Temporal trends in socioeconomic inequalities in deaths involving COVID-19 in England, 2020–2024

Background

Previous studies showed that COVID-19 mortality was higher in more deprived populations, particularly early in the pandemic, but less is known about how these inequalities changed over time using whole-gradient measures. We examined trends in deprivation-related inequality in COVID-19-related deaths in England from 2020 to 2024.

Methods

We analysed deaths involving COVID-19 defined using ICD-10 codes U07.1, U07.2, U09.9 and U10.9, by area deprivation decile for each year from 2020 to 2024. Age-standardised mortality proportion (ASP) were calculated using the 2013 European Standard Population. Inequality along the deprivation gradient was assessed annually using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII), which capture absolute and relative inequality, respectively.

Results

Marked inequalities were present in 2020 and narrowed over time. In 2020, the ASP was 228.2 per 100,000 in the most deprived decile and 80.0 per 100,000 in the least deprived decile. Absolute inequality fell substantially, with SII changing from 152.9 per 100000 (95%CI 149.0 to 156.0) in 2020 to 8.6 (7.5 to 9.8) in 2024. Relative inequality also weakened overall, with RII changing from 3.62 (3.49 to 3.76) to 2.26 (2.03 to 2.53). By 2024, the ASP had fallen to 16.4 per 100,000 in the most deprived decile and 7.9 per 100,000 in the least deprived decile. Although the gap narrowed over the study period, deaths involving COVID-19 remained consistently higher in more deprived areas.

Conclusions

Deaths involving COVID-19 were strongly shaped by socioeconomic disadvantage in England, particularly at the start of the pandemic. Both absolute and relative inequalities narrowed overall by 2024, but the deprivation gap persisted. Monitoring these patterns can help public health systems plan fairer preparedness, prevention and response in future health emergencies.

Key messages

• Deaths involving COVID-19 were substantially higher in more deprived areas in England, especially in 2020.

• Absolute and relative inequalities narrowed by 2024, but mortality remained higher in more deprived areas.