# Clostridium Difficile (C.diff) Deaths

## Clostridium Difficile (C.diff) Deaths

### Main points

**Introduction**

·Table 1 shows the annual totals for 2000 to 2017 along with the numbers for the quarters in which the deaths were registered.

·Information about the three bases on which figures for Clostridium difficile deaths have been produced is given in a note which is available via Death Certificates and Coding the Causes of Death

Deaths for which Clostridium difficile was the underlying cause

- In 2017 there were 29 deaths for which Clostridium difficile was the underlying cause, compared with 47 in 2016. This is a lower number of such deaths than in each of the previous 17 years for which these figures are available (the next lowest numbers were 38 such deaths in 2000 and 39 in 2014).
- Registrations of deaths for which Clostridium difficile was the underlying cause increased, year by year, up to 2008, when there were 248 such deaths, then fell sharply over the next two years to 65 in 2010. The latest eight years’ numbers have all been in the range from 29 (in 2017) to 70 (in 2011), well below the higher level seen from 2006 to 2009.

**Deaths to which Clostridium difficile contributed, without being the underlying cause**

- In 2017, there were a further 77 deaths for which Clostridium difficile was a contributory factor, compared with 80 in 2016. In 2017, Clostridium difficile was a contributory factor to fewer deaths than in any of the previous 17 years for which these figures are available. The next lowest figures are 78 in 2000 and 80 in 2016.
- The number of deaths for which Clostridium difficile was a contributory factor rose in most of the years up to 2008, when there were 517 such deaths, then fell sharply over the next three years to 99 in 2011. The latest six years’ numbers have all been in the range from 77 (in 2017) to 109 (in 2015), well below the level seen from 2005 to 2010.

**Deaths for which Clostridium difficile was mentioned on the death certificate (either as the underlying cause or as a contributory factor)**

- There was a total of 106 deaths in 2017 for which Clostridium difficile was mentioned on the death certificate (either as the underlying cause of death or as a contributory factor), 21 fewer than in 2016. This is a lower number of such deaths than in each of the previous 17 years for which figures are available. The next lowest figures are 116 in 2000 and 127 in 2016.
- The total number of deaths for which Clostridium difficile was mentioned (either as the underlying cause of death or as a contributory factor) increased in most of the years from 2000 to 2008, when it was greatest (765 such deaths), then fell sharply over the next three years to 169 in 2011. The latest six years’ numbers have all been in the range from 106 (in 2017) to 160 (in 2013), well below the level seen from 2004 to 2010.

**Quarterly numbers of deaths for which Clostridium difficile was mentioned on the death certificate (either as the underlying cause or as a contributory factor)**

- On a quarterly basis, the number of deaths for which Clostridium difficile was mentioned (either as the underlying cause of death or as a contributory factor) reached a peak at 225 in the first quarter of 2008, then fell in every subsequent quarter to 62 in the third quarter of 2010. Since the start of 2011, the level had not changed much in recent years: it had generally been around 40 per quarter, and the scale of the fluctuations around this were such that they could well be the result of “random” statistical quarter-to-quarter variability. However, in 2016 and 2017 only the third quarter had figures at that level, with the average per quarter being around 30 over the two-year period.
- The highest quarterly figures since the start of 2011 have been 53 in the fourth quarter of 2013 and 50 in the second quarter of 2011; Up to 2015, the lowest quarterly figures were 27 in the second quarter of 2014 and in quarters two and three of 2000, and 29 second quarter of 2015. Such values fall within, or only slightly outwith, the “likely range” that would be expected if the number of deaths represented the outcome of a “Poisson process” with an underlying rate of 40 per quarter. (In statistical terms, a “Poisson process” is a process in which events occur at random, with the probability of an event occurring depending upon the underlying rate of occurrence - see the note “Fluctuations in the numbers of deaths may be represented as the outcome of a Poisson process”, which is available via Fluctuations in and possible unreliability of death statistics for small areas, for small sub-groups of the population, or for short periods page.
- The unusually low numbers in the first two quarters of 2014 led to the total for that year as a whole being (at that time) the lowest since 2000. The annual total in 2015 then returned to around the level seen in 2012 and 2013. However, in 2016 and 2017 all four quarters recorded less than 40 deaths and in 2017 three of the quarters recorded less than 30 deaths. This resulted in a drop in the annual total to the lowest level recorded in this publication.

### Clostridium difficile deaths by NHS Board and by place of death

- Table 2 contains breakdowns by NHS Board of residence and Table 3 shows the place of death, where Clostridium difficile was the underlying cause of death.
- Tables 4 and 5 contain similar breakdowns to Tables 2 and 3 respectively, for deaths where Clostridium difficile was a contributory factor, but was not the underlying cause.
- Tables 6 and 7 contain similar breakdowns to Tables 2 and 3 respectively, for all deaths where Clostridium difficile was mentioned on the death certificate (either as the underlying cause or as a contributory factor).