Elsevier

Health & Place

Volume 76, July 2022, 102848
Health & Place

Continuing inequalities in COVID-19 mortality in England and Wales, and the changing importance of regional, over local, deprivation

https://doi.org/10.1016/j.healthplace.2022.102848Get rights and content

Highlights

  • Spatial inequality in COVID-19 mortality is highest when overall mortality is lowest.

  • COVID-19 mortality inequality peaked in October 2020, before decreasing over winter.

  • Deprivation explains almost all inequality during this peak but explains little earlier.

  • Regional deprivation more strongly associated with local mortality than local deprivation.

  • Transmission heterogeneity in secondary infections appears structured by deprivation.

Abstract

Background

Observational studies have highlighted that where individuals live is far more important for risk of dying with COVID-19, than for dying of other causes. Deprivation is commonly proposed as explaining such differences. During the period of localised restrictions in late 2020, areas with higher restrictions tended to be more deprived. We explore how this impacted the relationship between deprivation and mortality and see whether local or regional deprivation matters more for inequalities in COVID-19 mortality.

Methods

We use publicly available population data on deaths due to COVID-19 and all-cause mortality between March 2020 and April 2021 to investigate the scale of spatial inequalities. We use a multiscale approach to simultaneously consider three spatial scales through which processes driving inequalities may act. We go on to explore whether deprivation explains such inequalities.

Results

Adjusting for population age structure and number of care homes, we find highest regional inequality in October 2020, with a COVID-19 mortality rate ratio of 5.86 (95% CI 3.31 to 19.00) for the median between-region comparison. We find spatial context is most important, and spatial inequalities higher, during periods of low mortality. Almost all unexplained spatial inequality in October 2020 is removed by adjusting for deprivation. During October 2020, one standard deviation increase in regional deprivation was associated with 20% higher local mortality (95% CI, 1.10 to 1.30).

Conclusions

Spatial inequalities are greatest in periods of lowest overall mortality, implying that as mortality declines it does not do so equally. During the prolonged period of low restrictions and low mortality in summer 2020, spatial inequalities strongly increased. Contrary to previous months, we show that the strong spatial patterning during autumn 2020 is almost entirely explained by deprivation. As overall mortality declines, policymakers must be proactive in detecting areas where this is not happening, or risk worsening already strong health inequalities.

Keywords

Inequality
Coronavirus
Deprivation
Socio-economic position
Geography

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