Tackling COVID-19 Life Expectancy Falls Needs Tailored Approach

Liam Davenport

October 28, 2021

While the COVID-19 pandemic set life expectancy gains in England back 10 years, and actually resulted in small falls in 2019-20, its role in exacerbating existing health inequalities means a one-size-fits-all approach to improving outcomes will not be enough, argues leading researcher.

Dr Veena Raleigh, PhD, Senior Fellow, Policy, The King’s Fund, London, said that the fall in life expectancy is “a big mountain to climb back up…and a massive challenge”.

Combined with this is the severe impact of the pandemic on the determinants of health, such as deprivation, housing and employment, she told the Royal College of Physicians (RCP) Med+ 2021 conference on October 27, and prevention is therefore “paramount”.

“But public health budgets have been cut by a quarter in real terms per capita over the last five years, and the cuts have been heavier in deprived areas, so that’s something that really needs to be turned around.”

Calling for a cross-party inequalities strategy with clear goals, Dr Raleigh said “we have become inured in this country in inequalities widening…but the slow drip, drip, drip on inequalities…really needs to change”.

Dr Raleigh began by emphasising that health inequalities are not only “unfair” but also are “not inevitable and can be significantly reduced”.

Indeed, some of the drivers of health inequalities include individual factors, such as diet, obesity, exercise, smoking and alcohol use, alongside poorer access to and uptake of healthcare services.

There are also adverse socioeconomic circumstances, such as poverty, low educational attainment, poor housing quality, unemployment, crime, air pollution and geographical factors.

She underlined that the consequences of health inequalities “start early”, with stillbirth rates in the most deprived areas double those in the least deprived, and neonatal mortality rates 73% higher.

However, the largest contributors to life expectancy inequalities are circulatory and respiratory diseases, and lung and some other cancers; in other words, diseases that “can be prevented and treated”.

Dr Raleigh said that, since 2010, there has been a “slowdown in life expectancy gains” in England, accompanied by an increase in the number of years spent in ill health.

This has not been across the board, however, as there have also been widening inequalities in health, with stagnating or falling life expectancy in deprived areas, especially in the urban north and among women, and longevity gains in London and the South East.

The latest data from the Office for National Statistics shows that, in 2017–2019, the life expectancy gap between people living in the most deprived and least deprived areas of England was 7.7 years in women and 9.5 years in men.

Moreover, while life expectancy increased markedly in the least deprived areas of the country between 2011–2013 and 2017–2019, the gain was substantially smaller for men in the most deprived areas and fell for women, by almost 0.3 years.

The difference between the least and most deprived areas was even more stark for the number of years spent in good health, with an almost 20 year difference in both men and women.

The COVID-19 pandemic only made these differences worse.

Between March 2020 and April 2021, the age-standardised mortality rate (ASMR) due to COVID-19 was almost 2.5 times higher in the most versus the least deprived areas, while the ASMR due to other causes was almost double.

Dr Raleigh also showed that, in 2019–2020, men in the most deprived areas saw their life expectancy fall by almost 2.0 years, versus around 1.0 years for those in the least deprived areas. In women, the fall was almost 1.6 years and 1.0 years, respectively.

Focusing on deprivation, she continued that it “broadly reflects a geographical divide”, with northern urban areas with high poverty and poor education, such as Blackpool, Leeds, Liverpool, Manchester and Newcastle, particularly affected.

This contrasts with what has been seen in the most deprived parts of London, where areas such as Lambeth, Hackney, Newham and Tower Hamlets have seen some of the highest life expectancy gains since 2001.

This throws up the question as to whether ethnicity pays a role in health inequalities.

Dr Raleigh showed that, in Black, Asian and South-East Asian ethnic groups, both men and women have greater life expectancy than White and mixed ethnicity groups.

This is driven by lower rates of breast, lung and colorectal cancer, dementia and Alzheimer’s disease, respiratory disease and influenza and pneumonia among ethnic minority groups versus White and mixed ethnicity groups.

Yet COVID-19 initially had a greater impact on ethnic minority groups, who faced higher risks of infection due to their geographical location, population density, level of deprivation, occupation, and household size and density.

Rates of obesity, cardiovascular disease, diabetes and hypertension also tend to be higher in ethnic minority groups, placing them at increased risk of adverse outcomes due to COVID-19.

The result was that, during the first wave of the pandemic, most ethnic minority groups had significantly higher mortality rates than White British populations.

By the second wave, there were fewer ethnic differences, however, which Dr Raleigh said has been attributed to greater awareness over infection control, although risks remained higher for groups with large, multigenerational households.

“Overall, the picture is one of heterogeneity, both between ethnic minority groups and with the White group…rather than universal disadvantage,” she added.

“So strategies for tackling socioeconomic and ethnic differences in health should really be tailored to the specific healthcare needs of different groups.”

Following the presentation, session chair Anton Emmanuel, MD, PhD, professor of neuro-gastroenterology, University College London, London, asked whether life expectancy is, in fact, “the appropriate metric to use to measure inequality”.

Dr Raleigh replied that it is an “international yardstick [and] a summary health measure”, but “as epidemiologists we would always say you need a hierarchy of indicators”.

These include life years spent in good health, cancer, infant mortality, smoking and “things that don’t translate into death, like mental health”.

 

No funding declared.

No relevant financial relationships declared.

Med+ 2021: Session Health inequalities - the growing challenge. Presented 27 October.

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