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Widening of inequalities in COVID-19 years of life lost from 2020 to 2021: a Scottish Burden of Disease Study
  1. Grant M A Wyper1,
  2. Eilidh Fletcher2,
  3. Ian Grant2,
  4. Oliver Harding3,
  5. Maria Teresa de Haro Moro2,
  6. Gerry McCartney4,5,
  7. Diane L Stockton5
  1. 1 Place and Wellbeing Directorate, Public Health Scotland, Glasgow, UK
  2. 2 Data Driven Innovation Directorate, Public Health Scotland, Edinburgh, UK
  3. 3 Directorate of Public Health, NHS Forth Valley, Stirling, UK
  4. 4 College of Social Sciences, University of Glasgow, Glasgow, UK
  5. 5 Clinical and Protecting Health Directorate, Public Health Scotland, Edinburgh, UK
  1. Correspondence to Mr Grant M A Wyper, Place and Wellbeing Directorate, Public Health Scotland, Glasgow, G2 6QE, UK; grant.wyper{at}


Background Previous studies have highlighted the large extent of inequality in adverse COVID-19 health outcomes. Our aim was to monitor changes in overall, and inequalities in, COVID-19 years of life lost to premature mortality (YLL) in Scotland from 2020 and 2021.

Methods Cause-specific COVID-19 mortality counts were derived at age group and area deprivation level using Scottish death registrations for 2020 and 2021. YLL was estimated by multiplying mortality counts by age-conditional life expectancy from the Global Burden of Disease 2019 reference life table. Various measures of absolute and relative inequality were estimated for triangulation purposes.

Results There were marked inequalities in COVID-19 YLL by area deprivation in 2020, which were further exacerbated in 2021; confirmed across all measures of absolute and relative inequality. Half (51%) of COVID-19 YLL was attributable to inequalities in area deprivation in 2021, an increase from 41% in 2020.

Conclusion Despite a highly impactful vaccination programme in preventing mortality, COVID-19 continues to represent a substantial area of fatal population health loss for which inequalities have widened. Tackling systemic inequalities with effective interventions is required to mitigate further unjust health loss in the Scottish population from COVID-19 and other causes of ill-health and mortality.

  • Health inequalities
  • COVID-19

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  • Twitter @GMAWyper, @gerrymccartney1

  • Contributors GW, IG, OH, GM and DLS generated the idea for the study. GW, EF and GM developed the methodological approach. GW and EF carried out all analyses. GW drafted the original manuscript. All other authors provided critical input into the interpretation of the results and revisions to the manuscript, and approved the final draft.

  • Funding All authors are salaried by NHS Scotland except GM who is salaried by the University of Glasgow. GM recently received funding from the WHO.

  • Competing interests None declared.

  • 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.