Area level deprivation and monthly COVID-19 cases: The impact of government policy in England

Karyn Morrissey,Fiona Spooner,James Salter,Gavin Shaddick

doi:10.1016/j.socscimed.2021.114413

Abstract

This paper aims to understand the relationship between area level deprivation and monthly COVID-19 cases in England in response to government policy throughout 2020. The response variable is monthly reported COVID-19 cases at the Middle Super Output Area (MSOA) level by Public Health England, with Index of Multiple Deprivation (IMD), ethnicity (percentage of the population across 5 ethnicity categories) and the percentage of the population older than 70 years old and time as predictors. A GEE population-averaged panel-data model was employed to model trends in monthly COVID-19 cases with the population of each MSOA included as the exposure variable. Area level deprivation is significantly associated with COVID-19 cases from March 2020; however, this relationship is reversed in December 2020. Follow up analysis found that this reversal was maintained when controlling for the novel COVID-19 variant outbreak in the South East of England. This analysis indicates that changes in the role of deprivation and monthly reported COVID-19 over time cases may be linked to two government policies: (1) the premature easing of national restrictions in July 2020 when cases were still high in the most deprived areas in England and (2) the introduction of a regional tiered system in October predominantly in the North of England. The analysis adds to the evidence showing that deprivation is a key driver of COVID-19 outcomes and highlights the unintended negative impact of government policy.

Highlights

The UK reported its first case of COVID-19 on the 31st of January 2020
This paper aims to understand the relationship between area level deprivation and monthly COVID-19 cases in England in response to government policy throughout 2020
A GEE population-averaged panel-data model was employed to model trends in monthly COVID-19 cases with the population of each Middle Super Output Area (MSOA) included as the exposure variable

Summary

Introduction

The UK reported its first case of COVID-19 on the 31st of January 2020. As cases continued to rise, on the March 23, 2020, the government declared a national lockdown in Britain. The decision to ease national lockdown measures from the 4th of July 2020 coupled with the subsequent introduction of local restrictions predom inantly in the North and the Midlands of England. The introduction of the three-tiered system of local COVID-19 Alert Levels on the 14th of October 2020 due to increasing cases in North West and North East regions of England. With both policies, Northern leaders felt that the introduction of local restrictions would be both ineffective and economically unfair due to the higher proportion of deprived communities in these areas (Daras et al, 2021; ; Zhang et al, 2021).

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