Abstract
We use population-wide data from linked administrative registers to study the distributional pattern of mortality before and during the first wave of the Covid-19 pandemic in Belgium. Over the March-May 2020 study period, excess mortality is only found among those aged 65 and over. For this group, we find a significant negative income gradient in excess mortality, with excess deaths in the bottom income decile more than twice as high as in the top income decile for both men and women. However, given the high inequality in mortality in normal times, the income gradient in all-cause mortality is only marginally steeper during the peak of the health crisis when expressed in relative terms. Leveraging our individual-level data, we gauge the robustness of our results for other socioeconomic factors and decompose the role of individual vs. local effects. We provide direct evidence that geographic location effects on individual mortality are particularly strong during the first wave of the Covid-19 pandemic, channeling through the local number of Covid infections. This makes inference about the income gradient in excess mortality based on geographic variation misguided.
Highlights
The Covid-19 pandemic affects everyone, but not everyone is affected
While a rapidly growing literature suggests that socioeconomic factors are important determinants of Covid-19-related mortality (e.g., Chen et al 2020, Drefahl et al 2020, Jung et al 2020 and Williamson et al 2020), a strong income and/or socioeconomic gradient in health outcomes and in mortality in particular was present prior to the arrival of the coronavirus
While (EuroMOMO 2020) do find significant excess mortality for 45-64 year olds in Belgium during some weeks in the Covid-19 crisis, when we look at the entire March-May 2020 period, we do not find significant excess mortality for this age group
Summary
The Covid-19 pandemic affects everyone, but not everyone is affected . An important concern is that the burden of the Covid-19 crisis falls disproportionately on people with low income or socioeconomic status. We use the mortality registers updated until June 2020 and linked to income registers as well as other demographic and socioeconomic information This allows us to measure the income and socioeconomic gradient in mortality at the individual level, which we compare during the height of the Covid-19 health crisis - from March until May 2020 - with the corresponding months from 2015 to 2019. We study individuals living in nursing homes separately, as excess mortality during the Covid-19 pandemic has been high for this subgroup, but we do not find any income gradient in mortality before or during the Covid-19 crisis for them. For papers that did not find a clear association, we provide further details below aDesmet and Wacziarg find that a higher level of Covid-19 mortality in a county was positively correlated with median household income in the first months after the onset of the pandemic, but the correlation turned negative afterwards. Mortality increased most starkly for this group, but it did so uniformly across income groups
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