Accuracy and completeness of death recording in primary care electronic health records compared with national death registrations in England using OpenSAFELY-TPP

Lay summary

We used OpenSAFELY-TPP to compare death information in GP records with official death registrations in England. Most deaths appeared in both sources, usually with the same date. However, some officially registered deaths had no death date in GP records. Deaths recorded only by GPs were uncommon but became more frequent closer to the date the data were extracted. Deaths appearing in only one source were more common among younger people and those from Mixed, Asian, Black, and Chinese or Other ethnic groups, while differences by sex and neighbourhood deprivation were small. Officially registered deaths without a GP death date were more common in London and the West Midlands, and their frequency also varied between GP practices. Patients’ GP registration usually ended on or shortly after death, with same-day deregistration becoming more common over time. Researchers should consider these differences, as missing or delayed death records could affect findings and comparisons between population groups.

Abstract

Introduction: Primary care electronic health records (EHRs) are an important resource for health research, but death recording in primary care EHRs may be incomplete or differ from Office for National Statistics (ONS) death registrations. We used OpenSAFELY-TPP to assess the completeness and concordance of death recording and provide recommendations for using date-of-death information.

Methods: Using linked primary care EHRs and ONS death registrations, we assessed whether ONS-registered deaths from 2020–2025 had a primary care date of death and, where present, calculated the difference between dates. Where a primary care date was absent, we assessed death-related SNOMED CT codes. Analyses were conducted overall and by year, population subgroup, and general practice. We also examined GP registration end dates and primary-care-recorded deaths without a corresponding ONS record, including monthly patterns near the data extraction date.

Results: Among 1,409,275 ONS-registered deaths, 88% had the same date recorded in primary care and 8% had no corresponding primary care date. Among 1,324,995 deaths recorded in primary care, <2% had no corresponding ONS record. Deaths recorded in only one source were more frequent among people aged <45 years and those from Mixed, Asian or Asian British, Black or Black British, and Chinese or Other ethnic groups. ONS-only dates were also more frequent in London and the West Midlands. Primary-care-only deaths increased close to date of data extraction, reaching 7% in February 2026. Same-day GP deregistration increased from 9% in 2020 to 85% in 2025.

Conclusions: Death recording in primary care EHRs showed high completeness and concordance with ONS registrations, but discrepancies remained for recent deaths and some population groups. Data recency and population-specific completeness should therefore be considered when using linked mortality data for research.