MRC Integrative Epidemiology Unit, University of Bristol, Bristol, BS8 2BN, United Kingdom; Population Health Sciences, Bristol Medical School, Bristol, BS8 2BN, United Kingdom.
Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GL, United Kingdom.
Health Place. 2022 Jul;76:102848. doi: 10.1016/j.healthplace.2022.102848. Epub 2022 Jun 21.
Observational studies have highlighted that where individuals live is far more important for risk of dying with COVID-19, than for dying of other causes. Deprivation is commonly proposed as explaining such differences. During the period of localised restrictions in late 2020, areas with higher restrictions tended to be more deprived. We explore how this impacted the relationship between deprivation and mortality and see whether local or regional deprivation matters more for inequalities in COVID-19 mortality.
We use publicly available population data on deaths due to COVID-19 and all-cause mortality between March 2020 and April 2021 to investigate the scale of spatial inequalities. We use a multiscale approach to simultaneously consider three spatial scales through which processes driving inequalities may act. We go on to explore whether deprivation explains such inequalities.
Adjusting for population age structure and number of care homes, we find highest regional inequality in October 2020, with a COVID-19 mortality rate ratio of 5.86 (95% CI 3.31 to 19.00) for the median between-region comparison. We find spatial context is most important, and spatial inequalities higher, during periods of low mortality. Almost all unexplained spatial inequality in October 2020 is removed by adjusting for deprivation. During October 2020, one standard deviation increase in regional deprivation was associated with 20% higher local mortality (95% CI, 1.10 to 1.30).
Spatial inequalities are greatest in periods of lowest overall mortality, implying that as mortality declines it does not do so equally. During the prolonged period of low restrictions and low mortality in summer 2020, spatial inequalities strongly increased. Contrary to previous months, we show that the strong spatial patterning during autumn 2020 is almost entirely explained by deprivation. As overall mortality declines, policymakers must be proactive in detecting areas where this is not happening, or risk worsening already strong health inequalities.
观察性研究表明，对于 COVID-19 死亡风险，个体居住的地点远比其他因素重要。贫困通常被认为是造成这种差异的原因。在 2020 年末局部限制期间，限制程度较高的地区往往较为贫困。我们探讨了这种情况如何影响贫困与死亡率之间的关系，以及是地方贫困还是区域贫困对 COVID-19 死亡率的不平等影响更大。
我们使用公开的 COVID-19 死亡和全因死亡率的人口数据，研究了 2020 年 3 月至 2021 年 4 月期间的空间不平等规模。我们使用多尺度方法同时考虑了三个可能影响不平等的空间尺度。我们进一步探讨了贫困是否可以解释这些不平等。
在调整了人口年龄结构和养老院数量后，我们发现 2020 年 10 月的区域不平等程度最高，中位地区间比较的 COVID-19 死亡率比为 5.86（95%置信区间 3.31 至 19.00）。我们发现，在低死亡率时期，空间背景最重要，空间不平等程度更高。在 2020 年 10 月，通过调整贫困因素，几乎消除了所有无法解释的空间不平等。在 2020 年 10 月，区域贫困程度每增加一个标准差，局部死亡率就会增加 20%（95%置信区间，1.10 至 1.30）。
在总体死亡率最低的时期，空间不平等程度最大，这意味着随着死亡率的下降，下降并非均匀分布。在 2020 年夏季长时间的低限制和低死亡率期间，空间不平等程度急剧增加。与前几个月不同，我们表明，2020 年秋季强烈的空间模式几乎完全可以用贫困来解释。随着总体死亡率的下降，政策制定者必须积极主动地发现那些没有下降的地区，否则可能会加剧已经严重的健康不平等。
