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Home Publications Socioeconomic inequalities in mortality were growing for adults pre-pandemic, but falling for young children

Socioeconomic inequalities in mortality were growing for adults pre-pandemic, but falling for young children

Lucy Kraftman, James Banks and Pia Hardelid
Press release

Inequalities in mortality rates by socioeconomic position had been rising in England prior to the pandemic, both for men and women. Males in the poorest 10% of local geographical areas were on average 37% more likely to die than men in the richest 10% of areas in 2003. By 2017, they were 63%, or 1.63 times as likely to die. For females, the rate of deaths in the poorest 10% of local areas was 1.32 times that in the richest 10% in 2003 and had risen to 1.54 times by 2017.

But this overall summary trend in inequality is not the whole story. For infants and young children, mortality inequality was falling over this period, whereas for age groups 40 and over inequality increased.

For older adults (55+) the increase in inequality occurred both because the most disadvantaged groups were falling behind the rest and because of the least disadvantaged were accelerating away from the middle. For those aged 40-54 the increase in inequality was all due to the most disadvantaged falling behind. This is the first study to disaggregate changing patterns of mortality inequality in this way.

These are among the findings of a new paper published today by researchers in The Lancet Regional Health: Europe, from the Institute for Fiscal Studies and University College London. The study, which exploits publicly available data on mortality, populations and deprivation in England, examines mortality inequalities at different ages and whether changes over time come from the richest, the middle or the poorest areas changing at different rates. The paper also finds:

  • The largest increase in inequality was seen in 65 to 79 year-old women. In 2003, a woman in the 10% of poorest neighbourhoods had a death rate 1.85 times higher than a woman in the 10% of richest neighbourhoods. By 2017, this had increased to 2.22 times higher.
  • The group with the largest mortality inequality is 40 to 54 year-old men. In 2003, men in the poorest neighbourhoods already had death rates more than three times higher (3.21 times higher to be precise) than those in the richest neighbourhoods. By 2017, this had increased to 3.31.  
  • In the age groups 65 and over, the increase in inequality arose both because the richest pulled away from the middle and the poorest fell further behind. For those younger than 65 there were often different trends in inequality in each half of the distribution.
  • One single policy is unlikely to be able to deliver reductions in overall mortality inequality. Instead, the different patterns across cohorts and deprivation groups suggest that reducing mortality inequalities requires separately addressing the various health behaviours and other risk factors that different age-gender and socioeconomic groups are exposed to over their life-cycle. This would require a coordinated approach from multiple government departments and policymakers.

Lucy Kraftman, a Research Economist at the Institute for Fiscal Studies and a co-author of the study, said:
“Crude summaries of mortality inequalities hide important parts of the picture. Infant mortality inequalities have been falling whilst older age inequalities have been rising, and for some groups those living in the poorest neighbourhoods are two or even three times as likely to die in any given year as those in the richest neighbourhoods. The groups with the largest inequalities are not the same as the groups for which the increases in inequality have been largest. It is important not to lose these nuances when we document inequality and think about how policies might address it.”

James Banks, a Senior Research Fellow at the Institute for Fiscal Studies and a co-author of the study said:
“We found marked differences in pre-pandemic mortality inequality trends for different age groups in different parts of the socioeconomic deprivation distribution. These trends provide an important context when thinking about the subsequent Covid-19 pandemic, and suggest that summary statistics on the way in which Covid-19 has affected overall mortality inequalities between the poorest and richest areas might not be the whole story.”   

Pia Hardelid, Associate Professor UCL GOS Institute of Child Health and a co-author of the study, said:
“We must not lose sight of the good news that, in amongst the rise in overall inequality, we still saw important reductions in socioeconomic inequalities in infant mortality between 2003 and 2017, both in the top half and in the bottom half of the socioeconomic distribution. Whether this trend had continued during and immediately following the pandemic will be an important question for future research.”

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Journal article
We describe the association between recent changes in socioeconomic inequality and trends in mortality disparities for different age and sex groups at small-area level in England.