Biggest killer in the UK is now COVID-19, but deaths from dementia remain high

Annual statistics report COVID-19 as the UK’s biggest killer, moving dementia to second for the first time since 2015. But deaths from dementia remain high compared with other major diseases. We explore why.

This article was first published on 6 September 2019 and most recently updated on 28 July 2021.

Annual death statistics for England and Wales, released by the Office for National Statistics (ONS) in 2018, showed the number of people dying with dementia is steadily increasing year on year.  

However, the latest report, released in early July 2021, shows the number of people dying with dementia has reduced.

Due to the pandemic, COVID-19 was the leading cause of death in England and Wales in 2020. Although numbers of people dying with dementia may appear lower at first glance, this is not necessarily the case.  

What is the link between dementia and deaths involving COVID-19?

While the most recent ONS report focuses on the primary cause of death, it also provides information on the underlying pre-existing conditions people who died of COVID-19 may have been living with, such as dementia.

Of the 73,766 people who died from COVID-19 in 2020, almost 25% (18,420) also had Alzheimer’s disease or another disease that causes dementia.

Summing together the deaths caused by dementia and the number of people with dementia who died from COVID-19 accounts for 14.5% of total deaths in the UK in 2020.

Additionally, the number of people getting diagnosed with dementia in England decreased during coronavirus, and it's estimated that similar trends occurred in the other UK nations.

This reduced rate of diagnosis also impacts the recording of dementia or the diseases that cause it on death certificates.  Although dementia is not the leading cause of death in England and Wales currently, high numbers of people with dementia still sadly passed away last year.

This is in part due to COVID-19 disproportionately impacting people with dementia combined with the high numbers of deaths from dementia-causing diseases, even with decreased diagnosis rates.   

At a glance: the top 5 leading causes of death in England and Wales in 2020

In 2020, the top five causes of death were:

  • COVID-19 (12.1% of all deaths)
  • Dementia and Alzheimer’s (11.5% of all deaths)
  • Ischaemic heart disease (9.2% of all deaths)
  • Cerebrovascular disease (4.9% of all deaths)
  • Lung-based cancers (4.7% of all deaths).

For deaths with a primary cause attributed to dementia, the 2020 figure shows a decrease in percentage from 12.5% in 2019 and 12.8% in 2018. This reduction has likely been impacted by coronavirus-related dementia deaths and a decreased diagnosis rate. 

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Why did COVID-19 disproportionately impact people with dementia in 2020? 

It is estimated at least a quarter of people who died from COVID-19 in 2020 also had a dementia diagnosis.

There are several possible reasons why people living with dementia were at increased risk of contracting COVID-19, including their age and any underlying health problems.

Additionally, close care required for people living with advanced dementia makes social distancing a challenge.  Having to adapt to new behaviours which decrease the risk of infection, like washing hands more often and mask-wearing is particularly difficult for people with dementia.

People with dementia were also isolated from loved ones during the pandemic. The effects this had on individual well-being, which can impact physical health, is yet to be fully understood.

Why are the diseases which cause dementia still a leading cause of death in the UK? 

There are a few reasons why dementia remains a leading cause of death in England and Wales.

1.) Overall, more people are getting a dementia diagnosis

Greater awareness and understanding of dementia mean more people are now receiving a diagnosis. Even with these levels decreasing during the pandemic, they are still higher than they were in the past. 

Before the pandemic, it was estimated that two-thirds of people with dementia in the UK have been diagnosed which is up from only 40% of people in 2012. 

Alzheimer's Society has long campaigned to increase the number of people with dementia receiving a diagnosis so they can gain access to vital treatments and support services. 

Especially after seeing diagnosis rates decline during the pandemic, we have been campaigning for funding to ensure diagnosis levels get back up to where they were before. 

2.) More people are living longer in the UK

Due to medical advances, more people than ever are surviving heart disease, strokes and many cancers.  

Age is the biggest risk factor for dementia, so as more people live longer, the number of people developing dementia is increasing. 

Dementia is a life-limiting condition and more research is needed to find treatments that can slow or stop the diseases that cause dementia from worsening. 

3.) Changes in the way UK deaths are recorded

Reliable death records are important to follow changes in the impact of diseases and to decide priorities for medical research. In 2011, the ONS made changes to the way deaths due to dementia are recorded to better reflect guidance from the World Health Organisation (WHO).  

Now if a person dies with dementia, doctors can report it as the main cause of death on their death certificate. Previously, the immediate cause of death would be listed, such as a fall or an infection like pneumonia.  

But in many cases, these illnesses are a result of underlying dementia causing increased frailty, a weakened immune system, or problems with swallowing.  

The ONS also updated their coding system so that vascular dementia would be reflected in the dementia category instead of the stroke (cerebrovascular disease) category. 

Additionally, if people with dementia die from other causes – such as COVID-19 – they are not counted as dying from dementia.This reduces the numbers recorded for people with dementia who have passed away.

This is important to consider if rates of deaths caused by dementia appear to fluctuate because it might not necessarily be an indicator of a change in the number of deaths.

How does the number of deaths from dementia compare to other diseases in the UK?

Under the revised methods, the ONS groups all of the diseases causing dementia – like Alzheimer’s disease and vascular dementia – together into one category.  

This contrasts to conditions like cancer, which is separated out by disease type. Deaths from diseases such as lung cancer, breast cancer, and pancreatic cancer are all analysed separately. Lung cancer caused the most deaths of all cancers in 2020, recorded on 4.7% of death certificates.  

However, if all the different types of cancer were grouped together, the picture would look different. For example, cancer would have been responsible for 1 in 4 UK deaths in 2017 if this was the case.

The grouping of diseases therefore influences how these conditions rank in the causes of deaths in the nations of the UK. 

This graph shows the leading causes of death in women in England and Wales in 2018 with all types of cancer combined. (Age-standardised death rates per million women). 

Urgent action is needed for dementia research

Although things are changing, current death records are still a big underestimation of the true numbers of people dying with dementia - particularly during the pandemic.

Whichever way you cut the numbers, dementia is rising. It is a major health crisis.  

With an ageing population, no approved treatments to slow it and an overstretched care system, we need to take action to tackle dementia in the UK.  

We need to boost investment into research for treatments that can slow or prevent dementia. Research is also critical to find effective ways to care for people with dementia from diagnosis through to the end of their lives.  

Medical progress has saved and improved the lives of thousands of people with heart disease, stroke and cancer.

Now it is time to see the breakthroughs in dementia too. 

Support dementia research

Alzheimer’s Society is working tirelessly to challenge perceptions, fund research and improve care and support. We rely on your donations. Let’s take on dementia together.

Donate today
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25 comments

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My daughter aged just fifty two has just been diagnosed with 'young onset Alzheimers' disease after spending the last year being treated for anxiety and depression after the death of her husband. I feel she became very unwell after a change of medication and then more recently psychotic drugs, could this have excelerated her condition?

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My mother died today , from a progressive , destructive , incurable brain disease . Alzheimer’s!
Not old age , or just what old people get .
It’s a disease which kills people , in a traumatic way for the person and family .
When will the NHS and CHC accept that this is a serious disease instead of saying it’s a social services concern .
3 times in 2 years we have been refused CHC , my mother was eventually fast tracked on April 7th and died on 22nd !
The system is not fit for purpose and must be changed to reflect the needs of the people who contact this disease .
Why are they discriminated against. ?

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Your headline is untrue. Alzheimer's/dementia is NOT the leading killer in the UK - cancer is. Your first graph is one of the worst examples of cherry-picking I have ever encountered. Why do you compare Alzheimer's/dementia with lung cancer Why not all cancers? Why have you separated heart disease and stroke when they are both circulatory diseases. By contrast, you seem to have combined the data for all the different forms of dementia , of which there are many.

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My sister, 74, was diagnosed in January 2020 with Alzheimers but the onset probably started several years ago and looking back the signs were there. We think she also has an underlying personality disorder, again all her life. This has been devastating for us all. She tells people it's only mild. She still has a good quality of life but the changes are evident now. Her long term memory is excellent, but she's asking a 'memory' question and answering it herself 'do you remember etc, I use to like that, didn't I '. She has also started doing a creepy laugh at anything, and you think 'what's funny about that'. It can be quite stressful as I know she can't help it. I ask her a question and she sits with a blank look 'I don't know '. But we are always looking for ways to improve her diet, her life etc. We can never give up searching for a cure, or something to slow the process down, and one day there will be a breakthrough. Just wanted to share my thoughts xx

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Look into the world of cbc/THC treatment

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Has any research been done into the effect of aluminium on the brain? The NHS pushes flu & now pneumonia vaccines and there has been a substantial increase in volumes being given to the elderly. All these vaccines have an aluminium adjuvant in and I wonder if it could be adding to the statistics?

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Hi Lindsay,
Thanks for getting in touch.
We know that metals have been labelled as a potential concern in news headlines in the past. However, there is no strong evidence to support these fears.
Take a look at our page on this for further information - including a section specifically about aluminium: https://www.alzheimers.org.uk/about-dementia/risk-factors-and-preventio…
We hope this helps.
-
Alzheimer's Society blog team

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People are NOT living longer.

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This is true go to any graveyard and just look
Its child mortality that dragged the average age of death down in the past

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I disagree. My grand parents and their siblings (around a dozen) were all gone by their mid 70's. (Heart, cancers, strokes) Both mine and my wifes parents along with many of our friends parents are in their mid 80's early 90's. Nearly all of these have signs of dementia to a greater or lesser degree. Of those, several have survived issues like those mentioned above, that a generation ago were usually fatal. Advances in medical science and healthier living are testament to that. But as we know the brain does not regenerate with exercise and low fat diets (forget crosswords and jigsaws) and once it is on the slippery slope. It is only a matter of time. The best we can hope for, for now is you keep your fingers crossed, and then try to slow the degeneration down. Depressing stuff I know, but why not face reality instead of chasing moonbeams. Dementia in all its forms, is I'm afraid one of those things the define the general life span of an average human being. If we ever conquer this horrible condition, maybe humans may survive well into their second century. However for now that is confined to science fiction.

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people are living longer but many have the last 10 years in a poor living state, i.e. dementia

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Thank God somebody as said it! Government's are using this excuse so they can keep pushing the retirement age up and up, it's people born in the 1920,s who are and have reached grand old age,s, the fifties and sixties children and beyond won't see anything like the longevity of that era in my opinion due mainly to the food chain, in the twenties upto and including the war food wasn't plentiful and what there was wasn't full of additives remember you are what you eat, obesity will take most of our generation well before retirement age the government will be coining it in

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Interesting that the word “disease” is mentioned. When my father in law contracted altzheimers we were told he wasnt eligible for health care- for a DISEASE that KILLED him,

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I think work needs to done on the causes of dementia. My mother was diagnosed with vascular dementia in 2013 we think she started in 2011. She was on tamazipan sleeping tablets from 1958. The heart failure tablets from about 2010. She had a stroke on 1 September 2019. We didn’t think she would make the end of September. They took her off all tablets. She celebrated her 94 birthday on 15 jan. 2020. I wonder why on earth she was on heart tablets. I am sure drugs are behind the rise in dementia. Some people in my mothers care home are my age. Please do research into the causes.

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I've been experiencing brain fog, problems with memory, concentration, word finding, executive functioning, spatial cognition and egocentric orientation for some time. I do not as yet have a diagnosis of AD, but my neuro-cognitive vitals are very low (I'm 59 and generally very fit despite a diagnosis of vestibular migraine, which may be linked to sensitivity to certain foods, such as dairy and gluten). I had an MRI brain scan in 2017 and all was fine, but my symptoms are slowly progressing. I'm seeing a group of Functional Medicine practitioners who have also trained with Prof Dale Bredesen (published his book, 'The End of Alzheimer's' in 2017). There is no mention anywhere on this website about his work.....people are recovering from Alzheimer's disease by using a form of his ReCode method, but also independently by simply changing their diet, sorting out exposure to toxins in the environment and avoiding the additives in our food chain, among other things including MCT oil. I appreciate the evidence base is still in its infancy, but this research could revolutionise our whole understanding of AD and perhaps other dementias!

I am awaiting the results of the ApoE gene test, but I've started the Terry Wahls's Paleo diet and I'm already noticing an improvement. Dr Terry Wahls develop her dietary protocol when facing a life bedridden from MS....within a year she was walking again and started cycling. We have to look more at the why, not just the what.

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Hi Liz, thanks for your comment.
The Bredesen Protocol, which you’ve mentioned, is a type of alternative therapy that intensively uses diet, physical activity, nutritional supplements and herbal medicine to 'reverse' dementia. It is mostly sold through the services of alternative health practitioners, particularly naturopaths and nutritional therapists.
Given what we already know about risk factors for dementia, it makes sense that managing health issues (such as vitamin deficiencies, type 2 diabetes and high blood pressure) would have a positive effect on someone’s memory and thinking abilities. Despite some claims, there is no firm evidence that this type of intensive lifestyle regime can ‘reverse’ Alzheimer’s disease, so the way this approach is being marketed is concerning.
A holistic and person-centred approach to treating dementia is welcome, but Professor Bredesen’s intervention would need to be properly tested in clinical trials so that people can make informed decisions about its benefits. As you’ve mentioned, the evidence is currently lacking.
Here’s more information on what we do know helps to reduce the risk of dementia: https://www.alzheimers.org.uk/about-dementia/risk-factors-and-preventio…
We hope this is useful, Liz.
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Alzheimer’s Society research team

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could you define what proper testing means in this context?
thankyou

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Hello Patricia, thanks for your comment.

In this context, we are referring to thorough and robust clinical trials.

We wrote an article on myth-busting around clinical trials, which may be of interest: https://www.alzheimers.org.uk/blog/truth-about-clinical-trials-5-big-my…

Thank you,

Alzheimer's Society Research Communications team

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There's little point, it seems to me, for doctors to prescribe a host of pills just o keep suffers of dementia more or less alive. The aim should be to make the dying of an Alzheimer sufferer as 'comfortable' as possible. Death is a fearsome matter for most people. There must be ways to lessen the fear and dread.

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Hello Howard, thank you for sharing your thoughts.
End of life care, and research into ways to improve it, is a priority of Alzheimer's Society.
Burdensome end of life care, such as medical interventions that cause unnecessary suffering but do not extend life, is an area that we are currently researching.
You can read more about this work here: https://www.alzheimers.org.uk/research/our-research/burdensome-care-adv…
Our researchers are putting into practice Namaste care in care homes in the UK. This is a multi-sensory technique that helps people with advanced dementia connect to the world around them and soothe agitation. Ongoing research is finding better ways to support carers, care homes and health and social care professionals during end of life care.
We hope this helps.
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Alzheimer's Society research team

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It is really important to have quality life years at the end of life not just extending the time people live a poor quality of life . I know this is an obvious statement to make but at the moment I would I think we are just increasing the quantity of time but not the quality .

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Is it common for antidepressants to be taken alongside the taking of medication for dementia.

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Hi there, thanks for getting in touch.
Depression and anxiety can coincide with dementia. Some forms of dementia, such as Parkinson’s disease dementia, are more commonly associated with depression. We know that people living with long-term depression can be at greater risk of developing dementia than those who don’t. In some cases, depression can mask the early symptoms of dementia, which can make diagnosis more challenging. It can also sometimes make the symptoms of dementia worse. There are many different ways of treating depression, from talking therapies or cognitive behavioural therapy (CBT) to prescription medication. You can read more here: https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/tre…
We hope this helps.
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Alzheimer's Society research team

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Yes, support research for a cure but in the meantime, we must do things to improve the quality of life for those currently living with dementia. They can’t sit in boredom and loneliness waiting for a cure. These two things must happen together!

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Hi Mary, thanks for your comment.
We agree – improving the quality of life for people living with dementia now is very important.
In fact, Alzheimer’s Society is the only UK charity investing in research into the cause, cure, care and prevention of dementia.
You might be interested in learning more about our research Centres of Excellence. They focus on themes that really matter to people living with dementia – such as the best ways to support people after a diagnosis and how to live well with dementia: https://www.alzheimers.org.uk/centresofexcellence
We are always dedicated to defeating dementia through research.
Sign up to our monthly research update to learn more: https://www.alzheimers.org.uk/research-updates
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Alzheimer’s Society blog team

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