Excess years of life lost to COVID-19 and other causes of death by sex, neighbourhood deprivation, and region in England and Wales during 2020: A registry-based study

Abstract

Background Deaths in the first year of the Coronavirus Disease 2019 (COVID-19) pandemic in England and Wales were unevenly distributed socioeconomically and geographically. However, the full scale of inequalities may have been underestimated to date, as most measures of excess mortality do not adequately account for varying age profiles of deaths between social groups. We measured years of life lost (YLL) attributable to the pandemic, directly or indirectly, comparing mortality across geographic and socioeconomic groups. Methods and findings We used national mortality registers in England and Wales, from 27 December 2014 until 25 December 2020, covering 3,265,937 deaths. YLLs (main outcome) were calculated using 2019 single year sex-specific life tables for England and Wales. Interrupted time-series analyses, with panel time-series models, were used to estimate expected YLL by sex, geographical region, and deprivation quintile between 7 March 2020 and 25 December 2020 by cause: direct deaths (COVID-19 and other respiratory diseases), cardiovascular disease and diabetes, cancer, and other indirect deaths (all other causes). Excess YLL during the pandemic period were calculated by subtracting observed from expected values. Additional analyses focused on excess deaths for region and deprivation strata, by age-group. Between 7 March 2020 and 25 December 2020, there were an estimated 763,550 (95% CI: 696,826 to 830,273) excess YLL in England and Wales, equivalent to a 15% (95% CI: 14 to 16) increase in YLL compared to the equivalent time period in 2019. There was a strong deprivation gradient in all-cause excess YLL, with rates per 100,000 population ranging from 916 (95% CI: 820 to 1,012) for the least deprived quintile to 1,645 (95% CI: 1,472 to 1,819) for the most deprived. The differences in excess YLL between deprivation quintiles were greatest in younger age groups; for all-cause deaths, a mean of 9.1 years per death (95% CI: 8.2 to 10.0) were lost in the least deprived quintile, compared to 10.8 (95% CI: 10.0 to 11.6) in the most deprived; for COVID-19 and other respiratory deaths, a mean of 8.9 years per death (95% CI: 8.7 to 9.1) were lost in the least deprived quintile, compared to 11.2 (95% CI: 11.0 to 11.5) in the most deprived. For all-cause mortality, estimated deaths in the most deprived compared to the most affluent areas were much higher in younger age groups, but similar for those aged 85 or over. There was marked variability in both all-cause and direct excess YLL by region, with the highest rates in the North West. Limitations include the quasi-experimental nature of the research design and the requirement for accurate and timely recording. Conclusions In this study, we observed strong socioeconomic and geographical health inequalities in YLL, during the first calendar year of the COVID-19 pandemic. These were in line with long-standing existing inequalities in England and Wales, with the most deprived areas reporting the largest numbers in potential YLL.

Sociodemographic inequalities and excess non-COVID-19 mortality during the COVID-19 pandemic: A data-driven analysis of 1,069,174 death certificates in Mexico

“…In the European region, countries with high excess mortality, such as Bulgaria, Russia, and Serbia were impacted by diverse social barriers with difficulties to full adhere to social isolation policies (30,31). Two recent reports in England revealed that communities with high-density of care homes, with a high proportion of residents on income support, overcrowding conditions, and ethnic minorities were at higher risk of excess mortality and years of life lost due to the COVID-19 pandemic (32,33). In Latin American countries, the impact of socioeconomic disparities was sharp mainly due to countries experiencing diverse social barriers to sustain lockdown mandates driven by low stipend support, a high proportion of their population working in informal conditions, and uncovered health care basic needs even within healthcare workers personnel (3,30,34).…”

The excess mortality connected with COVID-19 pandemic

“…Предполагаемое избыточное число смертей за этот период составило 8071 [7]. При этом нужно учитывать, что многие страны могут занижать и завышать число смертей от COVID-19, так как свидетельства о смерти, как известно, в целом заполняются с ошибками, и их число, возможно, в связи с пандемией выросло [8]. В странах с высоким уровнем дохода почти все умершие имели сопутствующие заболевания, что вызывает споры о наличии причинно-следственной связи случаев смерти с COVID-19 [9].…”

Socioeconomic inequalities of Long COVID: findings from a population-based survey in the United Kingdom

“…10 Previous studies have found significantly higher risk of COVID-19 exposure, hospitalization, and mortality in the elderly, in ethnic minority populations, in people living in areas of lower socioeconomic status, and in those working in certain employment sectors (e.g., healthcare and frontline workers). [11][12][13][14][15][16][17] The disproportionate impact of pandemic on people living in deprived areas may partly be due to having greater concentration of minority ethnic groups, higher prevalence of chronic medical conditions, occupational exposure, heavy reliance on public transport, crowded or multigenerational households, and limited access to healthcare. 18,19 Occupation is particularly important because workplace setting can modify exposure risk (e.g., a higher exposure risk for public or client facing roles) as well as the effect of the exposure on various COVID-19 related outcomes.…”