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Inequalities in excess premature mortality in England during the COVID-19 pandemic: A cross-sectional analysis of cumulative excess mortality by area deprivation and ethnicity

Lookup NU author(s): Professor Paul BurtonORCiD



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


© 2021 BMJ Publishing Group. All rights reserved.Objectives To examine magnitude of the impact of the COVID-19 pandemic on inequalities in premature mortality in England by deprivation and ethnicity. Design A statistical model to estimate increased mortality in population subgroups during the COVID-19 pandemic by comparing observed with expected mortality in each group based on trends over the previous 5 years. Setting Information on deaths registered in England since 2015 was used, including age, sex, area of residence and cause of death. Ethnicity was obtained from Hospital Episode Statistics records linked to death data. Participants Population study of England, including all 569 824 deaths from all causes registered between 21 March 2020 and 26 February 2021. Main outcome measures Excess mortality in each subgroup over and above the number expected based on trends in mortality in that group over the previous 5 years. Results The gradient in excess mortality by area deprivation was greater in the under 75s (the most deprived areas had 1.25 times as many deaths as expected, least deprived 1.14) than in all ages (most deprived had 1.24 times as many deaths as expected, least deprived 1.20). Among the black and Asian groups, all area deprivation quintiles had significantly larger excesses than white groups in the most deprived quintiles and there were no clear gradients across quintiles. Among the white group, only those in the most deprived quintile had more excess deaths than deaths directly involving COVID-19. Conclusion The COVID-19 pandemic has widened inequalities in premature mortality by area deprivation. Among those under 75, the direct and indirect effects of the pandemic on deaths have disproportionately impacted ethnic minority groups irrespective of area deprivation, and the white group the most deprived areas. Statistics limited to deaths directly involving COVID-19 understate the pandemic's impact on inequalities by area deprivation and ethnic group at younger ages.

Publication metadata

Author(s): Barnard S, Fryers P, Fitzpatrick J, Fox S, Waller Z, Baker A, Burton P, Newton J, Doyle Y, Goldblatt P

Publication type: Article

Publication status: Published

Journal: BMJ Open

Year: 2021

Volume: 11

Issue: 12

Print publication date: 23/12/2021

Online publication date: 23/12/2021

Acceptance date: 08/10/2021

Date deposited: 26/01/2022

ISSN (electronic): 2044-6055

Publisher: BMJ Publishing Group


DOI: 10.1136/bmjopen-2021-052646


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SB acknowledges funding received from the ARC Centre of Excellence for Children and Families over the Life Course (Life Course Centre).