some cases and that has definitely been to the detriment of some people.

“I know from GPs across the country that they can’t convince their patients to go to hospital because of the concern about having a protracted stay in the emergency department — that they might be there hours or even days in some centres.”

Coroner for Mayo, Patrick O’Connor, is the public information officer for the Coroners Society of Ireland and has recently compiled his statistics for his district for 2022. 

He said: “I had in total 1,008 deaths reported to me in that period. And in that, there were 720 which were ordinary reports, then there were 184 post-mortems in that period and I held 104 inquests — the biggest number ever. 

Some 10.3% of deaths I dealt with went to inquest and 18.25% went for post-mortems. That was an increase overall on the previous year of at least 20%.

“It doesn’t look like it is going to go down this year either given the start of the year.”

Mr O’Connor also pointed out there is an increasing number of people residing in Ireland now, which will lead to a natural increase in deaths.

Read More

Funerals delayed as increase in number of deaths puts mortuaries under pressure