Interrogating structural inequalities in COVID-19 mortality in England and Wales

Griffith, Gareth J, Smith, George Davey, Manley, David, Howe, Laura D and Owen, Gwilym (2021) Interrogating structural inequalities in COVID-19 mortality in England and Wales. JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, 75 (12). pp. 1165-1171.

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Official URL: http://dx.doi.org/10.1136/jech-2021-216666

Abstract

<h4>Background</h4>Numerous observational studies have highlighted structural inequalities in COVID-19 mortality in the UK. Such studies often fail to consider the hierarchical, spatial nature of such inequalities in their analysis, leading to the potential for bias and an inability to reach conclusions about the most appropriate structural levels for policy intervention.<h4>Methods</h4>We use publicly available population data on COVID-19-related mortality and all-cause mortality between March and July 2020 in England and Wales to investigate the spatial scale of such inequalities. We propose a multiscale approach to simultaneously consider three spatial scales at which processes driving inequality may act and apportion inequality between these.<h4>Results</h4>Adjusting for population age structure and number of local care homes we find highest regional inequality in March and June/July. We find finer grained within region inequality increased steadily from March until July. The importance of spatial context increases over the study period. No analogous pattern is visible for non-COVID-19 mortality. Higher relative deprivation is associated with increased COVID-19 mortality at all stages of the pandemic but does not explain structural inequalities.<h4>Conclusions</h4>Results support initial stochastic viral introduction in the South, with initially high inequality decreasing before the establishment of regional trends by June and July, prior to reported regionality of the 'second-wave'. We outline how this framework can help identify structural factors driving such processes, and offer suggestions for a long-term, locally targeted model of pandemic relief in tandem with regional support to buffer the social context of the area.

Item Type:	Article
Uncontrolled Keywords:	Humans, England, Wales, Health Status Disparities, COVID-19, SARS-CoV-2
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Population Health
Depositing User:	Symplectic Admin
Date Deposited:	17 Dec 2021 09:47
Last Modified:	18 Jan 2023 21:19
DOI:	10.1136/jech-2021-216666
Open Access URL:	https://jech.bmj.com/content/75/12/1165
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3145547