The death rate in Northern Ireland rose by almost a fifth during the coronavirus pandemic between March and June, new figures have shown.
The latest research published by the Northern Ireland Statistics and Research Agency (Nisra) revealed there were 885 excess deaths in the region between March 1 and June 30 - an average of 17.4% higher than what would be expected from five-year annual trends.
Most excess deaths (78.4%) and Covid-19 related deaths (79.8%) involved those aged 75 years and over. In this age group, excess deaths were 21.3% above expected levels, compared to 17.4% for all ages.
For both males and females aged 55 to 64, excess deaths as a proportion of expected levels were higher than the equivalent proportions for those aged 65 to 74. In the same period, Nisra noted 837 Covid-19 related deaths.
The latest Nisra figures also revealed the number of deaths in hospital was slightly lower than expected levels between March and June, despite 434 Covid-19 related deaths occurring in hospitals. Care homes had similar levels of excess deaths (336) and Covid-19 related deaths (346).
The majority of excess deaths (556 or 62.8%) occurred at home, while 44 Covid-19 related deaths occurred at home.
While Northern Ireland's death rate during the pandemic has been almost 20% higher than normal, this is still half the rate of increase in deaths seen in England and Wales.
The Belfast City Council area had the largest number of excess deaths with 218, accounting for almost a quarter (24.6%) of the total number of excess deaths in Northern Ireland.
However, the Antrim and Newtownabbey council area had the highest excess deaths as a proportion above expected levels (28.4%), while Mid Ulster had the lowest (7.0%).
Dr John Moriarty, lecturer in Social Sciences at Queen's University, said the statistics show deaths from Covid-19 alone are only part of the story of the impact of the virus.
"We should be wary of the possibility that the number of deaths from Covid-19 here has been under-counted and that the excess death figures may also include some 'hidden' coronavirus fatalities," he said.
"It is possible that some people have died from the virus having never been definitively shown to have had it."
He said there are other reasons that someone might die sooner than in previous years.
"Chief among them is that people have delayed seeking help for illnesses which would normally be detected and treated," he said. "One of the key statistics is that the majority of the excess deaths took place at home.
"While some of these may have been people who were never tested and confirmed positive for Covid-19, others will have stayed at home with complaints they might ordinarily have sought treatment for.
"A close examination of these causes will tell us much more in the future.
"What research tells us is that loneliness impacts severely on mental health and mortality. As well as the impact on a person's morale, not having their family members call to homes increases people's risk and vulnerability when timely treatment is critical.
"What is striking is that some of the groups hardest hit are ones we usually think of as healthier, such as women and those in the least deprived areas.
"We should be cautious here and remember that with relatively low numbers, it's possible for patterns to appear without sufficient numbers for us to generalise with any certainty. As with the Covid-19 deaths, the numbers of excess deaths are sufficiently small enough that a small cluster of illnesses can throw off the normal patterns we might expect to see.
"For example, a small number of deaths among people who have moved address to care homes in a less deprived area may inflate the death figures for that particular area.
"Taken together, the figures suggest that some of the means which protected certain groups in prior years haven't had the same effects this year.
"Again, seeking medical treatment is patterned by gender and socio-economic status, so if some people who might have otherwise sought medical care did not, the differential in help-seeking from previous years could be greatest among those groups usually keenest to seek care. Similarly, the positive impacts of exercise and green space may have been reduced. Having said this, the profound impact of Covid-19 itself on the most deprived areas shouldn't be understated.
"Another striking finding is the high number of excess deaths in care homes in addition to those already registered due to Covid-19," he said. "Undoubtedly provision of care has been stretched by the onset of the pandemic with workers under severe strain and there is much to be learned to ensure care homes and staff are equipped and supported in any future waves of this or other viruses.
"There is a wider picture to consider beyond the virus itself and its treatment, and that this picture is a deeply complicated one which will require more information and careful study to be fully understood."