Deprivation and excess deaths Reducing inequalities in mortality in England

Reducing inequalities in mortality

The Office for National Statistics publishes data on mortality by age and the deprivation of every area in England, divided into ten equally sized areas of population (or deciles), ranked by how deprived they are. Deprivation is a measure that assesses areas based on how they fare on multiple domains, including income, employment, quality of environment, health, education, and housing.

These statistics show that in more socioeconomically deprived areas, people are at greater risk of death at a given age. Looking across all age groups in 2018, women in the poorest decile were 86% more likely to die in the next year than those in the richest decile; for men this figure is 93%. This means that in the least deprived areas, 20% of deaths for women were among those younger than 75 (‘premature mortality’). But in the most deprived areas, this increased to 36%. For men, these figures are even more striking. In the least deprived areas, 28% of deaths were among men younger than 75 – in the most deprived areas, the figure rose to 52%.

How many fewer deaths would there be in England if this gap in inequalities were to close? By applying mortality rates in better off areas to the populations in more deprived areas, we can calculate how many deaths are ‘due’ to this inequality.

For example, there are 9,360 deaths among women younger than age 75 in the poorest tenth of the population. If these women instead experienced the mortality rates of women in the richest half of the population, there would be 5,500 deaths. So, the mortality resulting from inequality for women younger than 75 in the most deprived tenth of the population is 3,860.  Figure 1 shows the excess mortality from inequality in each decile of deprivation: applying the average mortality of the highest half leads to improvements up to at least the seventh decile.

If the five worst off deciles experienced the mortality rates of the better off half of areas, in 2018 there would have been around 77,000 fewer deaths overall: 35,000 among women and 42,000 among men. If we reduced the inequality further, so that all areas experienced the mortality of the 10% of least deprived areas, there would have been 107,000 fewer deaths.

Premature mortality from inequality is higher in ‘red wall’ seats

There has been considerable media focus on the seats that changed hands at the 2019 General Election to deliver the Conservative government its majority. These so-called ‘red wall’ seats are said to have ‘lent their votes’ and have taken on additional political importance.  

By aggregating lower super output area level data on age and mortality up to the constituency level, it is possible to produce estimates for the excess deaths that result from inequality in the same manner as above, examining the mortality over and above the average of the five least deprived deciles.  

This method gives us an estimate of around 78,000 excess deaths from inequality overall, very similar to the estimate above. The analysis also shows that the red wall seats have a disproportionate share of excess deaths from inequality: these account for 14% of these deaths, but only 8% of the population. This is equivalent to 11,100 deaths resulting from inequality in 2018. In contrast, the seats that the Conservative party already held going into the 2019 General Election accounted for 54% of the population, but 42% of the excess deaths resulting from inequality. Figure 2 shows these excess deaths as a ratio to the population of these areas. England as a whole is the benchmark with a score of 1. The Conservative gains from Labour have 1.72 times as many excess deaths from inequality as would be expected from population alone.  

COVID-19 is likely to increase mortality from inequality

Our analysis uses 2018 data, the most recent full year for which data is available. However, we do have partial data from 2020 including the impact of COVID-19 on mortality so far. The chart below shows mortality for men and women combined, by whether it involved COVID-19 or not, relative to mortality in the least deprived decile. COVID-19 mortality is more unequal at the more deprived end of the distribution than other forms of mortality so far in 2020. This, combined with the higher overall mortality figure for 2020, means that for 2020 the number of deaths related to inequality is likely to be higher than the estimate of 77,000 for 2018.

This analysis is being published alongside our briefing on the future of the public health system, following the abolition of PHE. PHE has some responsibility for driving broader health improvement in England, and so its dissolution will have consequences for these efforts. This analysis shows the scale of the challenge, with 77,000 excess deaths having resulted from inequality in 2018 and with red wall seats being particularly hard hit.