Article Text
Abstract
Background COVID-19 mortality risk is associated with demographic and behavioural factors; furthermore, religious gatherings have been linked with the spread of COVID-19. We sought to understand the variation in risk of COVID-19-related death across religious groups in England and Wales both before and after the first national lockdown.
Methods We conducted a retrospective cohort study of usual residents in England and Wales enumerated at the 2011 Census (n=47 873 294, estimated response rate 94%) for risk of death involving COVID-19 using linked death certificates. Cox regression models were estimated to compare risks between religious groups. Time-dependent coefficients were added to the model allowing HRs before and after lockdown period to be estimated separately.
Results Compared with Christians, all religious groups had an elevated risk of death involving COVID-19; the largest age-adjusted HRs were for Muslim and Jewish males at 2.5 (95% CI 2.3 to 2.7) and 2.1 (95% CI 1.9 to 2.5), respectively. The corresponding HRs for Muslim and Jewish females were 1.9 (95% CI 1.7 to 2.1) and 1.5 (95% CI 1.7 to 2.1), respectively. The difference in risk between groups contracted after lockdown. Those who affiliated with no religion had the lowest risk of COVID-19-related death before and after lockdown.
Conclusion The majority of the variation in COVID-19 mortality risk was explained by controlling for sociodemographic and geographic determinants; however, those of Jewish affiliation remained at a higher risk of death compared with all other groups. Lockdown measures were associated with reduced differences in COVID-19 mortality rates between religious groups; further research is required to understand the causal mechanisms.
- epidemiology
- socio-economic
- social inequalities
- COVID-19
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information. The study is based on deidentified census and death certificate data. We cannot provide further breakdowns. Further information on future statistical analysis plans is available upon request.
This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.
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Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information. The study is based on deidentified census and death certificate data. We cannot provide further breakdowns. Further information on future statistical analysis plans is available upon request.
Footnotes
Correction notice This article has been corrected since it first published. The provenance and peer review statement has been included.
Contributors CHG wrote the first draft of the manuscript. VN, CHG, CW and DA designed the analysis. CHG, DA and VN conducted the statistical modelling. All authors edited and reviewed the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Disclaimer The employers had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests The authors (except PG) are employees of the UK Civil Service. PG is an advisor at the University College London Institute of Health Equality.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
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