RESUMO
Objectives: To examine 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 sub-groups during the COVID-19 pandemic by comparing observed with expected mortality in each group based on trends over the previous five 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 (HES) records linked to death registration 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 sub-group over and above the number expected based on trends in mortality in that group over the previous five years. Results: The gradient in excess mortality by deprivation was greater in the under 75s (most deprived 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 deprivation quintiles had significantly larger excesses than the most deprived White group and there were no clear gradients across quintiles. Among the White group, only the most deprived had more excess deaths than deaths directly involving COVID-19. Among the Black group all deprivation quintiles experienced more excess deaths than deaths directly involving COVID-19. Conclusion: The COVID-19 pandemic has widened inequalities in premature mortality by deprivation. Among those under 75, the direct and indirect effects of the pandemic on deaths have disproportionately impacted ethnic minority groups irrespective of deprivation, and the most deprived White group. Statistics limited to deaths directly involving COVID-19 understate the pandemic's impact on inequalities by deprivation and ethnic group at younger ages.