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. In a registry-based study, Evangelos Kontopantelis and colleagues examine the excess years of life lost to COVID-19 and other causes of death by sex, neighbourhood deprivation and region in England & Wales during 2020. Author summary Why was this study done? The Coronavirus Disease 2019 (COVID-19) pandemic generated large numbers of excess deaths (additional deaths over those predicted from trends in previous years). These excess deaths were also unevenly distributed across different geographic areas and socioeconomic groups, exacerbating prepandemic inequalities. Up to a quarter of the excess deaths during the pandemic were attributable to coronary heart disease, dementia, and other noninfectious causes, and not directly to COVID-19 infection. Most measures of excess deaths do not fully account for differences in the ages at which people die in different social groups. If the pandemic killed disproportionally more young people in more deprived areas, then inequalities resulting from the pandemic will have been underestimated. Measuring years of life lost (YLL) rather than excess deaths would address this problem. What did the researchers do and find? In England and Wales, there were an estimated 763,550 (95% CI: 696,826 to 830,273) excess YLL during the first 42 weeks of the pandemic, of which 15% were not directly attributed to COVID-19 or another respiratory cause. For all-cause mortality, estimated deaths in the most deprived compared to the most affluent areas were as follows: 11 times as many for 15- to 44-year-olds, 3 times as many for 45- to 64-year-olds, 40% higher in 75- to 84-year-olds, and not significantly higher for those aged 85 or over. This pattern of disproportionately higher mortality in younger age groups exacerbated prepandemic inequalities between the most and least deprived areas, and varied widely across regions, with the North West particularly affected. What do these findings mean? Inequalities between socioeconomic and geographic groups resulting from the COVID-19 pandemic are more pronounced than previously reported. Future plans to manage pandemics, including decisions about vaccination rollout, should include an understanding of regional and socioeconomic variation in YLL and how this has exacerbated long-standing health inequalities. Immediate and longer-term recovery planning for communities and their health and social services should reflect historical disparities as well as the impact of the pandemic on YLL. Limitations of this study include the observational nature of the data and the need for accurate and timely recording of the deaths and their causes.