Excess death rates during pandemic reveal major disparities

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Excess death rates in England and Wales in the first 30 weeks of the COVID-19 pandemic show strong regional and socioeconomic differences.

Researchers at the Universities of Manchester and York compared the rates of deaths at the start of the pandemic with deaths expected according to historical trends. They found that deaths were unequally distributed, both geographically and socioeconomically.

The study has been published in The Lancet Regional Health – Europe.

Regional death rates

The highest excess mortality rates in England and Wales were in the West Midlands, the North East, and the North West. The lowest rates were in the South West of England and Wales.

There were 62,321 excess deaths in England and Wales in the first 30 weeks of the pandemic. Of these, 46,221 were attributable to respiratory causes, including COVID-19, and 16,100 to other causes. Only 78 excess deaths per 100,000 people occurred in the South West of England and in Wales; 130 per 100,000 occurred in the West Midlands. Additionally, 93 excess deaths per 100,000 people occurred in the most affluent fifth of areas, compared to 124 per 100,000 in the most deprived.

Professor Evan Kontopantelis, a data scientist from The University of Manchester who led the study, said: “Our analysis provides a comprehensive picture of excess deaths during the first 30 weeks of pandemic, including major causes both related and unrelated to COVID-19 infection.

“The models demonstrate that the COVID-19 pandemic has caused many more deaths than would have been expected during the same time period. But for England and Wales, these deaths were not evenly distributed across the population, with rates varying markedly by region, and between deprived and less deprived neighbourhoods.”

The analysis was carried out using Office of National Statistics weekly mortality data from December 2014 to October 2020 for England and Wales.

In England and Wales, a fifth of excess deaths during the first wave of the pandemic – from 7 March to 8 May 2020 – were attributable to causes other than COVID-19.

Delayed responses to acute health conditions and exacerbations of pre-existing health conditions led to substantial increases in mortality for cardiovascular disease, diabetes and other conditions. However, mortality rates for some health conditions, including other infectious respiratory diseases, fell.

Variation in rates

The researchers say the variation in rates reflects population susceptibility, in terms of age and pre-existing disease as well as local factors such as housing density, transport infrastructure, and air quality.

The researchers also acknowledge that a population’s occupational mix and ability, and willingness to engage in public health measures such as social distancing, and the capacity and quality of local public health, social, and healthcare services, could play a part.

Professor Doran, from the Department of Health Sciences at the University of York and senior author of the study, added: “These results emphasise that regional and socioeconomic variations are relevant to decisions about future pandemic planning, including current and future phases of vaccination roll-out.

“Immediate and longer-term recovery planning for communities and their health and social services should reflect historical disparities, as well as the COVID-19 related patterns described in this study.”



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