Evolution of geographical inequalities in COVID-19 mortality over the first wave of the pandemic in England

ABSTRACT

BackgroundEarly in the COVID-19 pandemic it was clear that inequalities were emerging in the distribution of deaths, with more deprived areas harder hit than less deprived ones. How these inequalities began, evolved, and changed with the implementation of the first national lockdown did not receive as much attention. We used COVID-19 death counts per local authority (LA) over the first wave (up to 4th July, 2020) to understand how COVID-19 impacted different areas, and to shed light on the equity effects of a strict national lockdown.MethodsWeekly COVID-19 death counts per LA were provided by the Office for National Statistics, along with population estimates for mid-2019 and data on the index of multiple deprivation (IMD) and median age per LA. Mortality rates for each area were calculated as deaths per 100,000 persons. Characteristics of the evolution of mortality rate per LA and decile of IMD were calculated, for example the speed of increase to each LAs peak rate. Simple linear models and descriptive statistics were used to compare areas.ResultsMore deprived LAs tended to begin recording COVID-19 deaths earlier than less deprived areas. Mortality rates in more deprived LAs rose at a faster rate to their peak, which was also higher than in less deprived LAs. All LA death rates peaked between 3 and 9 weeks following the implementation of the first lockdown. The time between the lockdown announcement and the peak death rate was significantly negatively associated with the speed of increase, adjusted for the median age of the population (95% CI -0.33 to -0.31 deaths per 100,000 per week). Total cumulative mortality varied from 10.79 to 170.61 deaths per 100,000 persons per LA. Cumulative death rates were significantly higher in the most deprived 10% of LAs compared to others (p<0.001). Until lockdown, the most deprived 20% of LA’s recorded 64% more deaths than the most deprived 20%. By 4th July, this gap had narrowed to 16%.ConclusionVariation in the timing and speed of increase of local mortality rate curves occurred in the first wave and led to large inequalities across deprivation quintiles. This inequality was reduced but not completely abolished by the strict national lockdown imposed in March 2020. Timings of future national lockdowns should consider differences in local epidemic evolution, with extra support offered to those areas hardest hit.