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

Griffith, Gareth J; Smith, George Davey; Manley, David; Howe, Laura D; Owen, Gwilym

doi:10.1101/2021.02.15.21251771

Cited by 8 publications

(11 citation statements)

References 31 publications

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“…However, the differences all but disappear between the ethnic groups when the index is recalculated for the age-standardised mortality rates, In fact, the Pakistani group does still have the highest value for 8 of the 11 months but the differences are trivial and illegible on the chart. The implication of this is that urban inequalities in mortality are more strongly expressed at the regional level and between major towns and cities (Gri th et al, 2021), whereas inequalities in infection are evident within towns and cities.…”

Section: Resultsmentioning

confidence: 95%

Measuring the exposure of Black, Asian and other ethnic groups to Covid-infected neighbourhoods in English towns and cities.

Harris

Brunsdon

2021

Preprint

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Drawing on the work of The Doreen Lawrence Review – a report on the disproportionate impact of Covid-19 on Black, Asian and minority ethnic communities in the UK – this paper develops an index of exposure, measuring which ethnic groups have been most exposed to Covid-19 infected residential neighbourhoods during the first and second waves of the pandemic in England. The index is based on a Bayesian Poisson model with a random intercept in the linear predictor, allowing for extra-Poisson variation at neighbourhood and town/city scales. This permits within-city differences to be decoupled from broader regional trends in the disease. The research finds that members of ethnic minority groups tend to be living in areas with higher infection rates but also that the risk of exposure is distributed unevenly across these groups. Initially, in the first wave, the disease disproportionately affected Black residents. As the pandemic has progressed, especially the Pakistani but also the Bangladeshi and Indian groups have had the highest exposure. This higher exposure of the Pakistani group is not straightforwardly a function of neighbourhood deprivation because it is present across a range of average house prices. However, we find evidence to support the view, expressed in The Doreen Lawrence Review, that it is linked to occupational and environmental exposure, particularly residential density.

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Section: Resultsmentioning

confidence: 95%

Measuring the exposure of Black, Asian and other ethnic groups to Covid-infected neighbourhoods in English towns and cities.

Harris

Brunsdon

2021

Preprint

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“…The Pakistani group does still have the highest value for 10 of the 14 months but the differences are trivial and illegible on the chart. The implication of this is that urban inequalities in mortality are more strongly expressed at the regional level and between major towns and cities (Griffith et al, 2021), whereas inequalities in infection are evident within towns and cities too.…”

Section: Resultsmentioning

confidence: 95%

Measuring the exposure of Black, Asian and other ethnic groups to COVID-infected neighbourhoods in English towns and cities

Harris

Brunsdon

2021

Appl. Spatial Analysis

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Drawing on the work of The Doreen Lawrence Review—a report on the disproportionate impact of COVID-19 on Black, Asian and minority ethnic communities in the UK—this paper develops an index of exposure, measuring which ethnic groups have been most exposed to COVID-19 infected residential neighbourhoods during the first and second waves of the pandemic in England. The index is based on a Bayesian Poisson model with a random intercept in the linear predictor, allowing for extra-Poisson variation at neighbourhood and town/city scales. This permits within-city differences to be decoupled from broader regional trends in the disease. The research finds that members of ethnic minority groups can be living in areas with higher infection rates but also that the risk of exposure is distributed unevenly across these groups. Initially, in the first wave, the disease disproportionately affected Black residents but, as the pandemic has progressed, especially the Pakistani but also the Bangladeshi and Indian groups have had the highest exposure. This higher exposure of the Pakistani group is not straightforwardly a function of neighbourhood deprivation because it is present across a range of average house prices. We find evidence to support the view, expressed in The Doreen Lawrence Review, that it is linked to occupational and environmental exposure, particularly residential density but, having allowed for these factors, differences between the towns and cities remain.

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“…England imposed a national lockdown during the first wave of the COVID-19 epidemic in March 2020 (19). This measure aimed to drastically reduce instances of interpersonal contact between infected individuals (whether symptomatic or not) and the wider susceptible population.…”

Section: Resultsmentioning

confidence: 99%

“…It has been noted that when national epidemic dynamics are used to examine population health, they can mask important sub-national variation in disease spread, thus mitigation strategies that rely solely on the national data to inform implementation timings could inadvertently worsen health inequalities across geographical areas (11,13). Previous descriptive studies and reports of inequalities in COVID-19 mortality have only focused on cumulative measures over set timespans, without documenting the disparities in evolution of mortality rates (5,14,15), have been restricted to higher geographies (18), or have not focussed on the effects of lockdowns (7,19). An understanding of how the evolution of the pandemic differed by area and the impact of national mitigation strategies on geographical inequalities in COVID-19 mortality could help inform future policies targeted at minimising viral spread whilst preventing the widening (or even actively decreasing) health inequalities.…”

Section: Introductionmentioning

confidence: 99%

Geographical inequalities in the evolution of the COVID-19 pandemic: An ecological study of inequalities in mortality in the first wave and the effects of the first national lockdown in England

Welsh

Albani

Matthews

et al. 2021

Preprint

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Objectives This is the first study to examine how geographical inequalities in COVID–19 mortality rates evolved in England, and whether the first national lockdown modified them. This analysis provides important lessons to inform public health planning to reduce inequalities in any future pandemics. Design Longitudinal ecological study Setting 307 Lower-tier local authorities in England Primary outcome measure Age-standardised COVID–19 mortality rates by local authority and decile of index of multiple deprivation. Results Local authorities that started recording COVID–19 deaths earlier tended to be more deprived, and more deprived authorities saw faster increases in their death rates. By 2020–04–06 (week 15, the time the March 23rd lockdown could have begun affecting deaths) the cumulative death rate in local authorities in the two most deprived deciles of IMD was 54% higher than the rate in the two least deprived deciles. By 2020–07–04 (week 27), this gap had narrowed to 29%. Thus, inequalities in mortality rates by decile of deprivation persisted throughout the first wave, but reduced somewhat during the lockdown. Conclusions This study found significant differences in the dynamics of COVID–19 mortality at the local authority level, resulting in inequalities in cumulative mortality rates during the first wave of the pandemic. The first lockdown in England was fairly strict – and the study found that it particularly benefited those living in the more deprived local authorities. Care should be taken to implement lockdowns early enough, in the right places – and at a sufficiently strict level – to maximally benefit all communities, and reduce inequalities.

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

Cited by 8 publications

References 31 publications

Measuring the exposure of Black, Asian and other ethnic groups to Covid-infected neighbourhoods in English towns and cities.

Measuring the exposure of Black, Asian and other ethnic groups to Covid-infected neighbourhoods in English towns and cities.

Measuring the exposure of Black, Asian and other ethnic groups to COVID-infected neighbourhoods in English towns and cities

Geographical inequalities in the evolution of the COVID-19 pandemic: An ecological study of inequalities in mortality in the first wave and the effects of the first national lockdown in England

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