Background There are concerns that post-pandemic mortality remains elevated compared to expected levels based on pre-pandemic data across the UK. One possible explanation is that the excess mortality is attributable to the continuation of trends caused by UK Government austerity measures introduced in 2010. These trends saw age-standardised mortality rates (ASMRs) — which fell consistently for most of the previous century — stop improving. The worsening trends were experienced unequally across society. ASMRs in deprived areas did not just stall but began to increase, leading to many years of life being lost prematurely and widening inequalities. The aim of this work was to compare expected ASMRs for 2022 (based on projecting trends between 2012–2019) with observed ASMRs in England and Scotland.

Methods Mortality data for England and Scotland for 2012–2022 were linked to deprivation quintiles from the relevant Index of Multiple Deprivation. Sex-specific ASMRs were calculated, standardised to the European Standard Population 2013. Linear models were fitted to these observed ASMRs for 2012–2019 and used to predict expected ASMRs for 2020–2022. Analyses were repeated, stratified by deprivation quintile.

Results In 2022 for females in England the observed ASMR was 847 (95% CI: 843–850) per 100,000 population, 6.4% higher than the expected ASMR of 796 (753–839). For males, the observed ASMR was 1145 (1141–1150), 9.9% higher than the expected ASMR of 1042 (1003–1081). In Scotland for females the observed ASMR was 989 (984–995), 4.2% higher than the expected ASMR of 949 (897–1002). For males the observed ASMR was 1305 (1297–1312), 5.4% higher than the expected ASMR of 1238 (1175–1301). Substantial inequalities persist. Observed ASMRs in the most deprived quintile were higher than those in the least deprived quintiles, with rate ratios ranging from 1.68 for females in England to 1.93 for males in Scotland. Observed ASMRs across both countries and sexes in the most deprived quintile were closer to expected ASMRs (-0.4–7.7%) than the least deprived quintile (6.3–11.4%).

Discussion Observed ASMRs remained higher than expected in 2022 compared to those predicted by trends in mortality in 2012–2019, trends which themselves are substantially worse than prior to 2012. Excesses were larger in England than Scotland. This may indicate the ongoing effects of the pandemic on health are compounding those of austerity. The policy implication of this work is that many years of lost life can be prevented by the reversal of austerity.