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Lookup NU author(s): Dr Natalie BennettORCiD, Professor Clare BambraORCiD, Dr David SinclairORCiD, Professor Adam ToddORCiD, Professor Fiona MatthewsORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group. Objective: To understand how area deprivation inequalities in COVID-19 mortality changed during the national vaccination programme in England and to identify the extent to which these inequalities might be explained by unequal vaccination uptake. Design Ecological study. Setting 307 Lower Tier Local Authorities in England, March 2020 - December 2022. Main outcome measure Inequality in age-standardised mortality rates 28 days after a positive COVID-19 test by area-level deprivation from March 2020 to December 2022. We employ three different measures of this inequality: the disparity index, the concentration and generalised concentration index, and absolute and relative measures of inequality. We use the 2019 edition of the Index of Multiple Deprivation, transformed into quintiles. Results Relative inequalities in age-standardised mortality rates 28 days after a positive COVID-19 test reduced substantially (from around 6.9 times higher in most deprived to least deprived to 1.2 times higher) in the 25 months after the national vaccination rollout began. Vaccination uptake between the most and least deprived quintiles widened with each dose. Inequalities in cumulative mortality rates developed quickly, and while they stabilised and reduced, they did not disappear. We estimate that if vaccination rates in the most deprived areas had been the same as those in the least deprived, absolute disparity inequality would have been reduced from 118.9 per 100 000 (95% CI 117.0 to 120.7) to 40.2 (95% CI 3.7 to 76.7) at the end of 2022. Conclusions National COVID-19 vaccination strategies offer the potential to significantly reduce inequalities in COVID-19 mortality rates. However, more could be achieved if barriers to vaccination uptake in the most deprived areas are overcome.
Author(s): Bennett N, Bambra C, Sinclair D, Todd A, Matthews F
Publication type: Article
Publication status: Published
Journal: BMJ Open
Year: 2025
Volume: 15
Online publication date: 21/01/2025
Acceptance date: 13/12/2024
Date deposited: 10/02/2025
ISSN (print): 2044-6055
ISSN (electronic): 2044-6055
Publisher: BMJ Publishing Group
URL: https://doi.org/10.1136/bmjopen-2024-085195
DOI: 10.1136/bmjopen-2024-085195
Data Access Statement: Data are available in a public, open access repository. The code used for the analyses in this paper is available from the authors upon request.
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