Bennett Natalie, Bambra Clare, Sinclair David, Todd Adam, Matthews Fiona
Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK.
Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
BMJ Open. 2025 Jan 21;15(1):e085195. doi: 10.1136/bmjopen-2024-085195.
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.
Ecological study.
307 Lower Tier Local Authorities in England, March 2020 - December 2022.
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.
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.
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.
了解在英格兰全国疫苗接种计划期间，新冠病毒病（COVID-19）死亡的地区贫困不平等情况如何变化，并确定这些不平等在多大程度上可能由疫苗接种率不平等所解释。
生态学研究。
2020年3月至2022年12月期间，英格兰的307个下层地方当局。
2020年3月至2022年12月期间，按地区层面贫困程度划分的COVID-19检测呈阳性后28天的年龄标准化死亡率不平等情况。我们采用了三种不同的不平等衡量指标：差异指数、集中指数和广义集中指数，以及不平等的绝对和相对衡量指标。我们使用2019年版的多重剥夺指数，并将其转换为五分位数。
在全国疫苗接种推广开始后的25个月里，COVID-19检测呈阳性后28天的年龄标准化死亡率的相对不平等大幅降低（从最贫困地区比最不贫困地区高约6.9倍降至高1.2倍）。随着每剂疫苗的接种，最贫困和最不贫困五分位数之间的疫苗接种率差距不断扩大。累积死亡率的不平等迅速显现，虽然有所稳定和降低，但并未消失。我们估计，如果最贫困地区的疫苗接种率与最不贫困地区相同，到2022年底，绝对差异不平等将从每10万人118.9例（95%置信区间117.0至120.7）降至40.2例（95%置信区间3.7至76.7）。
全国性的COVID-19疫苗接种策略有可能显著降低COVID-19死亡率的不平等。然而，如果克服最贫困地区疫苗接种的障碍，可能会取得更大成效。
