Abstract
Background: During the initial wave of the COVID-19 epidemic in England, several population characteristics were associated with increased risk of mortality - including, age, ethnicity, income deprivation, care home residence and housing conditions. In order to target control measures and plan for future waves of the epidemic, public health agencies need to understand how these vulnerabilities are distributed across and clustered within communities. We therefore generated an empirically informed vulnerability index for small areas across England based on predictors of mortality risk observed during the first wave. Methods: We performed a cross-sectional ecological analysis across 6,789 small areas in England. We assessed the association between COVID-19 mortality in each area and 5 vulnerability measures relating to ethnicity, poverty, prevalence of long-term health conditions, living in care homes and living in overcrowded housing, whilst accounting for the age profile of the population and the regional spread and duration of the epidemic. Estimates from multivariable Poisson regression models were used to derive a Small Area Vulnerability Index (SAVI) based on the association between these population vulnerability factors and COVID-19 mortality. Results: Four vulnerability measures were independently associated with age-adjusted COVID-19 mortality. Each standard deviation increase in the proportion of the population (1) living in care homes, (2) admitted to hospital in the past 5 years for a long-term health condition, (3) from an ethnic minority background and (4) living in overcrowded housing was associated with a 28%, [IRR=1.28, 95%CI 1.26 to 1.31], 19% [IRR=1.19, 95%CI 1.15 to 1.22], 8% [IRR=1.08, 95%CI 1.03 to 1.13] and 11% [IRR=1.11, 95%CI 1.06 to 1.15] increase in age-adjusted COVID-19 mortality rate respectively. Vulnerability to COVID-19 was noticeably higher in the North West, West Midlands, and North East regions, with high levels of vulnerability clustered in some communities. Conclusion: A second wave of the epidemic is likely to have more severe consequences for those communities identified as highly vulnerable by our index, with disproportionate affects in the North of England and the Midlands. Action is needed now to develop control measures to reduce vulnerability and increase resilience, in order to protect these communities and prevent further avoidable deaths, underpinned by proportionate allocation of resources.
Highlights
Whilst the COVID-19 pandemic has claimed tens of thousands of lives, the impact has not been equal across the UK.[1]
Our analysis identifies four important factors independently associated with COVID-19 mortality in addition to age: prevalence of long-term health conditions, living in care homes, living in overcrowded housing and ethnic composition
The association between income deprivation and COVID-19 mortality seen in the univariate analysis was largely explained by increased prevalence of long-term conditions and overcrowded housing which were both correlated with income deprivation
Summary
Whilst the COVID-19 pandemic has claimed tens of thousands of lives, the impact has not been equal across the UK.[1]. During the initial wave of the COVID-19 epidemic in England, several population characteristics were associated with increased risk of mortality— including, age, ethnicity, income deprivation, care home residence and housing conditions. We assessed the association between COVID-19 mortality in each area and five vulnerability measures relating to ethnicity, poverty, prevalence of long-term health conditions, living in care homes and living in overcrowded housing. Each SD increase in the proportion of the population (1) living in care homes, (2) admitted to hospital in the past 5 years for a long-term health condition, (3) from an ethnic minority background and (4) living in overcrowded housing was associated with a 28%, 19% 8% and 11% increase in age-adjusted COVID-19 mortality rate, respectively. Our analysis indicates the communities who will be most at risk from a second wave of the pandemic
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